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VOL. 128 | NO. 153 | Wednesday, August 07, 2013

Team Effort

Multidisciplinary approach helps lower area’s infant mortality rate

By Jennifer Johnson Backer

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A decade ago, about 15 out of every 1,000 infants born in Shelby County were dying before the age of 1 – one of the worst rates in the U.S., and worse than in many developing countries.

In Shelby County, many infants die because they are born too early or too small, said Dr. Giancarlo Mari, chairman of the department of obstetrics and gynecology at the University of Tennessee Health Science Center and a leading specialist in maternal and fetal medicine. Birth defects, prematurity and maternal complications from pregnancy also are leading causes of infant deaths in the first year of life, he said.

Dr. Ramasubbareddy Dhanireddy (front, left) of the Sheldon B. Korones Newborn Center at The MED,  Dr. Giancarlo Mari (front, right) of the High-Risk Obstetrics Center at The Med, Tammie Ritchey (front, center), vice president of development and executive director of The MED Foundation, and many other team members have been instrumental in leading a push to lower Shelby County’s infant mortality rate.

(Daily News/Andrew J. Breig)

Mari and other specialists, such as Dr. Ramasubbareddy Dhanireddy, who heads the Sheldon B. Korones Newborn Center at The Regional Medical Center at Memphis and the neonatal intensive care unit at Le Bonheur Children’s Hospital, were recruited by the UTHSC and The MED to advocate for the city’s youngest patients and their mothers. One of their primary goals is to bring down the region’s infant mortality rate through a multidisciplinary and collaborative approach.

Originally from India, Dhanireddy came to Memphis in 2005 from the Louisiana State University Health Sciences Center at Shreveport, while Mari, who is from Italy, joined the UTHSC faculty in 2008 as director of maternal-fetal medicine. Prior to joining UTHSC, Mari was a professor of obstetrics and gynecology at Wayne State University, where he also served as director of diagnostic endoscopy and fetal therapy.

In 2011, the number of infants dying in their first year of life dropped to 9.6 out of every 1,000 infants born in Shelby County – the area’s lowest infant mortality rate in history. That drop can be attributed in large part to multidisciplinary efforts among The MED, Le Bonheur Children’s Hospital, UTHSC, the Shelby County Health Department, and other regional and national partners.

While Shelby County’s infant mortality rate is still well above the overall U.S. infant mortality rate of 6.05 deaths per 1,000 live births, physicians like Mari say the region’s decline in infant mortality is a promising sign that bodes well for overall health trends. Infant mortality rates are one of the most important measures of overall community health. The rate reflects the health of women before, during and between their pregnancies.

The causes of infant mortality are very complex, but Mari said he has primarily focused on working with other specialists to treat underlying high-risk conditions that often lead to babies being born very early.

“The temptation is often to deliver these babies early if the mother has a high-risk condition,” Mari said. “But we’ve found if we can treat the underlying condition, and we can gain even as much as three days or three weeks – we can drastically increase the baby’s odds of living.”

Premature babies are at a higher risk of dying and also face other serious complications. Between 2007 and 2009, about 25 percent of babies born at The MED and weighing between 1.3 pounds and 1.7 pounds died. That figure dropped to 14 percent in 2010.

UTHSC’s and The MED’s multidisciplinary approach to care has led to the development of the state’s first maternal-fetal medicine fellowship at UTHSC. The three-year fellowship trains physicians to take care of mothers with complicated pregnancies through a multidisciplinary approach. The fellows work with faculty who are specialized in neonatology, pathology, anesthesiology, genetics, infectious diseases and cardiology.

While the rate of Shelby County babies that die in their first year declined 24.4 percent between 2007 and 2011, the number of infants that die between birth and 27 days declined by as much as 32.6 percent. Mari attributes much of that decline to better management of high-risk babies and their mothers.

“Though sometimes we just don’t know why a baby arrives very prematurely,” he acknowledged.

The temptation is often to deliver these babies early if the mother has a high-risk condition. If we can treat the underlying condition ... we can drastically increase the baby’s odds of living.”

–Dr. Giancarlo Mari
High-Risk Obstetrics Center at The MED

Tammie Ritchey, vice president of development and executive director of The MED Foundation, said the foundation also has made significant investments in specialized equipment and programs that also help target infant mortality. That foundation’s investments range from funding support groups that help high-risk teenage mothers to providing specialized training for nurses and physicians.

And while the plan is still in its infancy, even bigger plans to improve fetal and maternal health care in Shelby County are in the works.

In late July, the UTHSC announced plans to partner with The MED and Le Bonheur to build and operate a $200 million women and infants hospital next to Le Bonheur Children’s Hospital.

“The Women and Infants Pavilion will be a pathway for infants that need high-quality medical care,” said Dr. Ken Brown, executive vice chancellor and chief operations officer for the UTHSC. “From this new facility, we will be able to channel patients with serious conditions to one of the best children’s hospitals in the country.”

Brown said the work of world-class physicians such as Mari and Dhanireddy will be followed in the continuum of care by other UTHSC faculty physicians at Le Bonheur – including Drs. Christoher Knott-Craig, pediatrician-in-chief, Jon McCullers and others. Mari said he’s thrilled about the plans to build a new center, but says the region still has a long way to go toward improving overall maternal and fetal health.

“Things were so bad, it was not all that difficult to lower the (infant mortality) rate,” he said. “These are still far from optimal conditions.”

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