Melanie Cole: Today, we're highlighting the neonatal intensive care unit at Bryan Medical Center in Lincoln, Nebraska.

Host: Welcome to Bryan Health Podcast. I'm Melanie Cole. And I'm joined today by Dr. Craig Sitzman. He's a neonatologist at Heartland Neonatology Associates. Dr. Sitzman, it's such a pleasure to have you with us today. I'd like you to start by telling us a little bit about yourself. Tell us how you got into this field, why this specialty, and I'd also like you to tell us what drew you to work with these, the most vulnerable and special patients.

Dr. Craig Sitzman: Yeah, thanks for having me. I grew up always wanted to be a doctor. I had a mentor growing up. And so, from an early age, I really wanted to be a physician. I started out by attending the University of Nebraska Lincoln and did my undergraduate there, and then went on to the University of Nebraska Medical Center for Medical School and then down to Kansas City for both residency and fellowship training in neonatology.

Guest: I was drawn early on in my clerkship with pediatrics in the NICU. There was a neonatologist that kind of seemed like me and kind of how I wanted to be. And so, I started really focusing on neonatology in the long term. As far as my career choice, I was drawn to neonatology. Because like you said, they're fragile, vulnerable patients and I get to treat the patient as a whole. I get to do everything from respiratory to their GI system to their neurologic status. And so, I get to do and treat and take care of everything. And so, that really drew me into that field specifically.

Host: What's your role at the Bryan NICU?

Guest: I have a lot of roles. My main role as a neonatologist is to really guide our team here. Our team in the NICU is multidisciplinary, meaning that I am kind of the leader for the whole team. We have a group of specifically trained neonatal nurse practitioners that help in the unit in combination with specific neonatal respiratory therapists, nutrition, social work, pharmacy, and the bedside nurses. And so, I help guide the ship and help direct care on a daily basis. I am available pretty much at all times to assist when needed with kind of those really acute situations. I keep parents updated on a daily basis on how things are going. And so, that's pretty much my main role here at Bryan.

Host: Must be so rewarding for you, Dr. Sitzman. Tell us some of the great things that your NICU has to offer the community, and I'd like you to expand a little bit more on the team of neonatologists and neonatal nurse practitioners that are available. As you said, you're available all the time and they're available for all deliveries all the time.

Guest: Yeah. As far as the community goes, you know, we do a lot. One of the things that we do specifically is what we call outreach education. And so throughout the year, myself as the neonatologist and typically one of the maternal fetal medicine doctors, Dr. Byers, along with nursing, go out to various hospitals out usually in western Nebraska and put on simulation scenarios. We give education early in the morning. And then following that, we take out high-fidelity simulators and practice deliveries in maybe communities that don't typically deliver babies. And then, after the baby's delivered, they come to my side and I help them review and learn about resuscitating a baby that may be in distress and what to do with that and how to get ahold of us if they need help. A lot of these community hospitals over time just don't deliver as many babies as they once had. And so, providing that education over time and repeatedly keeps them in the know and comfortable with those situations. And so, it's nice to be able to do that.

And on top of that, our NICU has a transport team comprised of a neonatal nurse practitioner, a nurse, and then a respiratory therapist. That allows us to say if there's a baby out in Grand Island or Crete that is too sick for their hospital to take care of, we have the ability to go out there and take care of the baby initially, and then take the baby back to Bryan's NICU and continue on with care. And that requires a lot of resources with a specific neonatal transport ventilator and equipment of which we have. And so, that provides a lot of benefit to outlying communities knowing that we're here and we can come help when they need.

As far as our team with the NICU doctors, there's three of us in my team, Dr. Brisso and Dr. Ansah, and one of us is either in the unit or on call 24/7 in combination with their neonatal nurse practitioners, of which there's at least two of them in the hospital 24/7. And so, anytime there's an infant in distress or a premature baby that's going to be delivered, we're here all the time, ready to be there.

Host: Wow, that's so comprehensive. So, many pieces to put together. Dr. Sitzman, expand a little bit. You've mentioned a few different specialties that are represented, speech, respiratory therapy and, as I understand it, you even have NICU-trained lactation consultants. Speak about how this all comes together because there's so many pieces to put together.

Guest: Yeah. There are a lot of pieces and part of it comes together, at least, during rounds. And so, we round daily with the team all at the bedside. So, we have speech therapy and occupational therapy and lactation. And so, we kind of focus in as a team effort on what each individual patient needs. It is a huge benefit to have NICU-trained lactation consultants. Because as one can imagine, feeding a premature baby or even breastfeeding a premature baby is quite different than breastfeeding a term infant. And so, we have years and years of experience on their shoulders that really help give moms confidence and skills or anything they may need to become successful in that. And speech and occupational therapy along the way also help with infant's bottle feeding or developmental issues along the way because these babies are very sensitive to certain sounds or noises or stimuli, and so they can help guide us in keeping the baby in a developmentally appropriate environment.

Host: Dr. Sitzman, I'd like you to tell us about your capabilities to provide reach outside of Lincoln and how you're set up to serve all of Nebraska. Tell us what's involved in this transport. It's a very large area to serve and would take great planning and efficiency. Tell us how that all works.

Guest: It is a lot to coordinate. We have to have enough staff on board in the NICU that are available at any point in time to drop what they're doing and go on transport, which is, you know, the neonatal nurse practitioner, the respiratory therapist, and a nurse all that are trained on the transport system, specific transport ventilator and have to take several pieces of equipment, large pieces of luggage that have all of the equipment they may need out in whatever community hospital needs us because they may not have the right size IV or the right size tube or the right kind of fluids that a baby may need. And so, we take a lot of equipment with us that's pre-packed and checked and all those things. And so, it is a lot of work, but it certainly means a lot when we can go out there and help the community hospitals that don't have anywhere else to reach to sometimes.

Host: Dr. Sitzman, I'd like you to speak about your philosophy of care for these children and their families. You really are helping people during a time of their life considered to be one of their biggest fears come true. How do you help the families emotionally during this scary time?

Guest: That can be challenging. Part of my job is to provide that reassurance. I live and breathe in the NICU, and so I can understand the expectations for certain premature babies. And that while some things in the NICU may seem scary at the time, sometimes that is normal, and trying to provide that reassurance to parents that they will get over this, that we need to finish X, Y, Z and things will get better to try and provide them guidance on how many days, weeks or months it's going to take to get to those goals and prepping them early on. We do a lot of prenatal consults. So when moms come into the hospital and are threatening to deliver prematurely, you know, we usually go up before the baby's born and at least try and give moms and dads the guidance of, "If baby was to be born this early, here's how that looks. Here's what we do right out of the gate and here's the expectations and hurdles that we face moving forward." And so, I think that does help give some type of framework, even before the baby's born on how things are going to go. And one of the things we used to do before COVID was have this like parent support network. And so, that is really useful to have other parents in the NICU talk to each other, so that they could be convinced that, "Oh, what their baby is going through is just like this other baby." And I think that it's really nice and we're starting to restructure that now that some of the restrictions are decreasing because I think it's really helpful for other parents to hear from each other, and not just from me.

Host: That's so supportive and I can understand how important that would be to connect with other parents going through the same thing. And before we wrap up, Dr. Sitzman, tell us the message that you would like to impart to listeners about how whatever may come of their birthing experience, that the Bryan NICU is prepared with highly trained staff, the most advanced technology for any situation in Lincoln and even outside of Lincoln to support smaller community hospitals in their time of need as well. I'd like you to speak to parents now and to the viewers about what you would like them to know about the Bryan Health NICU.

Guest: Yeah, I would say the take home message is that we're ready. We have typically a high senses of babies that are quite premature. This is something that we do every single day. And while it may seem scary and unique, that's our job, that the course of the NICU is not something a lot of parents want to go through. But about 10% of babies are born prematurely and are going to end up in some type of NICU at some point. And so, they're not alone and that we're always here to answer their questions and we take care of their baby the best that we can.

Host: Thank you so much, Dr. Sitzman, not only for joining us today, but for all the amazing work that you and your staff are doing for these parents at such a scary time for them and you're so supportive. Thank you again for all the work that you're doing. And I'd like to thank our Bryan Foundation partner, McGill Restoration. To listen to more podcasts from our experts, you can visit bryanhealth.org/podcasts. That completes today's episode of Bryan Health Podcast. I'm Melanie Cole. Thanks so much for joining us today.