Greenhouse: Don’t change system that protects tiniest, most vulnerable infants

February 20, 2014 

Debbie Greenhouse

— In South Carolina, our smallest, most vulnerable babies are cared for at specialized neonatal intensive care units strategically located throughout the state. State law protects this system with a 60-mile rule that prevents a new higher-level neonatal intensive care unit from opening close to a current regional center. This system ensures that physicians and staff care for enough of these babies to maintain the very specialized skill set required.

Since neonatal intensive care was regionalized in South Carolina, our neonatal mortality rates have decreased significantly. The Centers for Disease Control’s analysis of perinatal care in the United States showed a 55 percent higher survival rate in states that use regionalized perinatal care systems similar to ours. The American Academy of Pediatrics recommends this type of system.

But today there are hospitals in South Carolina that are challenging our system; they want to open smaller high-level units and get into the business of caring for the tiniest and most vulnerable babies. The results could be devastating. Without the skill sets and experience needed to care for these babies, mortality rates at these new centers may be high.

In addition, mortality rates at the current high-level centers could increase as their patient volume is diluted by the new centers. This represents an unnecessary and unreasonable risk for our state’s smallest newborns.

Perinatal regionalization is one of the things that South Carolina does quite well. We need to be sure that we continue to protect our smallest and most vulnerable newborns. We can accomplish this by maintaining our 60-mile-rule, or by establishing a minimum patient volume for neonatal intensive care units (for example, high-level units must care for more than 100 very-low-birth-weight infants annually, regardless of the number of deliveries at the hospital). We need to protect these babies with these regulations, especially since we no longer have a certificate of need program in place.

We know that our tiniest and most vulnerable newborns require the highest level of specialized care in order to achieve good outcomes. It is our responsibility to be sure that we maintain neonatal units that care for high volumes of these babies and maintain the best facilities and the highest level of skills among their physicians and staff.

Continuing our system of regionalization of perinatal care is the best way for South Carolina to achieve this.

Deborah Greenhouse, M.D.

President, S.C. Chapter, American Academy of Pediatrics

Columbia

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