recognition for CHOC’s cancer program is well-deserved. There’s nowhere else
I’d rather have gone through treatment than CHOC,” says 17-year-old Sydney
Sigafus, CHOC patient and cancer survivor. “Everyone who works at CHOC cares
about you as a person, not just a patient. I was included in every decision and
conversation about my care.”
Children’s Hospitals rankings were introduced by U.S. News in 2007 to help families of children with rare or
life-threatening diseases find the best medical care available. Only the
nation’s top 50 pediatric facilities are distinguished in 10 pediatric
specialties, based on survival rates, nurse staffing, procedure and patient
volumes, reputation and additional outcomes data. The availability of clinical
resources, infection rates and compliance with best practices are also factored
into the rankings.
“We understand how scary it can be for parents whose children are dealing with life-threatening illnesses or injuries. That’s why we are committed to the highest standards of care, safety and service,” says Dr. James Cappon, CHOC’s chief quality officer. “While we are proud of our accolades, including being named a best children’s hospital, we remain focused on preserving the magic of childhood for all kids, whether they are seriously ill or healthy, or somewhere in between.”
In addition to treating newborn babies requiring critical care, neonatologist Dr. Irfan Ahmad strives to involve family members in the care of their infant, which he says is essential for providing the best possible care for babies in the CHOC Children’s neonatal intensive care unit.
“I always include parents as part of the care team when treating a baby in the NICU, especially the mother. A mother and her baby were a single unit up until right before the delivery,” Dr. Ahmad says. “Parents are an essential part of the healing team, and building a strong physician-parent relationship is an important aspect of patient- and family-centered care.”
The program will take up residence in CHOC’s recently-opened NICU, which features 36 private rooms with the latest technology and innovations in neonatal care. The 25,000-square-foot unit is nearly triple the size of CHOC’s prior NICU space, and will allow parents to stay overnight with their babies.
“We strongly believe in mother-baby bonding and the value of breast feeding, and our new private NICU rooms are designed to optimize that,” he says.
The recently-opened NICU also features three rooms with surgical lights, allowing minor procedures to be performed at the bedside.
The only Surgical NICU on the West Coast, CHOC’s program is comprised of a multidisciplinary team including neonatologists, pediatric surgeons and anesthesiologists.
“What inspires me the most about care being delivered at CHOC is the combination of passion for helping babies, multidisciplinary interactions, use of modern technology and an atmosphere of teaching,” Dr. Ahmad says. “From dedicated neonatologists present 24 hours a day in the NICU, nurses constantly advocating for best care, nutritionists and pharmacists rounding with the team, physical therapists, wound care teams, lactation specialists and social workers all working together to help a fragile small baby has no parallel.”
In addition to neonatologists, the dedicated ECLS team is composed of cardiothoracic and pediatric surgeons, intensive care physicians, nurses, respiratory therapists and cardiopulmonary perfusionists who are experts in their fields and have received additional education to manage the complex equipment and medical needs of the children needing this life-saving technology.
In addition to stewarding the Surgical NICU, Dr. Ahmad’s special clinical interests include caring for babies who require surgery, including those born with structural abnormalities such as diaphragmatic hernia, intestinal obstruction and imperforate anus. His clinical interests also include babies who develop the intestinal infection necrotizing enterocolitis or who have intestinal perforation. His most common diagnoses include intestinal obstruction and trachea-esophageal fistula.
Mandibular Distraction Program
Dr. Ahmad is especially passionate about caring for babies with difficulty breathing due to an undersized or recessed lower jaw, which can be caused by a condition called Pierre Robin Sequence.
In 2008, Dr. Ahmad helped launch a mandibular distraction program at CHOC. Dozens of infants have benefited from mandibular distraction osteogenesis, which involves a plastic surgeon placing a special device in the small lower jaw to expand it, prompting new bone growth over a period of two to three weeks.
Traditionally, babies with this condition have been treated by placing a tracheostomy that remains in place for several years until the child outgrows the condition. Mandibular distraction is a more permanent solution that takes a few months to complete, allowing a baby to go on to have a normal, healthy development.
Constant quality improvement
Passionate about quality improvement, Dr. Ahmad serves as director of quality improvement for NICUs affiliated with CHOC Children’s Specialists. He has participated in several quality improvement initiatives with Vermont Oxford Network and California Perinatal Quality Improvement Collaborative. This includes a project to improve the transition of care for surgical cases from one team to another, decreasing delivery room intubations and preventing premature newborn babies from developing hypothermia.
As the director of quality improvement for CHOC’s network of nine NICUs, he partners with quality improvement teams at each unit in carrying out improvement projects based on local needs. The team currently has nine simultaneous quality improvement projects in the hospitals where CHOC neonatologists round.
Passionate about educating the next generation of pediatricians and neonatologists, Dr. Ahmad also serves as NICU education director for UC Irvine’s pediatric residency program and is an associate clinical professor of pediatrics at UC Irvine. He also trains neonatology fellows through CHOC’s partnership with Harbor-UCLA Medical Center’s neonatal-perinatal medicine fellowship program.
His current research efforts include studying the breathing patterns of full-term babies in order to refine inclusion criteria for the mandibular distraction procedure. He is also currently studying the clinical outcomes of CHOC’s surgical NICU program.
Pursuing his calling to care for children
Dr. Ahmad attended medical school at Aga Khan University in Pakistan. He completed a residency in pediatrics at the University of Oklahoma and a fellowship in neonatal-perinatal medicine at UC Irvine. He has been on staff at CHOC for 10 years. He knew from an early age that he wanted to care for children, so pursuing a pediatrics residency after medical school was a natural choice.
“I was exposed to various specialized fields like cardiology and oncology, but I wanted to take care of the whole patient. I also wanted to see when I could have the most impact on the life of a person,” Dr. Ahmad says. “During my residency when I worked in the NICU, I noted that good care in the first few minutes of life was so critical. Effective resuscitation, followed by intensive care in the NICU could make all the difference for the patient, who can then live a long and accomplished life.”
Dr. Ahmad finds inspiration in the strength of his patient’s families, and is continually renewed and humbled by their gratitude.
“I have been impressed by the strength of the families who have a sick little baby in the NICU. It is extremely difficult to have your newborn on a ventilator struggling for life. Yet, we see the moms and dads holding on to hope and being there for their baby,” Dr. Ahmad says. “Neonatology is a very difficult field with long hours taking care of very sick babies. The gratitude you get from parents when the baby is finally well and going home and the amazing photographs and cards that are sent to us makes everything worthwhile.”
In his spare time, Dr. Ahmad enjoys golfing with his children and developing his photography skills.
CHOC Children’s Hospital has opened its new neonatal intensive care unit (NICU) with 36 private rooms, a feature that will allow parents the opportunity to stay close to their newborns receiving intensive care.
The 25,000-square-foot unit nearly triples the size of the hospital’s previous Level 4 NICU, which included an open layout that grouped patients in pod-style beds.
The new unit, located on the fourth floor of CHOC’s Bill Holmes Tower, creates a homey atmosphere with sleeping quarters and storage space outfitted in warm colors and wooden accents to help parents feel more comfortable while their infants receive highly specialized care for extended periods of time.
“CHOC is proud to offer private rooms to our smallest patients and their parents,” said Dr. Vijay Dhar, medical director of CHOC’s NICU. “No one’s vision of parenthood includes a NICU stay, but our new unit will provide parents with the space and privacy to get to know their new baby, and reassurance that they’ll be nearby while their newborn receives the highest level of care.”
Private NICU rooms are a new standard for improved patient outcomes. Benefits for babies cared for in single-family rooms include higher weight at discharge and more rapid weight gain. Also, they require fewer medical procedures and experience less stress, lethargy and pain. Researchers have attributed these findings to increased maternal involvement.
A private-room setting provides space and privacy sought by parents to breastfeed, practice skin-to-skin bonding, and be more intimately involved in their baby’s care. Further, individual rooms allow parents to stay overnight with their newborn, and give staff more access and interaction with the family and patient.
In addition to private rooms, the new space includes other features that will enhance patient care. Should an infant need a sudden surgical procedure, three rooms within the unit can quickly be converted into space for surgeries. The unit will also include a life-saving extracorporeal membrane oxygenation (ECMO) unit. Rooms that adjoin can be used to accommodate triplets.
Safety features include same-handed rooms, wherein equipment is positioned in the same location among all rooms to reduce human error; room-adjacent nursing alcoves; and an in-unit nutrition lab for the preparation of breast milk and formula.
CHOC’s new unit also features a family dining space, a room dedicated for siblings, a lactation room and other amenities to ensure the comfort of the entire family.
The CHOC Children’s Foundation has raised $4,381,984 toward the new NICU, including lead gifts from the Argyros Family Foundation, Credit Unions for Kids and philanthropist Margaret Sprague.
For several decades, CHOC has served infants requiring the highest level of care. With the unit’s opening, CHOC’s neonatal services now include 72 beds at CHOC Orange and the CHOC Children’s NICU at St. Joseph Hospital, and 22 beds at CHOC Children’s at Mission Hospital. In addition, a team of premier CHOC neonatologists care for babies at hospitals throughout Southern California.
A suite of specialized services comprises the CHOC NICU: the Surgical NICU, which provides dedicated care to babies needing or recovering from surgery; the Small Baby Unit, where infants with extremely low birth weights receive coordinated care; the Neurocritical NICU, where babies with neurological problems are cohorted; and the Cardiac NICU, which provides comprehensive care for neonates with congenital heart defects.
Having a baby in the Neonatal Intensive Care Unit (NICU) can be an emotional and fraught experience for even the most seasoned parents.
And though they can take comfort knowing that their infants are receiving exceptional care in the CHOC Children’s NICU, parents also look to physicians, nurses and other clinicians for reassurance and support.
Here, parents explain what clinicians can say to help them feel more confident and at ease while their child receives care in the NICU.
“Your baby is important and special.”
I know you treat many babies like mine, or even those sicker, but this is my baby. It’s important to me that you know her name. I’ve waited a long time for her, and everything I envisioned has been turned upside down.
“Let me explain that again.”
I realize I’ve asked the same question several times. Please be patient with me: I am learning an entirely new language and navigating a new world, and I might need to hear something a few times.
“You are not a burden.”
I’m sorry that I’ve called the nurses station every night and that I’ve asked for you to be paged so many times. I don’t mean to be a nuisance, but I am worried about my baby constantly.
“May I sit with you?”
You are so busy, but when you take the time to sit with me during rounds, I feel like my baby is your only patient and you really hear my concerns.
“You are doing a great job.”
I’m trying my hardest to advocate and care for my baby under circumstances I never would have imagined. I’ve been racking my brain to determine what I did wrong or how I could have prevented this situation, and my confidence as a parent is low. I need reassurance.
The opportunity to collaborate on research and quality improvement initiatives with neonatal intensive care programs at the nation’s top children’s hospitals is a key benefit of CHOC Children’s membership in the Children’s Hospitals Neonatal Consortium (CHNC). Dedicated to optimizing neonatal care, the CHNC is led by neonatologists, fellows, nurses, respiratory therapists and other NICU champions for quality and patient safety. In addition to being pediatric tertiary referral centers, members must have level IV NICUs with a minimum of 25 beds and annual admissions greater than 400, of which at least half come from out-born deliveries.
The Children’s Hospitals Neonatal Database (CHND) serves as the platform for the consortium’s quality improvement efforts and benchmarking research. As of July 2016, the database covered more than:
6 million patient days
78,000 surgical procedures
“CHND is not your typical NICU database,” explains Dr. Michel Mikhael, a neonatologist who will serve as the consortium’s physician sponsor on behalf of CHOC. “NICU patients at children’s hospitals are different from those treated at perinatal NICUs. Many of our patients have pre-existing diagnoses or complications and are at a higher risk of poor outcomes. Even though our patient population has the highest resource utilization, we – as a collective group – do not have much shared data.”
The database will help members
identify variations in diagnoses and outcomes
improve care in specialized populations
provide better information for families
provide guidance for local, state and national mandates
ensure appropriate reimbursement by improved, detailed documentation
CHOC will begin submitting data in April 2017, says Dr. Mikhael, who is already preparing for a strong CHOC presence at CHNC’s annual meeting in October, with small baby unit, surgical NICU and other quality improvement and research projects presented. The ultimate goal will be for CHOC’s neonatology team to contribute and participate in multicenter research projects and publications.
For more information about CHOC’s role in CHNC and its participation in the consortium’s database, contact Dr. Michel Mikhael at email@example.com.