More babies are being born underweight or addicted to ...



Not enough beds for sick babies in West Virginia, 2/13/08

By Anna Sale, West Virginia Public Broadcasting

Sale: More babies are born with low birth weights or addicted to drugs in West Virginia. A report by the West Virginia Perinatal Partnership says that has strapped the state’s three infant ICUs, and sometimes forces them to turn away babies.

(Sound of baby crying)

The problem can be clearly seen at Cabell Huntington Hospital.

Dr. Joseph Werthammer is a neonatologist there, a doctor who specializes in high-risk infants.

Werthammer: We’re full a good bit of the time. We’ve had probably four months of being on complete diversion where we cannot except new babies, or mothers who are pregnant into our high-risk obstetrical area.

Sale: He estimates the hospital turned away at least than 100 babies last year.

Cabell-Huntington isn’t alone. In Charleston and Morgantown, the state’s two other neonatal ICU’s, or NICUs, are increasingly in demand.

The number of babies discharged from a NICU in West Virginia increased by more than two and times between 1999 and 2005, from 679 to 1805 babies.

Not all of these infants are from West Virginia, but that’s a rate of six percent of babies born in the state.

WVU Hospitals recently added beds this year, and that seems to have averted a crisis in Morgantown for now. In Huntington, they’ve also added beds 7 beds in the last couple of years, but Dr. Werthammer says it’s still not enough.

Werthammer: We have so many more survivors that are so very immature, who previously had died in the first several weeks of life, and now might stay here for 2, 3 months before they go home.

(sound of heart monitor beeping)

Sale: But on this day, a walk-through the NICU shows that other factors are also at play.

Werthammer: Five years ago, we might have one or two babies born to a drug-addicted mother a year. Now we have 4 to 5 babies in our unit all the time.”

Sale: According to the WV Perinatal Partnership, 14 babies needed drug withdrawal treatment in 1999. In 2006, that number was 119.

There’s also fact that more than a quarter of pregnant mothers smoke in West Virginia. That’s the highest rate in the nation. Along with that come increased risks a premature or low birth weight baby, which often leads to the ICU.

And then there are multiple births.

During this visit, more than ten of the beds are taken up by twins, triplets, and one set of quadruplets. Fertility drugs have made multiple births more common, and when there’s more than one baby in the womb, there are higher chances that that they will be born premature or with low-birth weights, and need to stay in the ICU.

All this presents a number of problems.

Babies are alone in their ICU beds, which look like small plastic chambers, making it difficult for families to bond. There’s even more time apart if families don’t live in either Charleston, Huntington, or Morgantown and have to travel long distances for visits.

And it’s really expensive. 42 percent of babies in NICU are paid for by Medicaid. In 2006, Medicaid spent more than 8.6 million dollars on babies in ICU, and even then, Medicaid only reimbursed for 26 percent of what the hospitals charged.

All the demand also means there aren’t always beds available when another baby needs one.

(Phone rings: “Appointments, may I help you?”)

At his medical practice in Beckley, obstetrician Juddson Lindley knows well how crowded the state’s NICUs are.

Lindley: It’s almost a given my first place I call is going to be full.

When he’s trying to transfer a mother with a high-risk pregnancy, he calls Huntington first, then Charleston, and then Morgantown. If all their NICUs are full, his office starts calling out of state—to Columbus or Roanoke or Charlottesville.

Lindley: That probably out of all of our transfers, 10 to 15 percent of the time.

No one has exact numbers on how many babies have been forced out of state because WV’s NICUs didn’t have room for them. The state’s NICUs do not track where babies end up when they’re turned away. We were not able to find a family that had had the experience, even after calls to several doctor’s offices across West Virginia.

Dr. Lindley says that another part of the problem is that the state’s rural hospitals are increasingly not equipped to handle complicated births. In Beckley, Raleigh General closed its unit for more specialized care for infants closed in 2005.

Lindley: You have a much lower threshold for sending patients out because I would rather send them and have them be there unnecessarily then to have them accidentally delivered at a low-risk facility.

Sale: The Perinatal Partnership found that was a larger trend. Nancy Tolliver directed the group’s study. She says the problem isn’t just that so many babies are being transferred to NICUs, but that they are staying there for so long, until they are completely well.

Tolliver: The data shows that the majority of babies that leave a NICU go directly to their home. So if we can get some of the small community hospitals staffed and equipped to be able to handle some babies that are ready to come closer to home, we would also at the same time, open up more NICU beds because that baby’s going home to another facility.

Sale: Another recommendation from the study – stop early inductions when it’s not medically necessary.

The American College of Gynecology and Obstetrics advises against inducing labor before the pregnancy’s at 39 weeks if the mother or baby’s health doesn’t require it. But Tolliver says it happens here too often.

Tolliver: One reason might be that the woman appears ready for labor, and maybe she lives far away from the hospital, and the doctor and the family want to make sure that she delivers in the hospital without a lot of travel time.

Sale: She says any time you induce, you run the risk of miscalculating just how ready the baby is.

The group is also concentrating on working with the state Health Care Authority to get more NICU beds approved.

But Health Care Authority director Sonia Chambers cautions that there’s a more to the calculations than just what the demand is.

Chambers: Because the equipment and the staff are very high-tech, these are very expensive beds, and they are very expensive to the payers that pay for them, so we don’t want to have anymore than we absolutely need so it doesn’t drive up the cost.

Sale: Of course, long-term, the best solution is stopping the unhealthy behavior that leads to the preventable stays in the ICUs.

The state launched an outreach campaign last year to try to reduce smoking during pregnancy.

And there’s a bill pending in the legislature that would create a uniform screening tool for all pregnant mothers that would be kept confidential and would not reportable to law enforcement. The goal is to encourage mothers to disclose early if they use drugs, so their babies don’t end up born into withdrawal.

That bill passed the House of Delegates earlier this month, and is now before the Senate Health and Human Resources Committee.

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