Innovative program in the NICU improves infant outcomes

Esther Villarreal’s water broke when she was only 21 weeks pregnant. A mother of two, Esther knew something wasn’t right and checked into Sharp Mary Birch Hospital for Women & Newborns, where she learned she had placenta accreta. This serious pregnancy condition occurs when the placenta grows into the uterine wall.

“I had no idea I had a high-risk pregnancy,” says Esther. “The doctor discovered I had scarring in my uterus from a prior pregnancy, which may have contributed to this condition. It was a scary situation. She told me that my life and my baby’s life were at risk.”

Esther was admitted to the hospital and monitored in the Perinatal Special Care Unit, which specializes in caring for mothers with complicated pregnancies. A few weeks later, she began dilating and had an emergency cesarian section. Because Esther had such severe scarring, her obstetrician performed a hysterectomy during the C-section to remove the baby safely.

Jose Cervantes was born on Dec. 16, 2022, at 25 weeks gestation, weighing only 1 pound, 10 ounces. He was transferred to the Neonatal Intensive Care Unit (NICU) and required oxygen for over three months.

Optimizing babies’ outcomes

To help extremely premature babies such as Jose not only survive but also thrive, they are cared for around-the-clock in Sharp Mary Birch’s Level III NICU. They receive state-of-the art neonatal intensive care, including physical therapy and occupational therapy sessions that start as soon as these tiny babies are born.

“The assessments help further the development of motor, feeding and cognitive skills in the NICU, which allowed us to begin working on Jose’s development during his first few days of life,” says Robyn Wyzinski, a NICU physical therapist. “Many parents are interested in their child’s progress and want more information earlier, so we start therapies as soon as possible."

According to Wyzinski, in Jose’s case, this involved physical therapy exercises — tummy time for head control, hydrotherapy, neonatal massage and range of motion exercises — performed by the physical therapist and his parents to help with his joint contractures. Contractures are stiffness or loss of motion in joints, which limits range of motion.

Improving baby’s brain development

In addition to providing immediate physical and occupational therapy, Sharp Mary Birch recently initiated an innovative new program focused on optimizing neurodevelopmental (brain development) outcomes, starting as early as possible in the NICU. This program, called developmental rounds, serves as a bridge between inpatient therapies and outpatient services in a personalized way for each baby and family.

As part of the developmental rounds, a multidisciplinary team led by Dr. Rebecca Dorner, a Sharp neonatologist and director of the Nemeth NICU Follow-Up Clinic, meets with the family at each infant’s bedside. She explains physical therapy, occupational therapy and other specialized motor and developmental assessments of the baby and makes team recommendations for the baby after discharge.

Wyzinski notes that these sessions are unique. Although other hospitals may have neonatal intensive care, only a few centers provide multidisciplinary family-centered care and developmental rounds, especially with teams comprised of physical and occupational NICU-dedicated therapists.

Focusing on family involvement

One of the biggest aims of this program is to bring everyone together in the same place to talk about the infant’s development.

“Our goal is to empower parents at the very beginning, so that they not only understand what interventions their baby needs but also know about the ‘why,’ and learn how they can play an active role both in the NICU and once their child is discharged,” Dr. Dorner says. “Families are at the center of this program. In this way, developmental rounds are individualized to each baby’s strengths and the areas they need help the most.”

Neurodevelopmental assessments optimize outcomes through treatments based on research and baby development, such as SENSE, or supporting and enhancing NICU sensory experiences, therapies. SENSE enhances the NICU experience through appropriate, positive sensory exposures. “One of these tactics is using a scent cloth, which we put on Esther to help facilitate bonding between her and Jose,” says Wyzinski.

Enjoying adjusted milestones

Babies born prematurely, or in Jose’s case, who are extremely low gestational age newborns, or ELGANs, babies born at 26 weeks gestation or earlier, focus on adjusted milestones. This is an age correction calculated by subtracting the number of weeks premature the baby was born from their actual age.

Esther says she felt peace of mind being so involved in Jose’s care. She appreciated receiving information about his milestones for his adjusted age.

“I appreciate that the nurses and doctors gave me so much education about what was happening and how I could help — it made me feel hopeful,” Esther says. “I wasn’t expecting to spend time in the NICU but was overjoyed and fortunate to be at Mary Birch. Everything is so coordinated, and the quality of care is amazing.”

Families are educated on safe developmental positioning — when age-appropriate positioning and play are used to support baby development — at least twice weekly. They are also taught how to adjust therapy based on their baby’s development so they can do the activities at home.

“We are thrilled to hear how much the developmental rounds are helping our patients and their families,” Dr. Dorner says. “The program will continue to evolve, and now we are working on ways to make it more accessible. We already have it available in several languages through translators and are aiming to have even more!”

Mom and baby are now home enjoying the sweet — and as with all newborns, some sleepless — moments together with their family. Esther feels confident she has the tools she needs to continue helping Jose’s development.

Learn more about high-risk pregnancy; get the latest health and wellness news, trends and patient stories from Sharp Health News; and subscribe to our weekly newsletter by clicking the "Sign up" link below.

For the news media: To talk with Dr. Rebecca Dorner, contact Erica Carlson, senior public relations specialist, at erica.carlson@sharp.com.