“Bronx born and bred” is a badge of honor for countless Americans. Unfortunately, all too many of the borough’s babies get off to a rocky start in life; one in 10 Bronx newborns is premature, with an even higher rate of prematurity among Black infants.
Ethan Santana is a case in point. Ethan was born 10 weeks premature in August 2018. “The next 107 days would be the longest 107 days of our lives,” says Albania, his mom. As with many “preemies,” Ethan’s lungs were severely underdeveloped—just one of his many life-threatening health issues. Meanwhile, Albania was, in her own words, “hysterical on a daily basis,” unable to cope with this terrifying ordeal.
Albania and her husband were lucky that their baby was delivered at Montefiore’s Jack D. Weiler Hospital, home to the Bronx’s most-advanced neonatal intensive care unit (NICU).
“Una, the first night nurse, made sure I was comfortable with my baby,” she recalls. “There wasn’t a day that Mary, one of the NICU nurses, didn’t open her arms to me and wipe my tears as soon as I walked into the unit. Michelle and the whole respiratory therapy team made sure I understood the purpose of every machine Ethan was on. And Deborah Campbell [M.D.], one of the neonatologists, sat with me for hours, sharing advice on everything from breastfeeding to the importance of reading aloud to my baby. How lucky was I that this woman, as busy as she was, took time to sit with me and talk about my son. She made my family feel like he was the only baby in the NICU.”
While we equip our NICUs with the latest technologies and exceptional staff, we could certainly use more resources to meet the rising demand for neonatal intensive care.
— Dr. Deborah Campbell
The doctors aren’t sure why Ethan arrived in such a hurry. Premature births usually stem from genetic anomalies, infections, or underlying maternal conditions such as diabetes, obesity, or lack of prenatal care. Such risk factors were absent in Ethan’s case but abound in the Bronx, and they help explain why New York City’s infant mortality rates are highest in this borough.
Nearly 10 percent of Bronx women—double the nationwide rate—do not get any prenatal care until their third trimester. Over the past decade, the maternal mortality rate from complications of pregnancy or delivery has increased 12 percent in the Bronx while decreasing 31 percent in the rest of the city.
Those statistics would probably be far worse if not for the neonatology division of the Children’s Hospital at Montefiore (CHAM), which U.S. News & World Report consistently ranks among the top 20 such divisions nationwide.
“Our neonatologists are highly regarded for their care and their outcomes, even under the very trying conditions in which they work,” says Michael deCastro Cabana, M.D., M.P.H., physician in chief at CHAM, professor of pediatrics at Einstein, and the Michael I. Cohen, M.D., University Chair of Pediatrics at Montefiore and Einstein. “Imagine what we could do if we had more resources.”
Dr. Campbell has wondered about the same thing for decades. The Bronx native started practicing at Montefiore in the early 1980s, watching—and contributing to—the neonatology division’s rise to prominence.
“Like the Bronx itself, we’ve learned how to do more with less,” says Dr. Campbell, who is now chief of neonatology at Montefiore and a professor of pediatrics and an associate professor of obstetrics & gynecology and women’s health at Einstein. “It always impresses me how we can accomplish so much with so little. While it’s true that we equip our NICUs with the latest technologies and exceptional staff to provide state-of-the-art care, we could certainly use more resources to meet the rising demand for neonatal intensive care.”
Montefiore currently has two NICUs—the 35-bed unit on the Weiler campus and a 15-bed unit on the Wakefield Hospital campus—which together serve about 1,000 critically ill newborns a year. Both NICUs often operate at full capacity, which means that Bronx newborns must sometimes be taken out of the county for the highest level of neonatal intensive care. “We should be keeping families and infants together and close to home,” says Dr. Campbell.
Another issue, says Dr. Cabana, is that neonatal care has changed dramatically since Weiler’s NICU was last modernized. “It was once standard practice to separate babies from their mothers at birth and put as many as 16 preemies in a single, open-bay treatment room,” he notes. “Now we know it’s better to have single-family rooms, or smaller pods housing four to six babies, where mothers can stay near their newborns. That promotes breastfeeding and other mother-infant interactions that have a profound effect on newborn development.”
A third difficulty with the current NICU system: Both NICUs are physically separated from CHAM and its pediatric subspecialists, which means that babies who need highly specialized care must be transported several miles to CHAM. Since 2012, requests for pediatric transports to CHAM have increased by more than 50 percent, causing delays in care when every second counts.
“Our long-term dream to improve things is to build a NICU at CHAM, ideally as part of a single large perinatal center combining obstetrics and neonatal medicine,” says Dr. Campbell. “For all sorts of reasons, we’ve never had an opportunity to establish a NICU at CHAM with centralized care for our most-at-risk babies and mothers.”
The Bronx birthrate dropped during the pandemic, in part due to economic uncertainty and fears of exposing newborns to the coronavirus. But as COVID-19 recedes, demand for neonatal care is expected to rise, putting even more pressure on the NICUs.
“This virus has devastated the economic status and health of Bronx residents,” Dr. Cabana says. “We’ve already begun to see the pandemic’s harmful effects on expectant mothers.”
With more families battling even deeper poverty and food insecurity because of unprecedented job loss (during the pandemic’s 2020 peak, one in every four Bronx residents experienced unemployment), many parents lack adequate access to nutritious meals, prenatal vitamins, and other critical resources needed to raise healthy children.
Montefiore has had to deal with so much over its history. … But with every hardship, the medical center has found ways to innovate.
— Dr. Michael deCastro Cabana
The pandemic has only reinforced Dr. Cabana’s desire to expand CHAM’s outreach efforts so that fewer infants need neonatal intensive care in the first place. “Our goal is to provide the best-possible care following birth—but that’s not enough. There are so many factors that affect how a child fares, beginning with proper prenatal care, good housing, and safe neighborhoods,” says Dr. Cabana, whose own studies of asthma, sickle-cell disease, and other pediatric diseases show that early intervention can make a world of difference in a child’s development.
These challenges confronting Bronx babies convinced Dr. Cabana to join the Einstein and Montefiore faculty in 2019. “I first learned about Montefiore’s social pediatrics residency program and its commitment to social justice back when I was a medical student,” he says.
“And when I started working here I got my first glimpse of the institution’s resilience. Montefiore has had to deal with so much over its history, from poverty to the HIV crisis to rampant chronic illness. But with every hardship, the medical center has found ways to innovate,” he adds. “We started a children’s hospital from scratch, we developed new school-health programs, and we created a base of local primary-care providers.”
Today, Dr. Cabana and his colleagues make a point of collaborating with other departments at Montefiore to reach out to parents and infants. One such effort is the Maternal Fetal Infant Network, a program in which the departments of pediatrics and of obstetrics and gynecology collaborate to optimize care before, during, and after delivery.
Clinicians such as Kevin Fiori, M.D., M.P.H., M.S., assistant professor of pediatrics and of family and social medicine at Einstein and an attending physician at Montefiore, are leveraging new technology to improve care.
Dr. Fiori is developing a smartphone app that will enable community health workers to connect parents with local health resources. Reaching farther afield, Montefiore’s neonatologists partner with the city’s Department of Health and Mental Hygiene and the New York State Perinatal Quality Collaborative to bolster maternal-infant health.
Meanwhile, Einstein and Montefiore researchers are working to prevent neonatal complications. Praveen Ballabh, M.D., professor of pediatrics and in the Dominick P. Purpura Department of Neuroscience at Einstein and a neonatologist at Montefiore, for example, is studying how to reduce the number of crippling and often deadly brain hemorrhages that affect a quarter of all preemies. Mamta Fuloria, M.B.B.S., associate professor of pediatrics at Einstein and a neonatologist at Montefiore, is examining how nutrition and various environmental factors influence fetal growth.
“These are just a few examples of our singular focus on quality of care—on assuring the best practices and the best outcomes for our tiniest patients,” Dr. Campbell says.
Albania, for one, appreciates these efforts. “Our NICU experience was not one that we wanted to have, but we are grateful it was at Montefiore,” she says. “To all of the nurses and doctors who touched our son and our hearts: my family thanks you.”