Fauquier Hospital Intermediate Care Nursery Ready to Accept Patients

Neonatologist Dr. Elsie Mainali is the new medical director of the Intermediate Care Nursery at Fauquier Hospital.

Beverlyn Silberbauer, RN, makes last-minute adjustments
to prepare for the nursery’s opening.

During an open house last Wednesday at Fauquier Hospital’s FamilyBirthing Center, neonatologist Dr. Elsie Mainali smiled broadly as she patted an infant resuscitator machine like a mother stroking a child. Dr. Mainali said that the hospital’s newly renovated Level 2 Intermediate Care Nursery (ICN) is the best equipped of any ICN in the area. “We are truly state-of-the-art.”

As of April 14, the new seven-bed unit (up from four beds) will welcome newborns who need special care. The nursery has been closed since November 2015, when construction began.

Beverlyn Silberbauer, ICN RN, explained that the each of the tiny patient beds is equipped with a myriad of monitoring equipment, a scale, and temperature and humidity controls. “The temperature control keeps the infant’s body temperature stable, and the humidity regulator protects the baby’s delicate skin.”

Stations are also equipped with phototherapy lamps and special blankets that cover the small

pod-like beds, so that the babies can rest in complete darkness – “just as if they are still in utero.” There are “portholes” in the sides of the beds, so parents can reach in and interact with their babies easily. Silberbauer said, “Even with the portholes open, the air inside the bed doesn’t leave and the air from the outside doesn’t get in, so the temperature stays consistent. It’s amazing technology.”

When a child is born prematurely, he or she may have respiratory issues, jaundice, or present other difficulties that require special attention. The ICN can provide around-the-clock care for newborns that are born after 32 weeks and are at least 3.3 pounds. Before Fauquier Health opened the ICN in 2013, these babies were transferred to a neonatal intensive care unit in Northern Virginia or at the University of Virginia.

The ICN also cares for babies born addicted to opioids. Silberbauer said, “Sometimes it takes months for those babies to go through the withdrawal process. Our job is to make sure the baby is healthy and the mom has the support she needs to take care of her baby when they go home.”

Dr. Mainali agreed, “We see quite a number of these babies.”

The Intermediate Care Nursery was expanded to better meet the needs of patients and their families, as well as to meet newer space requirements for an intermediate nursery – set by the state health commissioner, Virginia Department of Health. Historically, the nursery has hosted an average of three babies, but the volume would sometimes surge to five or six. The new space will more comfortably handle demand.

Of the 762 babies born in 2015 (before the ICN closed for construction), 71 were cared for in the ICN. During construction, 15 newborns that would have stayed in the ICN were transferred for higher level care.

In addition to enlarging the space, other highly specialized equipment for at-risk babies has been added. The security system has been updated and new isolates and radiant warmers have been installed, as have wireless scanners for medication, a PACS system for radiology services, mobile computers and respiratory equipment.

The construction cost $991,000; equipment added another $480,000. (This equipment was purchased in 2013 as part of the original project opening, and was raised through a Mars family gift of $382,000 and other fundraising efforts.)

The ICN will be staffed with two neonatal intensive care unit registered nurses 24 hours a day. Respiratory services, lactation experts, case management workers, an RN clinical coordinator and another physician will support the effort. Dr. Mainali added, “All nurses have Neonatal Resuscitation Program (NRP) certification; most come from higher-level care nurseries and have years of experience.”

Fauquier Health’s ICN also has a collaborative relationship with neonatologists at the University of Virginia’s Neonatal Intensive Care Nursery, to ensure local babies have the resources of a university-level facility. Dr. Mainali explained, “We currently have telemedicine capabilities; experts at UVA are able to receive data about a newborn in our nursery, examine the baby remotely and work with our staff via video feed.”

The nursery features open visiting hours, and mothers are encouraged to breastfeed their babies if they choose. Two private rooms can accommodate newborns who need readmission after being home. When babies are ready to be discharged, parents are invited to stay overnight in a private room and work with nursing services to understand how to care for their newborns.

Dr. Mainali said that Fauquier Health Home Care Services is available to visit mom and baby at home, to assist with any lingering issues. “We want to ensure that there is a smooth transition.” CPR training for parents is available prior to discharge and outpatient lactation services recently have been added.

Community pediatricians are invited to visit with their patients in the ICN. All newborns that are admitted to the ICN are under the care of Dr. Mainali, who said, “We view it as a collaborative effort and understand that the community pediatricians are guiding care after discharge. Having their engagement and ensuring we are communicating effectively is a priority.”

Pediatrician Dr. Joshua Jakum of Piedmont Pediatrics said, “I am thrilled that Dr. Elsie Mainali is joining Fauquier Health. The academic knowledge she brings is outstanding. We have already begun working on quality improvement initiatives that have demonstrated promise for neonates as well as our general newborn population.”