We will improve the neonatal outcome of pregnancy by:
University of Washington Medical Center Neonatal Intensive Care Unit:
Dennis E. Mayock, MD, NICU Medical Director
Thomas P. Strandjord, MD, Associate Medical Director
A new state-of-the-art 47-bed NICU opened in October 2012. The new unit includes 39 single-bed rooms with space for a family member to stay near their infant, several additional rooms for multiples, and an integrated OR for surgical procedures. The UWMC NICU admits critically ill newborns from one of the highest risk obstetric services in the nation and has special expertise in management of the most fragile growth-restricted and premature fetuses and newborns. The high-risk perinatal program receives obstetrics referrals from throughout the WWAMI region for fetal abnormalities, severe maternal illness, and extreme prematurity and is the site of delivery for the most complex birth defects, including EXIT procedures for airway anomalies. The NICU medical team includes neonatal faculty, neonatal fellows, and pediatric residents, interns, neonatal nurse practitioners, and medical students along with a neonatal pharmacist and nutritionist.
Seattle Children's Hospital Neonatal Intensive Care Unit:
J. Craig Jackson, MD, MHA, NICU Medical Director
The Neonatal Intensive Care Unit at Seattle Children’s Hospital has 19 licensed Level IV beds and shares space with the Pediatric and Cardiac ICUs for a total capacity of 54 ICU beds. The average NICU census including pre-op cardiac neonates is only 14 because of limited ICU capacity; all Level II neonates are currently transferred to a NICU closer to home or to the Acute Care units at Children’s. The NICU medical team includes a faculty neonatology attending, a neonatal fellow or neonatal nurse practitioner, and 3 second-year pediatric residents. They round daily with the NICU nurses, respiratory therapists, dietician, pharmacist, social worker, and patients’ families. The NICU team accepts admissions of critically ill neonates up to 44 weeks’ post menstrual age (i.e., up to 4 weeks after due date) from a 5-state area; almost all are transferred from Level III NICUs because of highly complex and challenging problems. There is no obstetrical delivery service at SCH, but there is a close working relationship with the perinatal and neonatal services at the University of Washington Medical Center 2 miles away.
Overlake Hospital Medical Center (2003 – Present):
Shilpi Chabra, MD, SCN Medical Director
Thomas P. Strandjord, MD, Associate Medical Director
In May 2003, Overlake Hospital Medical Center obtained a Certification of Need (CON) to open a Level III NICU with a total capacity of 14 beds. Prior to this time, the Special Care Nursery transferred ventilated neonates to units with a higher level of care. In 2010, Overlake Hospital obtained another CON for a renovated single-room model NICU. The new unit opened in November 2012 with a total capacity of 18 beds, 13 of which are single-bed rooms with space for a family member to stay near their infant. Currently OHMC delivers between 3,700–4,150 babies per year resulting in 400-450 admissions to the NICU annually. The Overlake Hospital NICU’s care model is 24/7 in-house NNPs under the direction of attending neonatologists.
Providence Regional Medical Center Everett (2000 – Present):
Michael D. Neufeld, MD, MPH, NICU Medical Director
Paul Mann, MD, Assoc. Medical Director
Providence Regional Medical Center Everett’s 29-bed capacity NICU opened on Mother’s Day in 2002. The unit was developed through the efforts of an alliance between PRMCE and Seattle Children’s Hospital. Individual rooms provide privacy for patients and their families. The multidisciplinary team meets daily with parents and concentrates on family-centered care, teaching parents how to take care of their infants, especially those with special needs. In preparation for discharge, parents are provided in-depth instruction on how to manage emergencies that may arise in the home, including the need for CPR. The care model at PRMCE is 24/7 in-house NNPs under the direction of attending neonatologists.
Franciscan Health Care System Neonatal Intensive Care Unit and Special Care Nursery
Patricia Spitale, MD, Medical Director
Franciscan Health Care System has about 5,000 deliveries annually at its 3 obstetrical facilities: St Elizabeth Hospital in Enumclaw, St Francis Hospital in Federal Way, and St Joseph Medical Center in Tacoma. St Joseph Medical Center has a licensed capacity of 23 neonatal beds (18 Level II and 5 Level III, NICU) and has 24/7 in-house NNPs supported by in-house and on-call neonatologists. St. Francis Hospital has a licensed capacity of 6 Level II beds, with medical care from local pediatricians and with consultation and attendance at high-risk deliveries as needed from NNPs and/or neonatologists. St. Elizabeth is a critical access hospital with 250-300 deliveries a year. Franciscan has recently added two hospitals to their system including Harrison in Silverdale and Highline in Renton. Both have Level II Nurseries. Seattle Children’s Hospital partnered with the Franciscan Health Care System to begin providing Neonatology services and medical direction on April 1, 2013, and St Joseph Medical Center opened its new Level III NICU in June 2013. This partnership has made it possible for the vast majority of patients to stay within their community — close to their family and friends while providing the very best care for their fragile newborns.
Thomas P. Strandjord, MD, Contractor, Washington State Department of Health
Our faculty, fellows, neonatal nurse practitioners, and transport team members are involved in several aspects of Newborn Resuscitation Program training. They conduct skills labs with resuscitation training sessions/reviews, which include x-ray and case reviews for Seattle Children’s Hospital and Airlift Northwest flight nurses and respiratory therapists.
WWAMI (Washington, Wyoming, Alaska, Montana, Idaho):
In the sphere of outreach education, the faculty are also involved in the 5-state WWAMI program for medical student and resident education. Two or three times per year, faculty members visit selected programs for outreach education.
Kendra Smith, MD, Medical Director
Transport services are provided by the Seattle Children’s Transport and Airlift Northwest Teams. Seattle Children’s Transport Team is comprised of specially trained transport nurses and respiratory therapists. Airlift Northwest Team members are specially trained pediatric and adult critical care nurses. Infants from referral centers are transported to the University of Washington, Seattle Children’s, Providence Everett Regional Medical Center, Overlake Medical Center or other NICUs for ongoing care. Both services provide en route cardiopulmonary monitoring, conventional ventilator support, high frequency oscillation, administration of nitric oxide, and blood gas analysis. Team members are trained in the interpretation of x-rays, newborn resuscitation, endotracheal tube intubation, insertion of umbilical catheters, treatment of pneumothoraces, cardiopulmonary resuscitation, blood pressure management, care of the infant requiring general or cardiac surgical procedures and other newborn emergencies. Members of the Division of Neonatology serve as Medical Control Providers for both teams.
The Division provides 24/7 neonatal consultation services and medical control for neonatal ground and air transport for the 5-state WWAMI region for about 400 patients per year.
F. Curt Bennett, MD, Director
The University of Washington High Risk Infant Follow-up Clinic began in 1975, linked to the UWMC NICU for outcomes research purposes. Since then, it has expanded and taken on additional clinical service and interdisciplinary training functions. Its present staff includes health care professionals from developmental pediatrics, neonatology, psychology, audiology, nutrition, physical and occupational therapy, and social work. The majority of infants seen were either born prematurely or experienced prenatal drug exposure. Very low birth weight infants weighing less than 1500 grams at birth are prioritized for follow-up. Other infants with specific neonatal concerns, e.g., chronic lung disease, intracranial hemorrhage, infection, are also followed. Scheduled evaluation times include 4, 12, 24, 36, and 54 months and 6 and 8 years corrected age. Approximately 600 high-risk infants and children are seen annually in the clinic. About 40 percent of these visits are infants in the first year of life. A business plan is in progress, designed to expand the clinic to include long-term neurodevelopmental follow-up screening for additional high-risk infants, including post-ECMO, hypoxic-ischemic encephalopathy, cyanotic congenital heart disease, and selected surgical patients.
Michael D. Neufeld, MD, MPH; and, Thomas P. Strandjord, MD, Database Coordinators
The University of Washington Medical Center Neonatal Intensive Care Unit maintains a quality improvement and research NICU database that includes all infants admitted to the NICU, as well as all infants delivered at UWMC over 22 weeks gestation. The database is maintained by Division staff and faculty. In addition, since 2000, the University of Washington NICU has participated in the Vermont-Oxford (VO) database for 401-1500 gram infants. Data is selected for inclusion in the NICU database by consensus of the neonatology faculty and fellows. The NICU database contains a superset of the data required by the VO database and as such includes extensive admission, diagnostic, outcome and local QA/QI data. The outcome (morbidity and mortality) data is generated annually and reviewed with the faculty and fellows. In addition, ad hoc queries are performed at the request of fellows and faculty and reviewed as a group.
Current NIH-funded bench research programs are focused on neurodevelopment and neonatal neuroprotection using state of the art techniques including brain imaging. We use a variety of animal models, from rodents to non-human primates to determine the effects of neonatal stress and neurotropic drugs on the developing brain and to test the safety and efficacy of erythropoietin (Epo) as a neuroprotective therapy. The overarching research goal of the Division is to improve the neurodevelopmental outcomes of at-risk infants. Clinical research is focused on trials of Epo neuroprotection in preterm and asphyxiated infants, evaluation of sedative drugs in the setting of extreme prematurity and asphyxia, prevention of BPD, biomedical informatics, and medical education including the use of newborn infant simulators, as well as global neonatal-perinatal health and epidemiologic research. With the 2011 addition of senior scientist faculty member, Dr. Colin Studholme, we have additional expertise in brain imaging with which to evaluate our neuroprotective strategies. In 2013, Dr. Sunny Juul was awarded a $9 million UO1 grant supporting a 5-year multi-center clinical trial investigating Epo as a neuroprotective agent in extremely preterm infants.
Neonatal-Perinatal Fellowship Program
Taylor Sawyer, DO, MEd, Program Director
Sandra Juul, MD, PhD; Thomas Strandjord, MD; and Christine A. Gleason, MD; Assistant Program Directors
The Neonatal-Perinatal Medicine Fellowship Training Program at the University of Washington began in the mid-1960s. Our mission is to educate and inspire the next generation of neonatologists who will provide state-of-the-art, evidence-based clinical care and to assist and mentor them in finding and pursuing their scholarly passion so they are poised to be the future academic leaders of our field. The program's primary objective is to develop outstanding clinical skills and a high degree of scholarly/ academic competence for those pediatricians committed to a career in academic neonatology. We have designed our program to provide ample protected time for scholarly activities. Our research “areas of excellence” are diverse, including focuses on neuroscience (neuroprotection and neurodevelopment), global health, and ethics. We have strong research mentors both within and outside the Neonatology Division. Several of our Fellows have chosen to combine training in Neonatology with a complementary Master’s degree in Public Health. As of 2013, 53 physicians have successfully completed their clinical and research training and more than 50% have pursued an academic career.
More information is available on the UW Neonatal-Perinatal Fellowship Training Program website.