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Heather Cornell found out about that efficiency when she went into labor with her first baby. She had no warning, excellent prenatal care and no previous sign of early labor – but sometimes babies just come early. Her doctors delivered Heather’s first baby, a son named Tyler, at just 27 weeks gestation, or about three months early. She delivered him in Bowling Green, Ky.

“They told me they were calling Vanderbilt before they even began my delivery,” Heather said. Tyler weighed a tender 2 pounds, 6 ounces. Heather only got to touch his tiny foot for a moment before an Angel Transport team carried him on a 50-minute journey to Vanderbilt so he could receive the care he needed.

“My husband and his mother said goodbye to me while I was just out of surgical recovery, then drove to Nashville,” Heather said. “It was very scary… terrifying.”

Many families who deliver critically ill or very premature babies away from a Level 3 NICU may be divided almost immediately.

“If a baby is born elsewhere, the baby is whisked off, mom stays to get her treatment at the birthing hospital while dad tries to broker between two places and two loved ones (the mother and the baby), so collaborations are really important,” said Nancy Chescheir, M.D., the Betty and Lonnie S. Burnett Professor and Chair of the Department of Obstetrics and Gynecology.

“I had (Tyler) on a Monday and stayed in the hospital until Wednesday,” Heather said. “They wanted me to stay longer but I wanted to get to Vanderbilt.” She and her mother left the birth-hospital without even stopping at home first, “because (Vanderbilt) was where I was supposed to be; where I needed to be. I needed to know he was OK, not just for him – for me.”

The Cornell family was reunited and was able to rest in the family sleep rooms adjacent to the critical care unit. Heather, who developed an infection in her incision site, said the next six-and-a-half weeks were among the toughest she could imagine.

“I never thought my husband and I could go through something like that, but we did,” she said. “We still call on the Children’s Hospital for advice and reassurance, even now that Tyler is a rambunctious 10-month-old.”

Fixing the problem
The difficulties of separating families at birth and transporting infants are vexing problems for those who work in both Obstetrics and Neonatology. High-risk Obstetrics at Vanderbilt University Medical Center and the Neonatal and Pediatric practices at the Children’s Hospital now officially combine efforts in the Division for Advanced Maternal-Fetal Care and a corresponding Center at Children’s Hospital. Together, Vanderbilt experts are working to address many social, political and medical issues tied up in the question of how to improve the care of infants and mothers. It is an important topic for the state of Tennessee as well, which ranks just seven marks from the bottom of the barrel (43rd) in infant mortality.

It’s a shameful designation that Vanderbilt wants to help change. The Center, funded in part by a $2 million, six-year pledge from the Junior League of Nashville (JLN) is growing quickly. A recently announced plan for an expansion to the Children’s Hospital may give a new face and facility to women and children’s health in the region. A $5.4 million planning budget has been approved for the proposed $203 million, eight-floor Women’s and Children’s expansion, which could be open by 2012.

Leaders in the areas of maternal-fetal care and neonatology at Vanderbilt say Tennessee languishes at 43rd in the nation for infant mortality at least in part because of an outdated view of how to best improve the outcomes of pregnancy: that current view focuses almost exclusively on the babies after they are born. They argue that to make a significant improvement in birth outcomes in Tennessee, intervention must begin with their mothers.

“The infant mortality rate for babies born two months or more before their due date (about 32 weeks or earlier) is 75 times higher than for full-term babies,” said Aschner, Neonatology’s director. “We cannot effectively reduce infant mortality if we don’t partner with mothers and their obstetricians to change the rates of pre-term and low birth weight births.”

Aschner, Chescheir and Maureen Malee, M.D., Ph.D., director of the Division of Maternal-Fetal Medicine, have all practiced medicine in other states where infant mortality rates are much lower. They wonder: “Why aren’t more women in Tennessee receiving better prenatal education and care?” and “Why aren’t more families partnering with specialists to develop a game plan to help unborn babies with congenital defects in the early stages of pregnancy, rather than right before birth?”

The questions are many, and the problem is both expansive and expensive. The good news is it’s finally beginning to top the list of concerns for state officials. In March of 2006, the Tennessee Comptroller’s office came out with a report that laid out the startling facts:

• More than 30 percent of children who die in Tennessee are infants who are born prematurely.
  
  
• Birth defects are the leading cause of death among white infants, while low birth weight is the leading cause among black infants.
  
  
• The rate of death among black infants is 2.7 times higher than that of white infants.

In 2005, according to 2000-2002 data from the Tennessee Department of Health, Tennessee’s infant mortality rate of 8.8 per 1,000 live births was ranked the third highest in the nation. The Tennessee infant mortality rate during this period was 31 percent higher than the national average. The 2004 mortality rate for Tennessee black infants was 17.4 per 1,000 live births, compared with a mortality of 6.4 per 1,000 live births for white infants.

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