In the flu season, babies who were born prematurely and very small are at particular risk of serious infections and complications. A study at Women & Infants Hospital is targeting very-low-birth-weight babies – born at less than 3 pounds, 6 ounces – with special supports for them and their families after they’re discharged from the neonatal intensive-care unit.
The Comprehensive Health Integration for Premies (CHIP) program – funded by CVS Caremark Corp. (NYSE: CVS) – offers follow-up visits to a hospital clinic and with social workers; support from a parent consultant; and home visits from a nurse practitioner, all aiming to keep the babies healthy.
Dr. Betty Vohr, who is leading the study, answers questions about the program.
PBN: How many very-low-birth-weight infants do you see in the NICU, and do you keep them there until they reach a particular weight?
VOHR: Women & Infants cares for about 180 such babies per year. The smallest baby in the new Comprehensive Health Integration for Premies (CHIP) program weighed 13.5 ounces at birth. A full-term pregnancy lasts 40 weeks; the most pre-term babies in CHIP were born at 23 to 24 weeks. When these babies are born, they are very fragile, with immature organ systems. They need immediate specialized care – including ventilators, oxygen, nourishment through a vein, special medications and the controlled warmth of an incubator – that can be provided in the NICU. Most very-pre-term infants are stable enough to go home close to their due date. … [But] VLBW infants are at increased risk of neurosensory, behavioral and developmental delays, growth delays and recurrent illness resulting in emergency room visits and re-hospitalizations after discharge.
PBN: Are these infants particularly vulnerable to respiratory issues and, if so, why?
VOHR: Pre-term infants are born with their lungs not fully developed. They also do not have the neurological control of breathing or the muscular strength needed to breathe on their own. Almost all very-pre-term infants will need oxygen during their hospitalization. They go home on special formula and medications and, in some cases, monitors, oxygen, or a ventilator. Some may require a ventilator and oxygen for as long as a year or two. And respiratory illness is the most common cause of re-hospitalization for VLBW infants. Nationally, about 50 percent of VLBW infants are re-hospitalized in the first 18 months after discharge, most in the first three months.
CHIP provides families with extra support and education to address the special needs of these babies. Of the first 182 infants discharged and followed for at least four months, only 20 percent had an unplanned rehospitalization. Of those, 56 percent were for respiratory illness.
PBN: What does this program entail?
VOHR: New services include meeting with the CHIP social worker, Ellen Cavanaugh, to assess needs prior to discharge; a pre-discharge home visit if the parents wish; a post-discharge phone call within 24 hours; a home visit within the first week by a neonatal nurse practitioner; and an early visit to the Women & Infants Neonatal Follow-up Program two to four weeks post-discharge.
In addition, participation in a discharge class and CPR class is encouraged. During the home and clinic visits, families are also educated about prevention of respiratory illness, safety, breastfeeding, crying issues and the special needs of pre-term infants, among others.
The babies’ primary doctors are kept informed, and the CHIP coordinator or parent consultant also assesses the impact on the family and makes referrals to community resources as needed.
PBN: How did CVS get involved in this, and what is their role?
VOHR: Because of our concerns about post-discharge illness and re-hospitalization, we initially did a pilot study funded by March of Dimes which demonstrated a decrease in ER visits. The Women & Infants’ NICU and Neonatal Follow-up Program approached the CVS Charitable Trust for funds to support an expanded program, and the trust provided funds to support additional staff for a two-year demonstration of effectiveness.
PBN: Women & Infants has other initiatives geared to helping new parents and especially NICU parents with their babies. How will this program interact with them?
VOHR: This program is unique because it provides enhanced education and support by professionals with expertise in the care of infants both prior to and after discharge. It is also unique in that it begins prior to discharge, so that there is continuity for families during the transition home.
The CHIP team partners with the NICU team, March of Dimes NICU Family Support, the Rhode Island Parent Information Network, the primary care provider, and specialty services at Women & Infants and Hasbro Children’s Hospital.
Our goals with CHIP are to provide parents with the information needed to care for the special needs of their pre-term infants and to help make sure that all families get securely connected to the right resources and supports in their communities.
Women & Infants Hospital, a member of the Care New England health system, is the primary teaching affiliate of the Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics and the seventh largest obstetrical service in the country with more than 9,000 deliveries per year. For more information, go to www.womenandinfants.org.
