Beyond the Bedside: Increasing the Odds for Tennessee's Most Vulnerable Babies
“Neonatology wasn’t even a word in the 1960s,” Dr. Judy Aschner tells me emphatically. The view out her office window at the Vanderbilt University Medical Center complex offers architectural proof of the idea having found its footing beyond mere lexicon.
“The field really got its start here,” says Aschner.
A few floors down, the field of neonatology is well underway. In one of several neonatal ICUs scattered throughout the Monroe Carell Jr. Children’s Hospital at Vanderbilt, there’s a row of glassed-in rooms, each containing a single, impossibly tiny infant. Although the NICU flashes and beeps with an array of monitors, the place manages to convey a certain optimism that’s sometimes absent from adult hospital rooms — maybe it’s the brightly-painted baby-names on each window, the baby pictures and cheerful kid-drawings decorating the glass.
More likely, it’s the knowledge — in careworn new parents and bustling staffers alike — that these vulnerable new lives, though they’ve entered the world a bit too soon or too sick to go home with Mom and Dad right away, have a better shot at a long and full life than they have in all of human history.
When Dr. Judy Aschner came to Vanderbilt to head the Neonatology Division at the Children’s Hospital in 2004, the division had already carved out a niche as one of the premier neonatology departments in the country.
She’d known she wanted to be a neonatologist since the moment she first stepped into a NICU as a young pediatric resident. She loved interacting with families, loved watching babies slowly improve and then go home to relieved parents. “It’s where I was meant to be,” she says. “People are happy when they do what they’re good at.”
Aschner’s tidy office, sparely decorated with family photos and diplomas, and her appearance — an understated, no-fuss elegance — quietly suggest a modest, meticulous personality, outsized achievements, and a fierce attention to detail. “I tend to dot all the i’s and cross all the t’s,” she admits, her dark eyes smiling.
For years, she divided time as a mother of four and successful neonatology specialist, focused on caring for her tiny charges. But her ever-searching eye constantly saw ways the field could improve. She started thinking about how she might make a difference beyond the bedside, to more than one baby at a time.
When Aschner arrived at Vanderbilt, she was “dismayed to find that Tennessee had among the worst infant mortality rates and highest pre-term delivery rates,” she says. “And I decided that before I retire, we were not going to rank in the bottom 10 states.”
She quickly began implementing her vision for expanding the hospital’s neonatology division. She and her team have tripled faculty positions, increased research funding multifold, and added substantially to the number of NICU beds and critically ill newborns the division handles annually, as the Vanderbilt delivery volumes have grown.
She then cast her searching eye outside the institutional walls, brainstorming ways Vanderbilt could spearhead improvements in infant mortality rates and premature birth rates throughout the state. She lobbied for a statewide program called the Tennessee Initiative for Perinatal Quality Care, or TIPQC, that has been adopted to varying degrees in most NICUs in the state. “It’s been successful beyond my wildest dreams,” she says. One program, she explains, has reduced cases of hypothermia in pre-term infants; another aims to increase human milk nutrition for premature babies, which reduces complications of pre-term birth.
Still another project — simple but crucial — has reduced bloodstream infections caused by IV-feeding catheters by 75 percent in Tennessee NICUs. “I think people thought it just couldn’t be helped,” she says. “Turns out, this is a preventable occurrence. Not just here at Vanderbilt — the entire state has collaborated,” says Aschner, smiling at the thought of all those babies, now home and well, instead of sick with infection — or worse.
For the first time since 1990, Aschner says, “Infant mortality is starting to decline in Tennessee, and the rate of pre-term birth has flattened or started to decline.” And she believes TIPQC has played a role in that trend.
Aschner, passionate ambassador for her field and, once, frightened mother of a critically ill pre-term baby boy, wants to get the message out, “how lucky this community is to have a world-class children’s hospital in its backyard.
“The resources, the focus on children’s health care — as a mother of four, I wouldn’t dream of letting my child go anywhere else.”
And Aschner wants that care to follow babies home. She aims to involve families as much as possible in keeping their children healthy. “The more time we can spend with families at the bedside,” she says, “the more confident we are that that baby’s going to go home and thrive.”
Photo by Eric England
Shauntel Jennings has never slept like a baby. Even as an infant, her mother stood guard over her crib, waiting for her daughter to stop breathing. She shook Shauntel’s tiny body several times each night, rousing her from her breathless sleep.
To read this and other Her Well-Being stories, click here.