COLORADO PERINATAL CARE COUNCIL
A. MEETING Colorado Perinatal Care Council
B. DATE January 27, 2012
C. LOCATION University of Colorado Hospital
Aurora, Colorado
D. PARTICIPANTS
MEMBERS PRESENT
Chantielle Blackwell, Presbyterian/St. Luke’s Medical Center, Denver
Deborah Bopp, Memorial Health System, Colorado Springs
Kathleen Demarco, Presbyterian/St. Luke’s Medical Center, Denver
Amy Dempsey, Lutheran Medical Center, Wheat Ridge
Ellen Duran, North Suburban Medical Center, Thornton
Sandra Gardner, Colorado Nurses Association
Tracy Heaberlin, Yampa Valley Medical Center, Steamboat Springs
Mary Lou Hendrix, Member-at-Large, Aurora
Peter Hulac, M.D., Chairman, Member-at-Large, Denver
Sheila Kaseman, The Children’s Hospital, Aurora
Suze Ketchem, Good Samaritan Hospital
Vicki Lemmon, Boulder Community Foothills Hospital, Boulder
Anne Masterson, North Colorado Medical Center, Greeley
Carri Montgomery, Platte Valley Medical Center, Brighton
Mary McMahon, Association for Women’s Health OB & Neonatal Nurses
Alfonso Pantoja, M.D., Saint Joseph Medical Center, Denver
Kathy Pehanich, St. Anthony North
Donna Pinson, Parker Adventist Hospital
Pat Bohling Smith, Poudre Valley Hospital, Ft. Collins
Sherrie Williams, University of Colorado Hospital, Aurora
Tina Wilson, Montrose Memorial Hospital
GUESTS & RESOURCE PEOPLE PRESENT
James Barry, M.D., University of Colorado Hospital
David Belenky, M.D., Denver
Elise Brown, M.D., Exempla Good Samaritan Medical Center
Susan Clarke, The Children’s Hospital, Aurora
Stephen Conner
Tim Crombleholme, M.D., University of Colorado Hospital
Kira Covill, Centura
Abe Grinberg, M.D., English/Spanish Immersion
Theresa Grover, M.D., The Children’s Hospital
Jonni Halve, El Paso County Department of Health
Michelle Jacobson, Exempla Saint Joseph Hospital
Dee Parrett, Exempla Saint Joseph Hospital
Regina Reynolds, Denver
Kimberly Sisneros, Medela
Jessie Thurber-Dean, Presbyterian/St. Luke’s Medical Center
Jessica Vallejos, North Colorado Medical Center
Jim Woods, M.D., Denver Health
E. HANDOUTS (Available Upon Request)
1. Treasurer’s Report
2. Conference Calendar
3. CPCC Meeting Dates & Locations-2012
4. Article from The Denver Post: “Strengthen Rules for Vaccinations”
5. Article from The Denver Post: “Babies Read Lips When Learning to Talk, Study Finds”
6. Article from The Denver Post: “State Ranks 26th Nationally on Child Well-Being Index”
7. Article from The Denver Post: “Tiny Baby Leaves Hospital Amid Fanfare”
8. Article from Arizona: “New Guidelines Address SIDS”
9. NBS Bulletin: Proposed Newborn Screening Regulations Changes-Call for Comments
10. NIH News: “Study Shows Additional Benefits of Progesterone in Reducing Preterm Birth Risk”
11. MedlinePlus: “Study Sheds Light on Preemies’ Higher SIDS Risk”
12. MedlinePlus: “Exercise Doesn’t Prevent Pregnancy-related Diabetes”
13. Summary of Elise Brown, M.D., presentation: Reconsidering Risks of Early Onset Sepsis”
F. THE MEETING IN BRIEF
1. The Council thanked Sherrie Williams and University of Colorado Hospital for hosting the meeting.
2. Introduction of Council members and guests.
3. Dr. Peter Hulac, new Chairman of the Council gave his opening remarks.
4. Theresa Grover, M.D., and James Barry, M.D., talked about perinatal services at University of Colorado Hospital and how they implement Council initiatives.
5. Tim Crombleholme, M.D., presented Fetal Surgery: Current Status.
6. Elise Brown, M.D., presented “Reconsidering Risks of Early Onset Sepsis.: (ED. Note: David Horst, M.D., was going to present an opposing view but had a family emergency and could not attend).
7. The meeting was adjourned.
G. SUMMARY OF THE MEETING
1. Procedural Items
a. The Council thanked Sherrie Williams and University of Colorado Hospital for hosting the meeting and providing refreshments.
b. Introduction of Council members and guests.
c. The Minutes of the November 18, 2011 meeting were approved as written.
d. The Treasurer’s Report was presented by Sandra Gardner, Treasurer. If interested, please contact Jan at the CPCC office for a copy.
e. For a list of conferences, please refer to the Council’s website at www.coloradoperinatalcarecouncil.com.
f. Conferences and other announcements: Susan Clarke announced the NRP Instructor Course will be held on March 15th. The National AWHONN conference will be June 24-27 in Washington D.C. Jan requested that everyone take the list of meeting dates and locations for 2012 and get them on their calendars. She also stated that the Council was getting ready for fundraising and that we are attempting to go green. All membership dues letters will now be sent by email and she requested contact information from all hospitals.
g. Opening Remarks by New Chairman, Peter Hulac, M.D., and Executive Committee Report: Dr. Hulas began by introducing all the members of the Executive Committee and stating how this group is the driving force of the Council. He discussed how the Council has been focusing on statewide collaboration to improve the quality of care in Colorado. He went on to highlight the 4 initiatives the group has focused on: They included no elective deliveries before 39 weeks, reduction of central line infections, antenatal steroids, and exclusive breastfeeding. He mentioned the grant from the March of Dimes to help with collaborative efforts as well as Paco’s project for central line infections. Dr. Hulac very much wants to continue these collaborative efforts and would like to see more physician involvement especially in the obstetrical area.
II. Perinatal Services at University of Colorado Hospital. How Council Initiative are Implemented: Theresa Grover, M.D., Medical Director, NICU at the Children’s Hospital; James Barry, M.D., Medical Director, NICU at University of Colorado Hospital: Dr. Barry began by stating that Dr. Grover was not able to make it. He said they comprise two large nurseries on this campus and they collaborate together on quality improvement projects. He said he would discuss UCH NICU first hour vent weaning protocols. He explained that quality improvement is a huge multi-disciplinary effort and takes a lot of special people and energy. Dr. Barry said he became the Medical Director at University of Colorado Hospital about 5 or 6 years ago. They began a huge project in 2008. They began to gather data on how many times CO2 was out of range. He noted that bad CO2 levels are associated with bad outcomes. In 2008, a chart review determined that 40% of the times, PCO2 rates were out of range. A prospective study showed that there was little data in neonates. The data they had demonstrated that there was hyperventilation in patients who FI02 was <30%. Dr. Barry pointed out that they have developed an algorithm for weaning and that they will be submitting it for public scrutiny. They developed a protocol that they followed in 96% of their patients. They utilized their respiratory therapists much more than they did in the past. There were initial concerns about the loss of autonomy but after some analysis showed a dramatic improvement in safe ventilation, everyone was on board. He emphasized that a good system is better than a good individual. (ED. Note: We are hoping to get Dr. Barry’s full presentation for the CPCC website.)
III. Fetal Surgery: Current Status: Tim Crombleholme, M.D., Surgeon-in-Chief, Chair in Pediatric Surgery: Dr. Crombleholme began by saying that he came from Ohio and has only been here for a few months. He started the Fetal Care Center in Cincinnati, Ohio. By coming to Colorado, he was given the chance to integrate everything involved in this evolution of care from the time they have a diagnosis of anomalies until the baby is actually discharged. He explained that the logical next step is the integration of a multitude of specialties. Since being here, he has already done 2 fetal cases and 3 more are scheduled. He stated that he would like to present an overview of what is possible with fetal surgery, mainly focusing on older fetal surgery. He pointed out that they are now treating non lethal conditions and are progressively working towards less invasive surgeries. He reiterated that this is an evolution of a new specialty and he is seeing an expansion that is having a profound effect on obstetrical and neonatal hospitals. He said that there is virtually no diagnosis in the nursery that couldn’t be made in the first or second trimester. For Dr. Crombleholme’s full technical presentation, please refer to the Council’s website where you can find the full summary.
IV. Reconsidering Risks of Early Onset Sepsis-Dissecting the Literature that Informs the CDC Guidelines: Elise Brown, M.D., MPH, CPMG Internal Medicine & Pediatrics: Dr. Brown began by telling the group that she is an internist and pediatrician and is a hospitalist for Kaiser Permanente. She stated that she enjoys the continuity of care. Her goals for today were to take a look into the literature citations of the CDC guidelines with regard to care of infants whose mothers may have had chorioamnionitis and to consider alternate strategies for care of these newborns. She feels that the literature available might not apply to all babies that they see today. She pointed out the three big game changers that are out there today including: 1. Moms now get routine Group B strep cultures: 2. Moms now get routine antibiotics during delivery if they are Group B strep positive: 3. Moms now get routine antibiotics during delivery before cord clamping if they have chorio. Because of these three changes, Dr. Brown feels that there is not a one size fits all strategy for mothers who have chorio. Questions and answers followed. For a full summary of the literature available and Dr. Brown’s presentation, please go to the Council’s website at www.coloradoperintalcarecouncil.com. You will find Dr. Brown’s presentation as well as various articles on the topic. This discussion will also be continued at the upcoming CPCC meeting on Friday, March 30, 2012 at Boulder Community Foothills Hospital.
V. The meeting was adjourned. The next Council meeting is scheduled for Friday, March 30, 2012 at Boulder Community Foothills Hospital in Boulder, Colorado. The meeting will be from 9:00 AM-12:00 Noon.
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Jan Goldberg
CPCC Coordinator