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ROUNDS: A message from the Vice Chancellor

6/07/2012 - Recently, I visited the Neonatal Intensive Care Unit. Having attended medical school here, I have long been aware of the historic significance Vanderbilt holds in the field of neonatology. As I witnessed the remarkable way that history has evolved, those memories came flooding back.

Many people may not be aware that Vanderbilt opened this nation’s first neonatal intensive care unit. In 1961, care for newborns was revolutionized worldwide as Mildred T. Stahlman, M.D., professor of Pediatrics, founded the Division of Neonatology and began the Vanderbilt NICU, the first in the nation to make use of respiratory therapy to sustain the lives of infants with premature lungs.

Jeff Balser, M.D., Ph.D.

Jeff Balser, M.D., Ph.D.

Today, our NICU remains a world leader, and is widely acknowledged as one of the nation’s most distinguished and most advanced. Just this week, Neonatology was named among the nation’s top programs, ranking 9th by U.S. News & World Report in the Best Children’s Hospitals rankings. Pediatric Urology also continues to enjoy elite status in U.S. News, ranking 8th in the country.

The NICU is truly an amazing place. Combining to possess literally hundreds of years of experience, our nurses and doctors and staff representing a vast array of specialties, from pharmacy to Child Life, are simply the best of the best. Many have more than 20 years experience caring for premature babies. Their collective wisdom is priceless. One can only marvel at their indefatigable drive and compassion.

Just to put a fine point on it, the NICU team saves babies born weighing less than 1 pound. Even with the extraordinary advances we witness daily throughout health care, it still seems incomprehensible that a human born this small can be saved. Imagine a baby weighing only about three-fourths as much as a standard bottle of water.

The battle we wage against prematurity now resembles, in many ways, the dreaded infectious diseases that have plagued mankind for centuries. Today, nearly one in eight children born in the United States will be born prematurely. While we save so many, some will not survive, and some will endure lifelong disabilities. The World Health Organization estimates nearly 13 million children will be born prematurely each year worldwide. Prematurity may account for the loss of more life years of economic productivity than ANY disease.

To emphasize the local reality of this challenge, just a month ago we celebrated the opening of the Monroe Carell Jr. Children’s Hospital expansion, and our NICU grew to 100 beds, making it one of the largest in the U.S. Yet during my visit last week, not a single crib was empty.

The logistical task in managing not only the care, but the “air traffic control” to safely navigate so many hundreds of tiny and fragile patients from all over the region into beds in our NICU, is stunning to witness. The task requires a 24/7 “symphony of organization” that includes constant communication and active collaboration with area hospitals and physicians and seasoned judgment. The compassionate, “can do” attitude of the team of people making these minute-to-minute life and death decisions is stunning to behold.

While balancing the day-to-day pressures of critical care, it should be recognized that our Children’s team also leads the country in innovations aimed at early diagnosis of problems that cause birth defects and prematurity. Some problems, such as spina bifida, are both detected and corrected literally before birth through in utero surgical repair pioneered here at VUMC.

In 2008, we formed the Tennessee Initiative for Perinatal Quality Care (TIPQC). This program quickly grew into a statewide consortium of all 27 NICUs in Tennessee, as well as obstetrical practices, to join TIPQC and participate in evidence-based practice changes to improve prenatal care, reduce infant mortality and reduce complications of preterm birth.

And our research efforts are ever more extensive. Last year, the National Institutes of Health (NIH) awarded our investigators $1.6 million to increase the number of physician scientists that can be trained to help solve the problems of premature birth. And in 2010, the NIH awarded us $2.4 million to unlock the mysteries behind a common and deadly form of lung disease affecting up to 15,000 premature infants each year in the United States.

Through these efforts and many others, we’ve made strides since 2000. There has been a 9 percent reduction in Tennessee’s infant mortality rate. Thousands of lives have been saved.

Yet despite these extraordinary advances, the broader solutions to this enormous public health problem do not lay solely within our NICU or our operating rooms. In some Tennessee counties, babies die at rates equivalent to Third-World countries. The truth is, mothers who receive little or no prenatal care are at highest risk to give birth prematurely.

So as we work inside, waging a 24/7 war against the clock of human gestation — hoping to restore the hopes and dreams of parents experiencing births that come far too early — we also work outside. As a medical center, we invest millions in providing prenatal care for the uninsured and underinsured economically disadvantaged mothers in our region.

What is at stake? The survival and health of thousands of children with futures that are yet unwritten. Their lives are certain to impact the potential of our society for generations to come.

At VUMC, we are experiencing unprecedented financial challenges due to an uncontrolled national debt causing large cuts in federal budgets supporting the nation’s health care and biomedical research. So as we reflect on our own priorities, can we imagine any area of our mission more important to the future than this?

Jeff Balser, M.D. Ph.D.
Vice Chancellor for Health Affairs
Dean, Vanderbilt University School of Medicine

 

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