Dr. Betty Vohr, a neonatologist at Women & Infants Hospital, has received the 2020 Virginia Apgar Award. The annual honor represents the highest level of recognition from the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine.
Vohr discusses her career accomplishments and shares her observations on how neonatology has changed over the past four decades.
PBN: How long have you been practicing medicine, and why did you decide to specialize in neonatology?
VOHR: After completing my pediatric residency in 1968 at Rhode Island Hospital, I did a one-year neonatal fellowship at Women & Infants Hospital of Rhode Island, known at that time as Providence Lying-In Hospital. I rapidly fell in love with the opportunity to care for our most vulnerable newborns.
PBN: You join a long list of distinguished recipients of the Virginia Apgar Award. What accomplishments throughout your career are you most proud of?
VOHR: I recognized that the recovery of high-risk infants was dependent not only on the sophisticated medical care in the NICU [neonatal intensive care unit] but was facilitated by mothers and their infants receiving support and intervention in the NICU and after discharge.
In 1974, I proposed and developed a Neonatal Follow-Up Program at Women & Infants Hospital that incorporated clinical care, support services for the family and infant, and a database to record outcomes, which subsequently documented the improved outcomes of high-risk infants; particularly premature infants. This resulted in publications and in the subsequent requirement that all neonatal programs that train neonatologists in the U.S. have a follow-up program to document outcomes.
During the early ’80s I became acutely aware that we were identifying significant language delays in a subset of high-risk infants at their one- or two-year appointment in the Follow-up Clinic. We would refer the child to audiology, where a diagnosis of permanent hearing loss was made, and we then referred them for needed early intervention. At that time there was no newborn hearing screening available other than ringing a bell, which was not effective. I was able to obtain funding to purchase an auditory brainstem response machine, went for training and returned to train our NICU nurses to screen, and a hearing screening program was in place in the NICU.
In 1989, when the Maternal and Child Health and the Department of Education put out an RFA [request for applications] for centers to apply to prove the feasibility of newborn hearing screening, I was well-positioned and was one of the three states funded for a demonstration project to establish the feasibility of newborn hearing screening. The findings resulted in an NIH [National Institutes of Health] Consensus Conference recommending universal newborn screening in the U.S., and Rhode Island was the first state to pass legislation mandating universal newborn hearing screening. It has been rewarding to witness the significantly improved outcomes of children diagnosed as newborns with congenital hearing loss.
PBN: Are there any ways that neonatology has changed since you first started practicing medicine?
VOHR: The changes that have occurred in treatment (respiratory and nutrition) and the NICU environment (from one large bay to single room with optimal parent involvement) and diagnostic testing have resulted in improved survival and outcomes that have been absolutely amazing. For example, in the 1970s, extreme preterm infants of 26 weeks pregnancy (14 weeks early) did not survive. Currently with active treatment in the NICU, extreme preterm infants born at 26 weeks have an 80% survival rate and the majority do not have long-term major neurodevelopmental sequelae.
PBN: Have you learned any lessons from any of your tiny patients?
VOHR: I am always amazed at the resiliency and recovery of both parents and their tiny infants who have medical issues that require prolonged stays in the NICU, and I have learned the importance of being positive, supportive and available.
PBN: Did COVID-19-related hospital visitation restrictions mean that parents of hospitalized newborns had limited visits with their babies? If so, how did you and other hospital staff handle those types of difficult situations?
VOHR: The NICU of course has had to restrict visitation. Initially, only one parent per infant was permitted to visit, but we are happily up to two parents. WIH is fortunate to have an incredible neonatal and nursing staff in the NICU who are there every day to not only care for the babies but support the parents during this stressful time.
Elizabeth Graham is a PBN contributing writer.
