Parents will stay close to their preemies in $35 million NICU at Sacramento-area hospital

Jul. 3--Dignity Health is investing $35 million at Mercy San Juan Medical Center to expand the hospital's neonatal intensive care unit, adding space not only for state-of-the-art equipment but also 16 rooms where parents can stay with the frailest preemies until it's time to go home.

"We have learned over the last several decades that having parents be with their babies while they're in the NICU really contributes to shorter hospital stays and much better long-term developmental outcomes," said Dr. Carolyn Getman, head of the neonatal intensive care unit at Mercy San Juan.

"In our new unit, we will have the ability for one parent to room in with their baby 24 hours a day from the beginning of the hospitalization to the end of the hospitalization. That's not very common in many NICUs."

Carmichael's Mercy San Juan has seen a big jump in the number of babies needing intensive life support services, said Michael Korpiel, the chief executive of the medical center. Part of that is due to population growth, he and Getman said, but other reasons have to do with medical advancements. Because of new medical equipment and interventions, they said, the survival rate has increased for younger and younger preemies.

In addition, in vitro fertilization has led to an increased number of multiple births, Getman noted, and premature birth is the most common complication for women having multiple babies.

As demand has surged, the Mercy San Juan NICU expanded into rooms previously meant for offices or storage. It occupies just 1,200 square feet of space, Korpiel said, and typically at least 23 of its 26 beds are filled.

To ensure there's space for the most vulnerable infants born at Mercy San Juan, Korpiel said, the NICU staff sometimes calls upon its sister hospital, Methodist in south Sacramento, to take healthier preemies.

Dr. Robert Kahle, chairman of the pediatric department at Mercy San Juan, founded the unit. During a tour, he explained some of the equipment needed to ensure his tiny patients' survival and comfort. There are monitors at the nurses station and beside each of the frailest newborns. IV poles hold tubes supplying nutrition, blood transfusions and medications. A vacuum sits ready to clear out any obstruction. And preemies that could fit easily in an adult's hand rest inside the warmth of incubators.

"Although we have taken really good care of hundreds of babies since 1992, the families kind of get the short end of the stick, not because we don't treat them well," he said. "Families who come through our unit, have babies in the unit, feel very good about the care that their babies are given and what they're given, but the space just isn't conducive to family bonding and privacy ... and to be able to move into a space that's going to allow that is incredible."

The ward's close quarters, though, have brought parents together and fostered the bonds of friendship, Kahle said, and the new unit expected to open next summer will still provide opportunity for that. Many preemies will be put into pods with one or more infants, depending on how much nursing care they need, he said, and parents will have more room to sit with their infants and get to know one another.

Kahle so wanted this new unit that he pledged $75,000 toward the fundraising effort, said John McIntrye, chief philanthropy officer at Mercy Foundation, and other physicians and staff have also made donations. It was McIntyre's job to raise at least $3 million from the community for the project, a number that would demonstrate buy-in for the expansion.

McIntyre said he raised $2 million toward his goal within 18 months, but it got a lot harder to get the last $1 million. That's when he decided to go back to philanthropists Robert S. and Star Pepper. Robert Pepper was CEO of semiconductor maker Level One Communications, founded in Sacramento in 1984 and sold to Intel Corp. in 1999 in a stock swap for $2.2 billion.

The Peppers already had made a major gift, McIntyre said, but he had a feeling they might be willing to make an additional contribution if Mercy committed to raising funds to match it. They agreed to match up to $500,000, McIntyre said, and within a week, another donor had pledged the match.

Because of the Peppers' generosity, the new NICU will bear their names, McIntyre said. However, he's still giving tours of the new space to donors contemplating other gifts.

So many things are interrelated in neonatology, Getman said, and Mercy San Juan's team is focused on ensuring that all those factors come together in the new NICU, with 40 beds and 17,889 square feet of space -- 15 times more room than the current unit.

Getman noted that things have changed a lot since 1989 when she started moonlighting in what was the year-old, six-bed NICU at Mercy San Juan: Back then, physicians didn't understand the critical importance breast milk plays in boosting a newborn's immune system. And not many U.S. hospitals were encouraging parents to hold their full-term infants, much less their preemies, skin to skin, a practice also known as kangaroo care. There was less of the life-saving equipment -- ventilators, for instance -- that now allow preemies to survive, and the equipment used back then took up less space.

Kahle recalled that when he was in training, "babies under about 28 weeks gestation, under about a kilo, were never resuscitated because we really didn't have the ability to care for them. If they survived on their own, that was one thing, but if they came out and needed a lot of help, their chances of survival were essentially nil."

Since then, respiratory experts have learned that, while they need to get babies ventilated as quickly as possible to keep them alive, Getman said, they also must push just as hard to get them breathing on their own because prolonged use of ventilators increases the risk of infections.

The neonatology team used to wait four or five days to start giving preemies IV nutrition, she said, but now they try to start it within 24 hours of birth. Those first feedings need to be breast milk, she added, because it improves the function of their immune system, lowering the risk of respiratory and other infections.

"We know that getting fewer infections is very important, because infections are associated with an increased risk of adverse neurodevelopmental outcomes," she said. "We are really focused on providing good nutrition, including breast milk for our babies, and one way to get that for our babies is to have their moms here as much as possible."

To supply the amount of breast milk necessary, moms must pump every two to three hours around the clock, Getman said. By having moms stay in the NICU, Getman said, the staff can support breastfeeding, and the infant's need remains pressing and visible.

Like many hospitals, Mercy San Juan has a NICU reunion event every year, Getman said, so the staff can see how their former patients have grown. Sometimes, she said, 25- or 26-year-olds come back, allowing the staff to go back to parents worried about the survival of their 25-week gestation baby and tell them about the amazing lives their former patients are having.

"I'm so excited for our babies to have the space that they need," Getman said. " ...I'm just so excited that we're going to be able to have a parent there as much as possible, and we will have the ability to have them living in and being so much more involved in their baby's care."

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