The Front Line

Role of newborn hospitalists

by Charles T. Hankins, M.D.
Associate Professor of Pediatrics–Neonatology
Medical Director, Community Neonatology Program Medical Director, St. Luke’s Community Medical Center–The Woodlands

Over the years, Baylor College of Medicine’s (BCM) Section of Neonatology has led the way in providing state-of-the-art newborn care. Some 20 years ago community pediatricians delivered routine newborn care and neonatologists delivered intensive care. About a decade ago, neonatal nurse practitioners joined the mix to assist in intensive care and transition to ambulatory care. This nursing role expansion grew from the increasing population of very preterm newborns who benefited from intensive care.

Within the past three to five years, new factors drove the next progression of change. Economic factors, led by insurance companies’ reimbursement practices that reward outpatient care, have made it costly for private pediatricians to travel to visit their newborn patients in hospitals. Plus, the travel time required to visit a few patients in geographically separated hospitals hinders effective scheduling of office visits. Thus, it is more cost-effective for doctors to provide care from their offices. This trend has resulted in hospital-based neonatologists providing routine care of newborns in hospitals.

The BCM Community Neonatal Program has responded by creating a role for newborn hospitalists. These fully trained pediatricians chose to focus on delivering high-quality care to newborns; they are trained to address newborn issues and have the time to counsel parents during the first few days and weeks of their infant’s life. And if a newborn needs more intensive care for any reason, such as prematurity, the newborn hospitalist already is a part of the larger BCM neonatal team, which assures a seamless transition of care. This new role has allowed the newborn hospitalists to become focused and skilled at working with hospital staff to assure that each newborn receives an individualized plan of care during the first few days of life. At discharge, parents receive information about transferring care throughout infancy and childhood to their primary care provider.

To date, our team comprises about 15 such newborn hospitalists that deliver care to more than 1200 newborns each month in seven Houston-area hospitals, including The Methodist and St. Luke’s Episcopal Hospitals in the Texas Medical Center. By providing this new dimension in newborn health care, the BCM Section of Neonatology is continually responding to improve the outcomes for newborn infants.