1. Community Perspective Michael Sylvia, MD FAAP
Care of the neonate
Community Perspective
Michael Sylvia, MD FAAP

2. Context: Maria Parham Health
Located in Henderson, Vance County
44,000 people ; median income $32,000 ; 25% poverty ; 60% non-Caucasian*
Additional 140,000 citizens in surrounding Warren, Franklin and Granville Counties*
102 bed hospital built in 1925
annual deliveries
Level II NICU status
2-4 transfers per month
Joint venture between Duke and LifePoint Health
*Data sources: US Census Bureau and Data USA

3. Level of Care
>34 weeks gestation without significant need of support
Mild respiratory distress
Neonatal withdrawal monitoring
Neonatal sepsis evaluation and observation
Hypoglycemia
Poor feeding
CPAP but no HFNC / HiVNI
Echo available non-emergently
Stabilize and transfer all additional neonates

4. Common Scenario
36 week GA infant, mother had prenatal care, delivered through meconium fluid developed persistent respiratory distress after delivery. Started on CPAP, but remains distressed. Likely TTN or mild meconium aspiration.
1, maybe 2, nurse(s) available to assist
Respiratory therapy needs to be double checked
Infant needs labs, IV access, Xray, etc
Infant may require central line placement

5. Transfer Process Data Duke Neonatal Fellow Phone
No collaborative agreement, generally fist call
Parent has right to refuse but cannot specify location
UNC then Wake Med typical order of succession
Bed available  transfer usually accepted
No bed availability requires subsequent calls to other neonatal ICU
Arrange / discuss with transport service
Ground ~1 – 1.5 hours, Air 0.5 – 1 hr
Compile patient chart, copy notes / labs / etc.

6. Limitations Staff Time Resources Capability
Mother typically unable to transfer
Limited information to convey to parent(s)
Follow-up lacking
Currently no process for back transfer