The Department of Neonatology
The Department of Neonatology is a Level IIIC – the highest and most complex grade – national referral center and treats premature infants and full-term newborns from all over the country. Babies are admitted for a variety of medical conditions including multi-system congenital anomalies, congenital heart defects, disorders of the Central Nervous System, Digestive, Urinary and Genital Tracts, general surgery, orthopedic, plastic and neurosurgery, chromosomal and metabolic disturbances, ophthalmology, and ear, nose and throat disorders. Treatment results are compatible with the best Neonatal ICU’s in the world.
The department has 40 incubator stations: a 12-bed intensive care unit and a 24-bed intermediate care section, and treats approximately 900 infants annually. Occupancy frequently surpasses the 100% mark. In addition to board-certified attending neonatologists, the neonatal care team consists of fellows, residents, neonatal nurses, respiratory care practitioners, social workers, dieticians, physical and occupational therapists, and lactation specialists who provide round-the-clock care.
Modern Advances in pediatric medicine, together with the tremendous surge in IVF (in vitro fertilization) treatments have helped to contribute towards an increasing number of low and extremely low birth weight infants (ELBW). Sometimes born in the 24th week of pregnancy, these fragile infants weigh less than 1000 g (2.2 lb), and are no bigger than the size of an adult human hand. Despite their undeveloped systems,
the survival rate of ELBW infants has increased significantly over the last decade with those above 500-1000g (1.1–2.2 lb) having a 40% to 90% chance of survival.
While modern neonatal intensive care has improved outcomes for high-risk infants, their chances of complications are greater. Newborn infants with extreme prematurity, or who are critically ill or require complex surgery, merit the best care and facilities modern medicine has to offer.
When the Neonatology Department at Schneider Children’s was designed over two decades ago, it was outfitted with the latest equipment at the time. During the intervening period, pediatric medicine - and neonatal intensive care in particular – has become increasingly specialized alongside innovative therapies and emerging technologies. Facilities formerly considered ‘state of art’ have become obsolete by present day standards. At the same time, the popularity of the hospital has grown to such proportions that the Department frequently operates at 120% capacity. It is clear that a comprehensive response is needed as soon as possible; towards that end, Schneider Children’s views the refurbishment, redesign and overall upgrading of the Neonatology Department with the utmost urgency.
The Proposed Project
Modernization of the Neonatology Department aims to achieve several key objectives:
Increased patient beds from 40 to 50
30 individual cubicles for enhanced privacy and bonding
Upgraded workstations for staff (one per two cubicles)
Optimal infant care
Improved patient safety
More effective work-flow
Reduced costs and length of hospital stays
Enhanced parent facilities
Installation of the iMDsoft Information Technology Network
The refurbishment will require complete redistribution and reassignment of available space and quarters through the utilization of areas that have become ineffective or non-productive. Redesign will aim to promote more efficient work-flow particularly in the neonatal intensive care unit, with an eye towards projected needs over the next decade. Factors such as staff workstations, lighting and noise will be taken into account. New installations will include a new infrastructure to accommodate the iMDsoft network, an integrated computerized system for electronically managing patient data.
In addition to upgraded cubicles, parent and staff facilities, construction will include a large room for 20 incubators for "healthy growth preemies"; a going-home room for parents and infant the night prior to discharge; a breast-feeding room; and a lecture room for both personnel and families. Each staff member will have a special beeper so that any alert will beep instantly and summon personnel immediately to the patient.
Each cubicle will be outfitted with the full complement of equipment required for the critical care of the infant: giraffe incubator, vital signs monitor, ventilator, syringe and infusion pumps, gases and electrical supply points. The walls of each cubicle will be transparent for easier viewing by the staff; curtains will allow parents privacy when needed. An important addition will be the installation of breast pumps for nursing mothers.
The complexity of contemporary neonatal care requires intensive vigilance and monitoring of the infant’s status by the medical team both at the bedside as well as at central data management workstations. In order to facilitate prompt clinical attention, it is essential that optimum work areas meet the needs of both infants and members of the medical team. In addition to attaining the best possible use of space, the refurbished department will comprise ergonomic staff workstations which will be equipped with the latest technologies.
Light and Noise
Recent research findings and recommendations on light and noise control in neonatal units will heavily influence the design. Because fetuses normally develop in total darkness, lighting is a major factor. It is well-known that direct exposure to lights or sunlight could cause retinal damage. In addition to its effects on vision, light regulates fetal physiology that may have a positive effect on variables such as amount of sleep time, weight gain, and behavior in preterm infants. Unlike light, noise is a normal aspect of fetal development. Fetuses normally mature in utero accompanied by a variety of noises generated by the maternal viscera and voice. These uterine noises are rhythmic and familiar and are generally low frequency. In multi-patient rooms with infants of vastly different ages, however, any single routine for light or sound exposure could be inappropriate for one or more of the babies.
Within the framework of its efforts to upgrade the hospital's critical care capability in all intensive care units, Schneider Children's completed the infrastructure for iMDsoft network in the Pediatric Intensive Care Unit, Surgical Suite and Cardiac Intensive Care Unit. All medical data is now stored and interfaced electronically, obviating the need for voluminous paper documents, reports and files. The archive system has since been transformed into a paperless, state-of- the-art, digital entity.
Each incubator station will be outfitted with a computer work terminal that will be connected to the central network providing all patient parameters in a single location.
Data will be collected from bedside life-sustaining equipment and automatically stored in a database while other information (IHIS=integrated hospital information system) including directives, lab results, administrative data, imaging and more, will be dynamically updated on-line. The clinical flow sheet will provide an ongoing dialogue with events transpiring in the unit as they occur.
The iMDsoft considerably contributes to error reduction and resulting in improved health care and patient safety. Theoretically, every doctor, specialist and nurse in the Department will be able to obtain a comprehensive picture of the infant's status and information regarding treatment at any given moment.
Schneider Children’s will be most grateful to receive a contribution of $2.5 million towards the refurbishment and modernization of the Neonatology Department. The funds will support all reconstruction work, installation of the iMDsoft Information Technology Network, and acquisition of the latest and most advanced equipment and instrumentation.
- Individual preemie cubicles are available for naming in recognition of a contribution of $45,000.
- The 20-bed "healthy-growth room" is available for naming in recognition of a contribution of $150,000.
A permanent marker, in keeping with the standards of Schneider Children’s, will bear the name/s of the donor/s and be erected in an appropriate location.
A dedication ceremony in the presence of the donor/s will take place with the participation of senior hospital officials.
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