Jaime Lewis (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

Today I'm sitting down with Dr. Thomas Payne, Medical Director of the Neonatal Intensive Care Unit at Novant Health Forsyth Medical Center. And we're talking about providing care for premature babies. Before we get started, Dr. Payne, how did maternity care become a passion of yours? What made you want to become a physician?

Dr. Thomas Payne: I initially wanted to be a minister and it's probably good that didn't happen. And I had a teacher in the ninth grade, Julia Miller that got me interested in science. And, my aunt was an assistant director of nursing at a local hospital. And she got me my first job the day I turned 16 in the hospital. And I've worked in a hospital since. In that role, I was able to occasionally go by the nursery and feed babies and that started the whole thing.

Host: Oh my goodness. A lifelong interest. Well, why the NICU? I can imagine you're constantly on a roller coaster of emotions with your patients.

Dr. Thomas Payne: Absolutely. It's important to be there for babies and families when the outcome is good, as well as when the outcome's not going to be good. Everyone deserves to have someone who cares about them with whatever kind of situation they're going through. But the NICU is because my first rotation as a resident was in the neonatal intensive care unit with Dr. Tom Kieser, who it was his first attending job when I was an intern, and he just turned me on to the field of neonatology and perinatal medicine. The ability to use your mind and your hands for very delicate procedures was appealing to me.

Host: I was surprised to learn that 1 in 10 babies are premature. When did you start seeing early indicators that a baby would be born prematurely when you're working with a patient?

Dr. Thomas Payne: The clues are varying between every mother. But if someone has delivered earlier, that's obviously a premature infant at an earlier time. That's always a risk factor. If moms have had any kind of surgery or different medical conditions they may have, like diabetes or hypertension, can increase the risk of preterm delivery.

Knowing that is helpful, but the most important thing is, when someone's pregnant, they get prenatal care. Sometimes they may not know they have these conditions and it's found and then they can be directed into care that would prevent prematurity.

Host: You just listed off a couple of risk factors, but are there any other risk factors for preterm delivery that people should know about?

Dr. Thomas Payne: If moms have diabetes, oftentimes that will cause a mother's fluid to be too much around the fetus. It's called polyhydramnios. That can throw you into early labor. And with any moms that have hypertension, they can get preeclampsia, which is a very dangerous condition. We don't really know what causes it, but the reason for prematurity may not just be the baby. It may be the, for the mother's health.

Host: Right. Is there anything a patient can do to try to delay preterm labor?

Dr. Thomas Payne: Get prenatal care. Find out the issues that are specific to them. And, early in the course of their pregnancy, be directed to the care they need, if they need special medications, if they need to be hospitalized, if they need further evaluation, it can be done. If they don't seek prenatal care, it's hard to have that happen.

Host: I know sometimes you recommend that an expecting mother should be admitted early. Can you explain that process? What are you monitoring exactly?

Dr. Thomas Payne: If a mom has a chronic illness like hypertension or diabetes, it is best if she gets on medications that control that blood pressure, because if a mom has hypertension, it adversely affects the blood flowto the placenta. If a mom has diabetes and her sugars are sort of out of control, it can cause the baby to be very big, it can cause extra fluid to be around the baby, and it can cause the baby to have other problems in the womb that we can address by managing her blood sugars.

Host: Your hospital has an OB emergency department, which is pretty incredible. How does that work? Do other community hospitals refer to your hospital?

Dr. Thomas Payne: Oftentimes we do, we take all kinds of referrals. If, um, someone has a private OB practice and they have what they are concerned about to be an obstetrical emergency, they can come into our OB ED, be evaluated by the OB hospitalist, and they can communicate with either their OB or they can consult maternal fetal medicine.

So they have access to us, to do a prenatal consult, to talk to them about what may happen if they deliver early, as well as people that can help them manage their pregnancy.

Host: When it's time to deliver, can you explain how the NICU team is standing by quite literally in the room? Who is on that team? How do they help? And especially in that critical first hour.

Dr. Thomas Payne: It's nice to deliver if you're going to have trouble in the hospital and know that a preterm baby is coming. Sometimes we don't know and we're still available to come. But the team that is at Forsyth is a team of experienced nurses, experienced neonatal trained respiratory therapists and physicians, as well as the physician assistants and nurse practitioners. We all are available to go at delivery and we are one floor below labor and delivery. So it doesn't take long for us to get there. If we do know, hopefully we've talked to this mother before, the family before to sort of prepare them what to look for after the baby's born.

But, if someone is delivering vaginally, we have the team there when the obstetrician feels like delivery is imminent. And if it's a C-section, when mom gets anesthesia, we're called.

Host: Some NICU babies only need to stay in the hospital for a few days. And then others, mothers that I know have had their babies in NICU for months sometimes. What are the target goals you're trying to reach with each baby before discharge?

Dr. Thomas Payne: You know, obviously, the earlier a baby is, the longer they're going to be in the hospital. We, if, if a baby's extremely premature, we tell them to look towards the due date to go home. Hoping it's going to be earlier, knowing that sometimes it can be past their due date. But in general, for every baby, they need to do several things.

They need to maintain their temperature in an open crib, swaddled with just a blanket, and they need to maintain their temperature without any external thermal support. They need to breathe on their own with room air and not forget to breathe. Preemies can have episodes where they forget to breathe. It's called apnea of prematurity. And they can't be doing that for at least a week before they, they go home. We actually treat that with caffeine. And if they've had caffeine, they have to be off that for a week. So, I always find it interesting that mothers can't drink caffeine during the whole pregnancy and then their baby comes out and we start the baby if they're early on caffeine.

 And the last thing they have to do that is the most variable is they have to eat enough by mouth to grow. And oftentimes these preterm babies early on get IV nutrition followed by feeding tube feeds. And then we work on their oral feeding ability. We have great subspecialty support with speech therapy, occupational therapy, and physical therapy to help us if those babies need that to get them prepared to go home.

Host: Well share a little bit more about the NICU team that's taking care of the baby. How do you try to get mom and dad involved with them?

Dr. Thomas Payne: That's a good question. We try to do that early on before the baby's born. So if we know a mother's going to have a complication that could cause preterm delivery, or if the infant is known to problem that is going to be impactful after delivery, the obstetrician will call us and we'll come talk to the family beforehand to try to give them some ideas as to what to expect. Once the baby is born, we communicate with them in the delivery room, as the resuscitation is progressing, how things are going, we talk to them and do our best to let them, if possible, hold the baby or at least see the baby before we take the baby to the NICU.

Skin to skin is very important and when babies are out of risk for complications such as interventricular hemorrhage, we do our best to get the baby on the mom's chest, even if the baby's on a breathing machine, even if a baby has IVs in their belly button. All those things, are very risky, but having the mom and the dad hold their baby is exceedingly important.

Our nurses, our lactation specialists, and the speech, occupational, physical therapists and our nurses really want the families to be involved in their care, and we encourage that. We have rounds every day, and we encourage families to be part of the rounds and actually be a part of the baby's care, making decisions for their infant.

 We take everyone's viewpoint into consideration as we provide care for the baby, so the parents are very actively involved. When parents are getting ready to take the baby home, we provide them a place where they can actually sort of practice with us being nearby. There's a family integrated care unit we have, that's specific to our facility, and we have parenting rooms that we can allow them to have the baby in the room with them and still monitor the baby. And we do everything we can to prepare them for taking the baby home.

Host: Well, this all sounds so, there's so much hope giving with all of the care. There's also a lot of potential for emotionally draining experiences, right? So I'm wondering, are there team members or programs available to support parents with resources during this time?

Dr. Thomas Payne: Yes, there's family support, we have hospital chaplains, and we have wonderful social workers and case managers, and we're there with them regardless of the outcome. They are talked to. We do our best to care for them as providers both the physician, the nurses, the respiratory therapists. It's exceedingly important to be with a family through an event, even if it's not the expected outcome, to allow them to have time to love their child.

Host: Well, when it's time to go home, how do you ensure a safe transition from the hospital to wherever the family is going?

Dr. Thomas Payne: We start thinking about discharge on the day of admission for every infant. And we have this wonderful person called Lisa Jones who is our discharge planner who makes us remember everything we need to remember to have tested for the babies before they go home. And if babies need follow up appointments, she makes those.

She is an amazing person and she's the only person that does that. But the whole team participates in preparing the parents to go home by educating them, with every possible thing they might need at home to watch for if a baby were sick, how to feed the baby. Our lactation specialists are wonderful about getting moms to breastfeed or work with them if they're gonna pump and provide breast milk.

The whole team participates in getting them ready for care, for discharge,

Host: Well, thank you for all this time. I just have one last question for you. What's your best advice for parents of NICU babies?

Dr. Thomas Payne: Before they're in the NICU, my best advice is to get prenatal care. Once the baby's born is to be involved in their care. We don't kidnap your children. We want you to know what's going on with your baby. And you have every right to participate in the care and the decisions that we make to care for your baby.

Talk to us. We're there and we do our best to communicate and explain if there's something you don't understand or something you might rather not do. We talk about it and explain the science behind it and we will come to a decision that's amenable to you and your baby and us.

Host: Well, thank you, Dr. Payne, for all your time, your expertise, and your experience. We appreciate it.

Dr. Thomas Payne: It's an honor to do what we do and we appreciate being able to care for these babies.

Host: Well, once again, that was Dr. Thomas Payne. To find a physician, visit NovantHealth.org. For more health and wellness information from our experts, visit HealthyHeadlines.org. And thanks for joining us.