Carrol Hospital is going to allow NICU babies to stay in their mom's room in a new progam called Couplet Care. (Amy Davis, Baltimore Sun video)
Premature babies with health problems often end up in neonatal intensive care units, separated from their mothers. This once-standard practice can be emotionally taxing on mothers and, doctors say, it may not be the best care option for babies.
The infants often stay in the hospital long after their mothers are discharged, which means parents have to travel back and forth to see their children. Intensive care units for babies are often in tight quarters with little privacy, making it hard for mom and child to bond.
As a result, a handful of hospitals are trying to change the culture of neonatal intensive care units and in turn reduce costs and the time it takes babies to recover.
Carroll Hospital Center in Westminster is creating a "couplet care" program that will keep babies in the same room as their mothers rather than in a special nursery. Nurses and other staff will coach mothers on caring for their babies and allow mothers to stay at the hospital until their babies are healthy enough to go home.
Mercy Medical Center started a similar program in 2012 when it opened a new women's center.
Most hospitals already keep moms who had healthy deliveries in the same room as their baby, but few hospitals are doing this for babies in intensive care units.
"We know if the baby is being held more and taken care of by the mom and family, the baby's vital signs stabilize," said Dr. Cynthia Roldan, Carroll Hospital Center's director of pediatric hospitalists."They recover more quickly and are able to be discharged earlier."
Carroll Hospital Center is basing the new approach on a program developed by Karolinska University Hospital in Sweden. The hospital found that the bonding and nurturing between mom and baby helps with recovery. Carroll hospital officials are especially hoping it helps the growing number of babies born addicted to opioids.
Catholic Medical Center in Manchester, N.H., adopted the same program seven years ago and is seeing savings in medical costs because babies are staying in neonatal intensive care units, or NICUs, two to four weeks less than they once did.
More of the babies are also breastfeeding when they go home, said Gloria Yennaco, the hospital's clinical education specialist. Before the program was started, mothers couldn't focus on breastfeeding because they weren't with the baby for extended periods.
Couplet care doesn't cost more because the baby is the patient, not the parent, Yennaco said. And moms don't have to stay the entire time their babies are hospitalized. Some mothers may have to return to work, or may have to care for other children at home. There also can be other logistical problems.
"Some mothers can't stay 24/7 because they have other challenges, but we encourage them to stay as much as they can," Yennaco said.
The concept may not work in all NICUs. Babies with the most severe medical problems may need to be in rooms where they can get specialized care.
The 50-bed Drs. Rouben and Violet Jiji Neonatal Intensive Care Unit at the University of Maryland Children's Hospital is one of only two Level IV NICUs in the state. The hospital cares for the most critically ill babies in Maryland, including extremely low-birth-weight infants and those with surgical, genetic and cardiac conditions. Many babies are sent there from other hospitals around the state.
"If a baby is born a little premature but is stable enough to receive care on the mother-baby unit and nursery versus the NICU, we do provide and encourage couplet care," said Monika Bauman, director of patient care services for women's and children's health at University of Maryland Medical Center. "But typically, babies who require Level IV neonatal intensive care have nurses who are specially trained to take care of babies requiring intensive care."
"The hospital encourages moms to be with baby in the NICU as much as possible," Bauman said.
Carroll Hospital Center is a Level II NICU, which means it sees less severe cases, such as premature babies born at 32 weeks or later, but without severe health problems.
"It is the perfect model for us because most of our babies are not critically ill," said Linda Grogan, executive director of women's, children's and surgical services at the hospital.
The hospital's foundation received a $2 million donation from Greg and Robert Kahlert of the Kahlert Foundation to start the couplet care program. The new program will be part of a $13.5 million renovation to its family birthing center and will include a 9,000-square-foot addition. New NICU rooms will include a bed and family lounge area.
"Moms didn't appreciate the separation or the open NICU ward with no privacy," said Leslie Simmons, Carroll Hospital Center's CEO and president.
Dobry, 29, lives five minutes from the hospital and went there as much as she could, including every three hours for his feedings. But she didn't like that she couldn't be there with him more, especially overnight. She had a panic attack the first time she was home after being released from the hospital because she worried about her son all night.
"You don't expect to leave your baby at the hospital," she said. "You anticipate this perfect scenario where they come home. It was very emotional for me."
Dr. Susan Dulkerian, director of nurseries and interim chair of the department of pediatrics at Mercy Medical Center, said allowing mothers to stay with their babies relieves a lot of anxiety.
"Moms are not waking up in the middle of the night wondering if their baby is OK or if something has gone wrong," she said. "And if something does go wrong, they are there to see the medical staff help the baby get better."