Hospitals’ Joint Clinic Sends More Premature Babies Home Sooner

As recently as three years ago, Timothy Merrifield II--born five weeks premature in June--would probably not have survived his respiratory complications. And if by some slim chance he had lived, Timothy might have spent his first year in a hospital nursery.

Rapid advances in pediatrics and new technology developed over the last several years, however, saved the San Diego infant at the time of delivery. And Timothy is already at home with his parents less than three months after birth, thanks to an innovative new clinical concept for providing the follow-up care needed by the many newborns--an estimated 500 annually in San Diego County alone--who now live despite problems of prematurity.

The clinic is California’s first pediatric pulmonary clinic, and allows babies to be cared for at home with only occasional visits to a single medical office. Pulmonary specialists at Children’s Hospital, together with colleagues from UC San Diego Medical Center, head the clinic, working with therapists and nurses who can help parents with nutritional and psychological problems and reassure them about operating the necessary equipment at home.

The joint outpatient clinic also represents the first major result of an agreement in principle reached earlier this year by the two facilities to merge their pediatric programs.

“We now see babies here who previously would have been in a hospital for up to a year if they had survived at all, with families in essence living in the nurseries for up to a year,” said Dr. Ivan Harwood of UCSD, co-director of the clinic. “The clinic proves better for the families, for the babies and for society.”

The clinic is still experimental, while state and federal health officials monitor costs to see whether the outpatient care and its array of special services proves less expensive than previous protocols calling for extended hospital stays.

“I don’t think there is any doubt that this will be cost-effective,” said Dr. Sung Min Park, co-director at Children’s, in remarks echoed by his colleagues. “And while quality of life may not always be measured, I think it’s instinctive that the babies have a much better environment in their own home, with their own parents.”

Even the most attentive nurses and therapists in a hospital cannot provide as much attention and love as a parent at home, Park said.

“And it’s a fact from (studies) that babies at home for six months after being in a hospital for six months grow more than twice as fast as babies in the hospital for a year,” he said.

The initial idea for the clinic came as pediatricians noted a need for follow-up treatment for an increasing number of infants who were being saved from a variety of pulmonary problems caused by premature birth. Among those problems are: respiratory distress syndrome (RDS), where an infant’s lungs cannot breathe on their own because they are so immature; broncho-pulmonary dysplasia (BPD), where chronic lung disease develops in infants from changes caused by oxygen used as a treatment for RDS, and apnea, the lack of normal breathing caused by immaturity in the infant’s brain that causes it to forget to always breathe.

“I’m personally surprised at how quick the equipment, the technology, the advances have been” in saving infants at birth, Park said.

Dr. Michael Segall, head of Children’s neonatal intensive care unit, said he received many calls from pediatricians asking how to follow up with specialized treatment for the infants they had saved at birth. Segall got the ball rolling for a clinic, arguing that intensive care units are not set up for outpatient work once an infant has improved enough to be discharged.

“What has made the (clinic idea) work so well is UCSD and Children’s have joined forces,” Park said. “With lots of survivors to be looked after, I’m not sure that (running separate clinics) we would be able to provide good care.”

Harwood added: “With pooling, we’re able to bring everyone’s special interests and expertise to bear.”

Parents appreciate the ability to care for their children at home. With new advances in oxygen equipment, babies can now be supplied and monitored through portable equipment in the home, whereas as recently as three years ago, the treatment would have to be done at a hospital.

“Even something such as a respirator can be put in homes now,” Park said.

But parents are well-counseled before the babies are sent home.

“We didn’t even sleep for the first couple of nights,” Oceanside resident Frank Gayle said after he and his wife, Julie, took Adam home. Adam was one of the clinic’s first patients, and the 18-month-old is now healthy enough not to need oxygen during the day.

“We’re keeping him on it at night as a precaution for a little while so if there are any lung problems, they won’t (get worse) at night when a kid sometimes forgets to breathe,” Dr. Greg Heldt of UCSD said.

Heldt said the parents are involved from what he calls “time zero.”

“Before, most nurseries used to be off limits, but now we want parents to have a better understanding of what is going on,” Heldt said. “Nutritionists, social workers, therapists, all give a very comprehensive preparation for home care.”

The doctors hope to use the clinic as a model to present to other hospitals within a couple of years.

“We’ll have the experience and will have gathered substantial data that we expect to write up for (medical) journals,” Heldt said.