As part of the Full Line Access and Safe Handling (FLASH) team, Ivy Lynn Ersan shares how central line resource nurses are improving patient outcomes in the Newborn Center. Read more
March 30, 2021
September 18, 2018
Through dedication, hard work, research and partnership, Texas Children’s Newborn Center has lowered its rate of a serious lung condition in premature infants by more than 13 percent over the past year.
The center’s current rate of Bronchopulmonary Dysplasia (BPD) is below the national average for the first time in a decade and is well below what is expected based on the size of the unit and the type of patients cared for in the NICU at Texas Children’s Hospital, according to the Vermont Oxford Network, an organization that helps hospitals track outcomes of premature babies and allows comparison to other institutions across the country.
“This is a dramatic improvement for us,” said Dr. Monika Patil, one of the neonatologists involved in Texas Children’s campaign to lower BPD rates. “We now have the lowest rate of BPD since we joined the Vermont Oxford Network in 2006.”
Patil said every team member in the Newborn Center contributed to this outstanding achievement and that their work has been directed by the Avoiding Lung Injury (ALI) team. ALI is a multidisciplinary group focused on improving the respiratory outcomes of very low birth weight infants in the NICU through quality improvement projects. This team was created by Dr. Lakshmi Katakam, medical director of the NICU, and Dr. Gautham Suresh, chief of Neonatology, with the vision of empowering NICU staff to tackle one of the most important determinants of long-term outcomes in premature babies – that is, whether or not a premature infant develops BPD.
BPD is one of the key conditions that influences long-term outcomes in a low birth weight infant, Katakam added. And, for many infants, it determines whether they go home on oxygen or ventilator. That’s why close monitoring of these patients is so important.
What ALI has found, and clinicians have worked to implement, is that rates of BPD can be lowered if infants who need respiratory aid are treated with gentler modes of therapy that protect the premature baby’s lungs from being injured , such as Continuous Positive Airway Pressure (CPAP) instead of being intubated and placed on a ventilator. If intubation and assistance of ventilator are necessary, the group discovered infants fare better if clinicians closely watch the amount of ventilator support and oxygen being administered, only giving infants what they needed when they need it.
To implement and maintain these changes, the Newborn Center is trying innovative staffing models that enable nurses and respiratory therapists to become even more involved in respiratory care of premature patients. Instead of tending to more than one patient during their shift, nurses caring for infants on CPAP are now assigned to care for only one patient at a time during the first few days of life when premature babies’ lungs are most vulnerable to injury. There is also a team lead respiratory therapist that offers an extra layer of support and keeps a watchful eye to ensure that CPAP is successful.
“This method of care is highly involved and requires a lot of support from our nurses and respiratory therapists, but is what’s best for our patients during such a critical period in their lives,” Katakam said. “It’s also what sets us apart from other institutions that might not have the resources to give patients such individualized care.”
To ensure such close care is continued, the Newborn Center is working alongside nursing leaders, Rebecca Schiff and Heather Cherry, to perform a nursing research project to improve CPAP management. The project is focused on understanding the correlation between nurse-patient ratios and respiratory outcomes in infants on CPAP.
In addition, the ALI group is continuing its efforts to research and implement strategies for minimizing time a newborn spends on the ventilator by extubating as early as possible, using gentle ventilation modes, optimizing use of medications proven to be effective in reducing BPD, and minimizing exposure to oxygen, which can be harmful to premature infant’s lungs and eyes, if used in excess.
The ALI team is hosting a regional respiratory care conference on October 19 at Texas Children’s Hospital. NICU providers from all across the country will share their experiences and learn from experts at Texas Children’s. For more information about the First Annual Baylor Avoiding Lung Injury conference, please contact Katakam at Katakam@bcm.edu or ext. 6-1365. Online registration is available at https://www.bcm.edu/bali-conference.
“We are very excited about our progress but still have a long way to go,” Katakam said. “Preventing BPD is an ongoing effort but our team is determined and energized to do everything we can to prevent lung injury along a premature infant’s journey, from the time a baby takes the first breath in the delivery room to the time they leave our NICU.”
Excluding those mentioned above, those involved in the NICU’s effort to lower the rate of BPD in premature infants include:
- Isa Baruah
- Dr. Rebecca Cavazos
- Dr. Milenka Cuevas
- Dr. Shaeequa Dasnadi
- Anne Debuyserie
- Dr. Cary Fernandes
- Jennifer Gallegos
- Dr. Behru Gandhi
- Suzanne Iniguez
- Sheela John
- Maxine Keller
- Dr. Brian King
- Dr. George Mandy
- Jessica Ramirez
- Dr. Rita Shah
- Kymberly Sherwood
- Dr. Binoy Shivanna
- Dr. Nathan Sundgren
- Eva Vuong
May 27, 2015
Texas Children’s Newborn Center hosted its seventh annual Remember Me Always ceremony on May 16. The ceremony was generously sponsored by the Sinisi and Senn families in honor of their daughter, McKenzie.
Developed in partnership with families and staff, the Remember Me Always ceremony brought comfort to Texas Children’s families who suffered the loss of a beloved baby, and the physicians, nurses and staff who cared for them.
Special highlights of the ceremony included welcome remarks from Patricia Bondurant and Vincent and Erin Sinisi; keynote speakers Dr. Stephen Welty and Amanda Harris; soothing music from harpist, Heather Woitena; a beautiful memorial video presentation and the dedication of a memory tree in honor of babies who touched so many lives.
Families placed hearts in honor of their children on the memory tree. Prayers and notes written on biodegradable note cards were planted with the tree. The Remember Me Always memory tree, located outside the Feigin Center near West Tower, will serve as a permanent reminder of all the babies from the Texas Children’s Newborn Center family who left this world too soon.
May 19, 2015
May 15 was International Kangaroo Care Awareness Day. At Texas Children’s Newborn Center, our physicians and neonatal nurses are strong believers in the benefits of kangaroo care, which promotes parental bonding with a new baby from the earliest moments of life.
Kangaroo Care is a method of holding babies skin to skin with a parent. The infant wears a diaper and is placed on the parent’s bare chest and covered with a blanket for warmth, much in the same way a kangaroo cares for its baby in the pouch.
The benefits for the infant include improved feeding, temperature stability, stabilized heart rate and respiratory status, improved oxygenation and decreased length of hospitalization. Skin-to-skin contact also improves the bonding between parents and baby, and stimulates breast milk production for new mothers.
Texas Children’s neonatal nurse practitioner and mom Jennifer Gallegos shares her and her husband’s unforgettable bonding experience with their son, Bennett, moments after his birth.
“Kangaroo Care has always been a passion of mine as a bedside nurse and as a nurse practitioner. It took on new meaning when our second child, Bennett, was born at 34 weeks. The time spent with Bennett in skin to skin was memorable, and is treasured by both my husband and I to this day.
The first time my husband, Greg, held Bennett, our son was still on CPAP. For me, it was no big deal, but Greg was terrified of all the “wires and machines.” A little encouragement from Bennett’s nurse persuaded him to try it. The photo to the right is their first of several sessions. Greg became a believer, and he would use their special time to give Bennett “pep talks” on breathing so he could come off the CPAP. While I enjoyed holding Bennett skin to skin, it was just as special watching a father bond with his baby in this way as well.”
To learn more about the benefits of Kangaroo Care at Texas Children’s Newborn Center, click here.
March 3, 2015
Texas Children’s is excited to announce the arrival of Dr. Gautham Suresh who recently joined the neonatology team as the medical director of Texas Children’s Newborn Center.
Suresh earned his medical degree from JJM Medical College in Davangere, India. He completed his pediatric residency and neonatology fellowship at the Postgraduate Institute of Medical Education and Research in India. Suresh also obtained fellowship training in neonatology at Royal Alexandra Hospital for Children in Sydney, Australia and a fellowship in neonatal-perinatal medicine at the University of Vermont College of Medicine in Burlington. Suresh holds a masters of science degree in quality improvement and evaluative sciences from The Dartmouth Institute of Health Policy and Clinical Practice in Hanover, New Hampshire.
Suresh arrived at Texas Children’s from Dartmouth-Hitchcock Medical Center in Hanover, NH, where he served as the medical director for the hospital’s Neonatal Intensive Care Unit. Armed with impressive credentials, Suresh is known internationally for his expertise on patient safety, health care quality improvement and evidence-based medicine, and has been a guest speaker at numerous scientific conferences and workshops. Suresh has worked extensively with the Vermont Oxford Network as a faculty member of their quality improvement collaborative, the Neonatal Intensive Care Quality Project. Suresh also served on the teaching faculty at the Geisel School of Medicine at Dartmouth and at The Dartmouth Institute of Health Policy and Clinical Practice.
As the medical director of the Newborn Center, Suresh collaborates with leaders from nursing, respiratory care and other disciplines to ensure regulatory, accreditation and risk management requirements are met, while upholding the delivery of high quality patient care to our premature and critically ill infants.
Aside from his leadership role, Suresh serves as an attending neonatologist in the Newborn Center and is actively involved in mentoring fellows, residents, junior faculty and medical students from other disciplines. He is also a big proponent of Mindfulness Based Stress Reduction to improve health professional satisfaction and the quality of patient care. He hopes to share his personal experience and expertise in this field with staff in the Newborn Center and at Texas Children’s.
Suresh is the chair of the American Academy of Pediatrics’s online program on Education in Quality Improvement for Pediatric Practice. He is an associate editor of the Neonatal Review Group of the Cochrane Collaboration and co-editor of “Clinical Guidelines in Neonatology” and “Assisted Ventilation of the Neonate,” a comprehensive resource guide for the care of infants requiring assisted ventilation.
“We are honored to have Dr. Suresh share his extensive knowledge and expertise in quality improvement, patient safety and risk reduction programs to better serve our NICU patients and their families,” said Pattie Bondurant, vice president of nursing at Texas Children’s Pavilion for Women.
September 16, 2014
Texas Children’s Newborn Center is ranked No. 2 in the nation, but this impressive ranking is more than just a number. It demonstrates our hospital’s commitment to improving the long-term outcomes of premature and critically-ill infants in our Neonatal Intensive Care Unit (NICU).
Each year, more than 2,000 newborns are treated in all levels of our NICU where they receive the most comprehensive neonatal care available. Our Newborn Center combines research, advanced technology and world-class expertise to treat a myriad of complex medical conditions affecting newborns.
Texas Children’s is one of only two hospitals in the Greater Houston area that provides Level IV NICU care, which is the highest level of neonatal care available for extremely sick infants. Many community hospitals with less advanced NICUs transfer their patients to Texas Children’s where our neonatologists collaborate daily with an expert team of neonatal nurses in the Newborn Center.
“Improving neonatal outcomes is what our Newborn Center is all about,” said Texas Children’s chief of Neonatology Dr. Stephen Welty. “We use a collaborative, interprofessional approach to deliver high-quality care to our NICU patients, which include premature infants as well as full-term babies with complex medical diagnoses.”
Texas Children’s has reached numerous milestones to improve neonatal outcomes.
- Supported by our dedicated team of neonatal nurses in the Newborn Center, Texas Children’s neonatologists collaborate with physicians and surgeons from diverse pediatric subspecialties to ensure infants receive comprehensive NICU care. For instance, our Newborn Center has organized an interprofessional group of pediatric gastroenterologists and surgeons to treat babies with digestive health issues.
- Our Newborn Center partners with Texas Children’s Fetal Center to ensure babies in utero have the best possible outcomes after birth. Remarkable advances in fetal medicine have led to innovative therapies to treat congenital diaphragmatic hernias, spina bifida and heart disease. Our hospital recently performed a laparoscopic surgical procedure to correct spina bifida while in the womb.
- Texas Children’s is one of only two hospitals in the Greater Houston area to offer total body cooling treatments to babies deprived of oxygen at birth. This therapeutic treatment allows oxygen-starved brain cells to heal thereby decreasing the potential risk for severe neurological damage. Texas Children’s is the first and only pediatric hospital in Texas to offer whole body cooling treatments to infants during ambulance transport to our Level IV NICU.
- Since neonatal nutrition is vital to helping NICU babies grow, our Newborn Center is the first hospital in the world to add human milk fat to the diets of premature infants weighing less than 3.3 pounds. A recent Baylor College of Medicine study led by our own Texas Children’s Neonatologist Dr. Amy Hair, and published in The Journal of Pediatrics, found that adding human milk fat to the diets of premature infants in our NICU improved their growth outcomes.
- Texas Children’s has implemented an exclusive human milk diet fortified with proteins and carbohydrates derived from human milk to nourish our premature infants to health. The fortifiers add calories and nutrients without changing the volume of milk to help infants grow adequately in the NICU.
- Texas Children’s has developed a donor breast milk program to ensure babies in the NICU have access to donor breast milk if mother’s milk is not available. The Newborn Center also houses a Milk Bank and lactation support programs for mothers to ensure their babies get off to a healthy start.
“Our NICU has seen a significant reduction in the rate of necrotizing enterocolitis since we implemented the exclusive human milk feeding protocol in 2009,” said Dr. Patricia Bondurant, DNP, RN, and vice president of Nursing at Texas Children’s Newborn Center. “Necrotizing enterocolitis is a potentially deadly intestinal infection common in premature infants.”
These remarkable achievements are just a snapshot of what our Newborn Center is doing every single day to improve the long-term health and developmental outcomes of our NICU patients.
Click here to learn more about Texas Children’s Newborn Center and click here to take a video tour of our impressive Level IV NICU where miracles happen all the time. (there are two links in this sentence – you can get from the Connect story)