Physicians from different specialties have long collaborated to care for newborns who have developmental brain abnormalities or are at high risk of neurological injuries. However, says Johns Hopkins neonatologist Frances Northington, these relationships have usually consisted of one-at-a-time consults.
“A neurologist might talk with the neonatal team or a radiologist or maybe a maternal fetal medicine specialist,” she says. “That was the sum of it.”
At Johns Hopkins, that all changed in 2007. With the advent of cooling therapy for infants with hypoxic-ischemic encephalopathy, Northington and other specialists saw a need for a more intensive team approach. Banding together experts from neonatology, pediatric neuroradiology, pediatric neurology, maternal fetal medicine, developmental medicine and the nearby Kennedy Krieger Institute, these physicians and nurses formed theNeurosciences Intensive Care Nursery (NICN), a program that’s the only one of its kind in the region.
Together with co-directors pediatric neurologist Adam Hartman and pediatric neuroradiologist Thierry Huisman, and assisted by NICN coordinator Charlamaine Parkinson, Northington now leads the NICN. The program hosts a weekly meeting in which specialists who care for these infants meet in the same room at the same time to discuss their cases.
“It’s a different way of practicing medicine than most of us were taught in med school,” Hartman says. “It’s not about individual physicians, but how we as a team can provide better care for these babies. Rather than getting an extra second or third opinion, every baby might get 10 opinions about his or her case.”
The program is also helping everyone to think beyond their own specialty, says Huisman. “By discussing each case from multiple viewpoints,” he says, “we are becoming experts in each others’ fields.”
Although the NICN cares for some babies born at Johns Hopkins, most are referred from other hospitals, Northington says. A pivotal part of the program is providing guidance to referring physicians and helping them educate parents about the treatment their baby needs.
Another component is a burgeoning research program, also spurred on by collaboration. “Not only has everyone’s separate productivity grown,” says Northington, “but interaction between our physician-researchers has blossomed tremendously.”
This year, the NICN recruited former resident Monica Lemmon as its first fellow. The ability to provide training in the different specialties that make up the program is a sign of its maturity, Hartman says.
Perhaps most important, says Northington, is that each program component has contributed significantly to improving patient outcomes. “I can’t emphasize enough,” she says, “how much the babies benefit.”