A high-level of co-operation between health-care providers in the Maritimes helps assure the health of babies and mothers who may be at risk of problems around birth, says the division chief of neonatal-perinatal medicine at the IWK Health Centre.
“The rule of thumb is that if either part of that partnership -- the mother or the fetus -- are anticipated to need a higher level of care than they can get in their region, they come to the IWK,” said Dr. Krista Jangaard. “When that risk goes away, we try to get that mom and baby back home as soon as possible.”
The IWK’s mandate is to provide Maritime-wide intensive care for premature babies or specialty care for babies with other health difficulties at birth like the need for cardiac surgery, for example. The demand has grown, said Dr. Jangaard because babies who once died if they were born too early are now surviving as early as 23 weeks of gestation (full term is 40 weeks).
She said the current increase in birth rate, older women giving birth and increased multiple births (in part because of the use of reproductive technologies), means a higher demand for more complex care for longer periods of time for more mothers and newborns than ever before.
The IWK works in close cooperation with neonatal and maternal-fetal medicine care teams across the region to support care closer to home when possible and also receive patients from other regions when needed. Maritime hospitals provide differing levels of neonatal and maternal-fetal care. Neonatalogists provide care for babies and maternal-fetal medicine specialists care for women with high-risk pregnancies.
Dr. Jangaard said Cape Breton is a little different than other parts of Nova Scotia, because the regional hospital has a small neonatal intensive care unit (NICU) with one neonatalogist.
“If they have an uncomplicated course for their pre-term delivery, we don’t necessarily see them here,” says Dr. Jangaard. “But when you are one neonatalogist, you can’t work 24 hours a day, 365 days a year. When the neonatalogist is away, the cases do come to Halifax.”
Dr. Jangaard said besides seeing newborns from Cape Breton requiring complex care, the IWK will also share the care of women with high-risk pregnancies because there is no maternal-fetal medicine specialist outside the IWK.
Dr. Jangaard said that it’s important that our region have one tertiary care centre for the specialty care of the sickest babies, with other levels of support available closer to home. That’s because the numbers of very premature or gravely ill babies are low.
“It is not only important to remain current, but also to keep good at what you do,” said Dr. Jangaard. “You have to perform enough neonatal heart surgeries, for example, to stay good at it.”
The IWK also offers a Perinatal Follow Up Program where a multi-disciplinary team regularly assesses premature babies to monitor their growth and development (motor, cognitive and social) until they are three years old.
“The ultimate mission of the program is to identify concerns early and get the children with concerns referred to specialists and interventionists as early as possible,” said clinical leader Shelly McHugh. “This can make a huge difference in the outcomes for these children.”
McHugh said the team holds clinics around the Maritimes to follow these high-risk babies and to meet with local health-care providers to share information and best practises, as well as to fuel research studies.
McHugh says about 140 babies enter the program each year; there are currently about 400 in the program. The majority are from PEI and Nova Scotia, as New Brunswick babies tend to be followed within the province. The program appears to be helping as “77% of the babies who have been followed develop appropriately by their ‘graduation’ at three years old.”
Inside Your IWK is a joint project by the IWK Health Centre and IWK Foundation. To view some of the interview with Dr. Jangaard please see the videos below: