Scott Webb (Host): Today, we're going to learn more about the Elliot Hospital's Neonatal Intensive Care Unit, often referred to as NICU. And specifically, my guest today is going to tell us more about the NICU specialized transportation team and services that the Elliot offers. And I'm joined today by Dr. Matthew Ryzewski who specializes in neonatal and perinatal medicine with the Elliot Hospital.

This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about NICU specialized transportation and what that means exactly. And I know Elliot has a regional level 3 NICU. So, what does that mean and how many babies are transported to the Elliot each year?

Dr. Matthew Ryzewski: We take care of the sickest babies in the area. So, we take care of the full spectrum of neonatal care from babies born as early as 23 to 24 weeks, to babies born up until 40 plus weeks, and every baby in between. We're able to manage, you know, complex, critically ill neonates, babies who require treatment with ventilators, babies who require surgical interventions as well. From a transport perspective, we transport around 100 babies per year from the surrounding areas. In many cases, this ends up being about 25% of our admissions on any given year.

Host: Sure. Yeah, that's amazing. I was just going to follow up, but why is it important that the NICU is available to the region's families?

Dr. Matthew Ryzewski: Pregnancy and delivery of an infant is always a wonderful, joyous experience for the family. However, there are occasions where the mothers and the neonates on occasion will need advanced specialized care. So, the NICU here at the Elliot is available 24/7 to take care of high-risk pregnancies as well as mothers who are at risk to deliver prematurely. And we're also here to provide care for babies born here at the Elliot, but also babies born throughout our region who need advanced neonatal care for any number of issues that can go wrong after delivery.

Host: So, what is specialized transport and why does Elliot Hospital offer it? And are other hospitals not equipped for certain situations or conditions? Is that why it's so important that the Elliot has it?

Dr. Matthew Ryzewski: We offer a specialized transport team which includes a licensed, skilled, advanced practice provider, which could include a neonatal nurse practitioner, a neonatal physician's assistant and, on occasion, a neonatal physician, depending on the scenario. We also will send a specialized neonatal registered nurse who has received specialized training and education in transport. We'll also send a skilled respiratory therapist who is very comfortable taking care of babies requiring ventilator support and babies with respiratory issues, along with our emergency medical technicians who will transport the team to the outside hospital.

So, this is a very important service that we offer so that, when an outside hospital calls us for a baby who requires a higher level of care, we're sending a highly skilled, well-oiled team to go and help that baby on site. The reason why transport is so important in our region is that we are the only level 3 neonatal intensive care unit within the southern tier of New Hampshire. So, a lot of our surrounding hospitals are what we would consider level 2 or level 1 nurseries, which essentially take care of well newborns or sometimes babies requiring minimal feeding support or minimal respiratory, but not critically ill infants. So that when a baby is born at any of these surrounding hospitals and comes to require a higher level of care after delivery, our team is available to go to that outside hospital, stabilize the infant on site and bring the baby back to the Elliot for the intensive care here at the NICU.

Host: That's great. And you mentioned specialized education and training. I want to have you talk about that a little bit. What specialized education and training do the transport team members receive?

Dr. Matthew Ryzewski: Several years ago, myself and one of our lead nurse practitioners put together a syllabus, if you will, with the most common conditions that our team encounters on transport. And for the last five years, we offer an intensive quarterly education for our transport team members, which includes both didactic educational components, as well as work with our high-fidelity simulation mannequin in our simulation lab. So, we run simulated scenarios for our team on a regular basis so that our team is prepared for many of the common scenarios for a critically ill infant in the surrounding area. We feel like this training is unique, in that all of our personnel get on-the-job training from their regular work here in the NICU, but we offer this extra training so that our team is as prepared as possible when that call comes in.

Host: Yeah. When the call comes for sure. Maybe you can describe the specialized care during transport. You know, who's on board, what special equipment do they carry, what procedures and interventions can they perform?

Dr. Matthew Ryzewski: We have a transport isolette, which is essentially an enclosed infant crib on wheels with lots of extra equipment on board. So, on board with our neonatal isolette is a ventilator capable of delivering different modes of ventilation for a baby with respiratory concerns. We also have with us a portable cooling blanket, which we will use to deliver mobile therapeutic hypothermia for babies who've determined to be at risk for hypoxic ischemic encephalopathy. And we also carry different medications with us on transport, depending on the clinical scenario. And some of our other specialized equipment that we bring, for example, would be chest tubes for a baby who has a pneumothorax, which is free air inside the chest. We also bring multiple sizes of endotracheal tubes if a baby needs to be intubated and ventilated on transport. So, these are just some of the procedures that we do on transport to stabilize our infants.

Host: Yeah. It sounds really comprehensive and just amazing for families and babies, of course. I just want to finish up here, have you share a success story about Elliot Hospital's specialized transportation.

Dr. Matthew Ryzewski: There was a full-term baby who delivered at an outside hospital and, over the first day or two of life, had escalating respiratory concerns. And it got to the point where the outside hospital provider recognized the fact that the baby needed a higher level of care in intensive care. Call came in for our transport team to go and pick up the baby and bring the baby back here to the Elliot. And even though that baby was full term, that baby required one and a half weeks on a ventilator as well as multiple doses of a medication called surfactant to help with the fact that the baby's lungs were not expanded well enough to receive oxygen. And then, after that one and a half weeks on the ventilator, the baby was able to transition to straightforward room air. And that baby was discharged home by about two weeks of age and was taking all the feeds well and, doing all of the, you know, standard baby things. So, that's just one sort of basic example, but that's just another example of how our transport team was able to be helpful in the moment, bring the baby back here, and help ensure a great outcome from that baby and that family.

Host: That's great. You know, some podcasts bring a smile to my face more than others. And hearing that a baby went home and was just doing standard baby things, having had a couple of standard babies myself doing standard baby things, love hearing it. Love learning more today about the NICU specialized transportation that the Elliot offers. Thanks so much. You stay well.

Dr. Matthew Ryzewski: Take care. Bye-bye.

Host: And for more information, go to Elliothospital.org and search neonatal intensive.

And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.