Heather Lee (Host): Hi, everyone. I'm Heather Lee, host of Medically Speaking. And my guest today here is Dr. Kavya Rao, who is the Medical Director of the NICU at Millard Fillmore Suburban Hospital. Thank you for being here. Thank you for having me. So, we're going to talk about a lot today. But first, talk about your background in medicine and what drew you to neonatology.

Dr. Kavya Rao: So, I've always been drawn to science as a kid. So, growing up I loved science as a subject, kind of knew that there was something that just drew me to the human body. Just always asked questions. My dad's a pharmacist, so I always, like, was very fascinated by how things worked. And then, I went and did my undergrad in pre-med and then went to med school. And then, I actually moved to New York City for my residency and fellowship.

And during my peds residency, I just really enjoyed being around children. I really enjoyed how resilient they were, how the complexity of diseases in children worked, and then how they just are so strong. And it felt very gratifying to me. And then, when I did my NICU rotation, I really enjoyed working with families and watching how these children grew so beautifully and then they were discharged. And it's a very gratifying feeling.

Host: And then, also giving them the right care, that specialized care right from the beginning, sets them on a trajectory towards better health and, you know, just being kids.

Dr. Kavya Rao: Yeah. I learn a lot from my patients ironically. It's always a two-sided situation where they show you how strength can manifest in so many different ways. And they are truly warriors, and that's something that I always live with.

Host: Yeah. Talk about your role at Kaleida and sort of what your day-to-day looks like and also sort of big picture as the medical director of the NICU. What are your goals, and what is your role?

Dr. Kavya Rao: So as a medical director, I spend a lot of time with patient care and clinical responsibilities. I usually round with a big team of folks that includes our nurse practitioners and APPs, residents, fellows, and our beautiful nurses. And we center a lot of our care with our patients and their families. So, we truly practice family-centered care in the NICU. And then, at Millard, it is a 10-bed level II NICU, which basically means we take care of babies greater than 1500 grams in the NICU and above 32 weeks of gestation and relatively low complexity, because all the high complex high-risk pregnancies do deliver at Oishei. So, it involves rounding in the mornings, you know, coming up with care plans for the families and for the babies, and then also having really strong communication with the team and the nurses,

Host: And you talked about that family-centered care. You really want the parents to be as involved as possible and really explaining to them every step of the way what is happening with their baby, especially babies that need a little extra love in the very beginning.

Dr. Kavya Rao: Absolutely. And as a parent myself, I would totally want to know everything that's happening and we engage the families very closely where they're involved with our daily rounding, including, you know, lab results, x-rays, and then we collaboratively work with them and see what's best for the baby and themselves.

Heather Lee (Host): Yeah. The similarities and also the differences-- you touched on it a little bit-- between what we offer at Suburban and what we offer at Oishei. I think sometimes folks don't realize how much we offer at Suburban.

Dr. Kavya Rao: Yeah. So, Suburban is a level II, relatively new. It's about 10 years old. We have a 10-bed NICU there. So, we take care of pretty much all low-risk pregnancies or uncomplicated pregnancies, but we also do handle a certain level of complexity, so babies greater than 32 weeks' gestation that usually are called feeders and growers in the NICU. So, we make sure we optimize their breathing, their feeding, and make sure they're gaining weight. And ultimately, we want to keep the babies closer to their families in the North towns. And we do also have an option of other respiratory care that we offer. So, not invasive ventilation, but non-invasive modes like CPAP and and high flow.

Host: And that's something you've added some new equipment there, or that's relatively new, right?

Dr. Kavya Rao: Yeah. So, we are making strides in terms of adding some complexity to our respiratory practices there. So, we just recently introduced CPAP, which, I believe is going pretty well. And that way, we are able to get these kids off of conventional mechanical ventilation and that way they can actually stay and grow and thrive in our NICU there.

Host: And also not having them on the ventilation, what does that mean for the baby as well? I would imagine the less invasive, the better it is for them, the quicker they're able to heal, so to speak.

Dr. Kavya Rao: Yeah, absolutely. So, sometimes mechanical ventilation, if it's needed, it's needed, especially in the babies that have pretty significant lung disease. But our goal as clinicians is always to try to minimize the number of days on mechanical ventilation, like as you mentioned, sometimes being on the ventilator longer can sometimes cause further lung disease. So, we try to minimize that and try to extubate them sooner to other modalities like CPAP and high flow.

Host: And you talked about, I think, something that's very important and that's keeping mom and baby together. By offering some of these services, the baby doesn't have to be transferred to Oishei. I would think that from a mental standpoint for, you know, a brand new parent to be close to their baby. That's good for everybody.

Dr. Kavya Rao: Absolutely. I think that maternal bonding in the first few days and weeks of life is extremely important for both mom and baby. It facilitates many physiologic changes both in the baby as well. So, sometimes just having that skin to skin and being held by the parents, both mom and dad and family members is extremely crucial, because the babies do physiologically even respond better. They're calmer. They can feed better. They can breathe better. So, everybody loves it, including our staff.

Host: Yeah. And emotionally for the parents too, to not have that separation. Let's talk about some of the unit capacities and some of the subspecialties of the unit. Again, we've made tremendous strides over the past at least 10 years. And we continue to add new and better things at Suburban. Touch on some of those.

Dr. Kavya Rao: Yeah. So, we discussed the respiratory care options, and then also we're approved to get donor milk and which is also spread to our NICU there. So, donor milk is usually standard of care in preterm babies. We've been using it at Oshei for a long time and we're really happy and excited to be able to offer donor milk even in the NICU. So, donor milk is very protective and we usually use that as a bridge to mom's milk such that we can try to optimize and try to exclusively put these babies on exclusive human milk as per parent's preference.

Other things is also we are staffed by neonatal practitioners, which is a huge blessing. They are an incredible team that work very closely with us. They also cover neonatal transports outside in the field as well as it's the same group of folks that actually cover the delivery room. So, they're extremely experienced and their expertise is just incredible, because they're very capable of all kinds of procedures 24/7, and that really puts everyone at ease.

Host: Yeah. What's the difference, again, between a level II and a level IV NICU?

Dr. Kavya Rao: Yeah. So, level IV is-- we are at Oishei. We're a regional perinatal center, also known as an RPC. So, it is a New York State-approved designation that we have, and that basically means that we are able to take care of all babies 20-23 weeks and upwards. And that we also have all kinds of subspecialty coverage, including pediatric surgery and all the other subspecialties. So, we're very blessed to have that in the region. We do get referrals from all over the region, from other level Is and level IIs. And so, that is the only level IV in this area. A level II is also another designation by the American Academy of Pediatrics. So, with that comes a certain amount of limitations where we can only take care of babies greater than 1500 grams and above 32 weeks.

Host: So, the sickest babies, the very, very small and, you know, that need that extra, extra care would go to Oshei, but just because we're two separate buildings, there is a collaboration there between Suburban and Oshei. If you can explain that so that people know if their baby is born at Suburban and they need just a little bit more than what we can offer them, there is that pathway to get the care that they need.

Dr. Kavya Rao: Yes, that's absolutely true. We have our faculty that we are about 12 or 13 of us that actually work in both campuses. So, we are all neonatologists, board-certified in both pediatrics and neonatology. So, we actually have the privilege of working in both sites. So that way, the care is also consistent between both sites. And then, we also work with neonatal nurse practitioners that also cover transport teams and deliveries at Millard and at Oishei. So right from the top, you do see that consistency in care.

And then, other resources that we have are also access to subspecialties remotely. There are a few subspecialties that come in person. But a lot of the times, for feeder-growers and for low-risk pregnancies, we don't always need to have that subspecialty in person.

Host: Yeah. So if there is that escalation or the need for escalation of care, we can handle it.

Dr. Kavya Rao: Absolutely.

Host: Concierge-type care, how is that unique? How does that benefit mom and baby and what are we doing at Suburban to make sure that that is a reality?

Dr. Kavya Rao: So, we try really our best to try to deliver that concierge-type of medicine, like you mentioned. It's also curating care for a particular baby and family. We strongly believe in that one size does not fit all and every baby's different and every family is different. So when we make our care plans, when we're working collaboratively, we want to make sure that the family, the baby gets the best experience.

So, with that also comes our nursing ratios. We offer a very private setting. It's a 10-bed NICU, and they're all individual rooms. And they're beautifully designed to cater for both mom and the baby and the family. So, our nurses are just incredible. They take care of these babies like it's their own. And it's really nice to see that comfort that the parents have when our nurses are so individualized and with just very small ratios.

Host: I remember talking with a nurse who had worked in nursing, you know, with preemies for decades. And she described to me the very beginning of her career and the things that we once were not able to do for some of the most delicate babies. And she said, fast forward to today, the technology, the services, the talent, the expertise, babies that are born early, now you would never even know after a year or two. You never would've known some of the challenges that they had once faced. And I feel like that's such a testament to you, to your team, and what we're able to offer our patients.

Dr. Kavya Rao: Yeah, that's absolutely true and I feel like it's come a long way even since I finished fellowship. So, I mean, back in the day, you know, being a 32 or 34 weeker was sort of like the smallest babies being resuscitated in the 1970s and '80s. But nowadays, I think we are really pushing those limits in terms of how aggressively we can treat these preemies or premature babies.

So, as per New York state, we resuscitate everybody above 24 weeks. And then, you know, those limits are getting shorter and smaller. And it's really exciting to see such a drastic change in how we practice and our technology and how much science has come forward.

Host: You talked about the neonatal transport team. How delicate of a job is that, and how specialized are these teams that, again, move some of our littlest and most fragile patients?

Dr. Kavya Rao: So, it is made up of an incredible, incredible team that we work with. They're a very amazing group of nurse practitioners that require a lot of specialized training. It's a very incredible job where they're basically very competent in taking care of these babies in very minimal resource settings. So, they are the same group that goes out to get these babies from out of the region or within the region, but in other level Is and level IIs. And they're able to manage these premature babies and even term babies with just a very calm, skillful demeanor. So, they're able to do procedures like intubations, chest tubes, you know, invasive procedures. And they're able to transport these babies very delicately, both by ground and air. So, it is a very gratifying job, I tell them.

Host: Yeah. How gratifying is your job and when you see some of these babies after, whether it's a couple of days or a couple of weeks, finally being able to go home, do you have that sense of my work here is done until the next baby, right?

Dr. Kavya Rao: Absolutely. I think that's such a great question. And my kids ask me that question all the time, like, "Why do you love what you do?" I think it is just remarkable to be present at some baby's life from minute one of birth, and then watching them fight through, you know, minutes and days and weeks. And it's just incredible to see such a transformation based on the interventions that we do as a team. It is so gratifying to find these kids when they leave the hospital. And then, they come back for, you know, other appointments or see them in the hallways. A lot of the times, the parents bring the kids back just to come say hi. And just, there's no other job like this. We actually have a wall of fame in our NICU where we actually pictures and stories of these children that were born as premature babies. And now, they're growing and thriving, and it is very rewarding to watch that.

Host: As a mom, how do you take that personal experience as a mom, whether it was from delivery and being in the hospital to, you know, raising them now and translate that into the care that you provide for your patients? Because there's nothing like a mom's touch and expertise.

Dr. Kavya Rao: Absolutely. And I think having children definitely changes perspective because, you know, patients you are taking care of are somebody else's children and they are probably the most precious thing in their lives. So, I think, not just me, but everybody I work with treats our patients as their own children. Like, you know, if this was my baby, what would I want have been done on the baby? So, I think it's a very special and unique role that we have. And I think it makes a huge difference being a parent and a mother.

Host: Yeah. If you could sum up the care that we offer at Suburban, the services that we offer at Suburban, what do you want people to know that maybe they don't know or realize already?

Dr. Kavya Rao: Yes, Suburban, I think is a great hospital to deliver at. We're able to offer, you know, the same consistent care, because we share the same faculty and providers that work in both sites. And we are able to very comfortably manage low-risk pregnancies, full-term pregnancies, or even late preterm pregnancies past 32 weeks. And the kind of concierge care that we deliver at Suburban is very unique to this area, especially with the nurses and the family-centered approach that we use.

Host: And I think it's two words that come to mind. It's that collaboration, but most importantly, the compassion that you and your team offer.

Dr. Kavya Rao: Absolutely.

Host: All right. Well, Dr. Kavya Rao from Suburban, the Medical Director of the NICU at Millard Fillmore Suburban Hospital, I really enjoyed our conversation. I hope you did as well.

Dr. Kavya Rao: Absolutely.

Host: And I can't wait to have you on maybe in the future as we continue to expand our services and offer new and great things for new parents and, I would argue, the cutest patients. You probably have some of the cutest.

Dr. Kavya Rao: Yeah. Thank you. And we are very biased, but I do think they're cute.

Host: Well, thank you so much. We appreciate your time and we hope that you tune in for our next episode of Medically Speaking.