honoluluadvertiser.com

Sponsored by:

Comment, blog & share photos

Log in | Become a member
The Honolulu Advertiser
Posted on: Monday, July 7, 2003

Neonatal care unit goes for softer touch

By Robbie Dingeman
Advertiser Health Writer

The afternoon "quiet hour" begins in the high-tech neonatal intensive care unit at Kapi'olani Medical Center at 3:30 as nurses draw the curtains, lower their voices and slow the pace of the busy specialized nursery that cares for the hospital's youngest patients.

Kristin Ellis of 'Aiea Heights holds her son, Kala, at Kapi'olani Medical Center. The hospital has made its neonatal unit more "family friendly," an approach that can help premature babies such as Kala go home sooner.

Rebecca Breyer • The Honolulu Advertiser

Dr. Sherry Loo, a neonatologist focusing on the care of premature and newborn infants, is among those nationwide helping to change the way these especially fragile babies are treated.

The medical term is "developmentally supportive care" but it comes down to a more baby-friendly and family-friendly place. Nurses carefully swaddle even the tiniest infants in a flexed position, keeping them warm, talking in a soothing voice.

Loo said these techniques help the babies heal faster and gain weight while trimming medical costs because the infants go home sooner.

"I see it as a natural evolution," said Loo, who credits a multi-disciplinary team with introducing the concept to Hawai'i.

Over time, the units have become more family-friendly in a variety of ways, some simple: visitors aren't required to wear gowns and gloves anymore.

Other practical suggestions have helped the concept along: covers on incubators to soften the light and quiet the baby, a sensor on a sink faucet so staff won't have to bang on the metal buttons to wash their hands, padding on the rubbish cans so they don't clang.

Loo said the techniques, which first gained notice in a 1994 article in the Journal of the American Medical Association began to be adopted at Kapi'olani five years ago and have been gaining support ever since. Loo recently gave a presentation on the issue at a regional conference of the American Academy of Pediatrics at the Ihilani Resort.

Hospital administrators nationwide got interested in the techniques when the babies gained more weight and required less medical intervention. Loo said some Mainland studies have indicated that as much as $130,000 is saved per infant with the changes in care because the babies go home earlier.

Before the changes, more parents found the atmosphere intimidating. With incubators instead of bassinets, respirators, medical charts hanging over the babies and monitors beeping their mechanical beat around the clock, many parents felt their baby belonged more to the medical staff than to them.

Loo said the innovative treatment keeps the family at the center of the care, so the infants are treated like babies, not just patients who are little.

Kristin Ellis of 'Aiea Heights appreciates all the effort to make her and her son, Kala, more comfortable. He was born four weeks early, on June 15. It was the third time that Ellis found herself in a neonatal intensive care unit with a newborn. Her 6-year-old son came five weeks early and her 4-year-old daughter arrived four weeks before her due date.

Ellis appreciates the family-friendly techniques and the way the medical staff members explain what's going on without acting superior, she said. "They enjoy what they do and care for each individual baby," she said.

Kapi'olani social worker Waynell Hee-Goodman said she sees a big difference in the approach from when she began working in the field 17 years ago. And she feels the difference in the intensive-care unit. "The flow seems less formal," she said.

Hee-Goodman said the overall effect of the changes makes families feel more confident with their babies. The quieter atmosphere makes a big difference, she said, by reducing the stress for the infants which allows them to rest better.

Statewide, Loo said Kapi'olani handles the largest number of babies in its intensive care unit. They admit about 500 babies each year, 70 percent of them are premature or less than 37 weeks gestation. Some babies are born after only 23 weeks gestation and the average length of stay in the unit ranges from a few weeks to three months.

Loo has been a neonatologist since 1982. She is a graduate of Roosevelt High School, the University of Hawai'i-Manoa and Yale University Medical School.

She said a study in Sweden attempted to document the improved health of babies who received the more supportive care. But she said the study ended early when the nurses in the control group refused to provide only the standard care after seeing the babies thrive under the newer techniques.