Tiniest babies, biggest need for scarce space at Sick Kids
A surge in at-risk infants means intensive care for preemies ‘not up to standard’
At Sick Kids hospital, a room with six babies is tremendously quiet — but far too full.
“There’s no space for the equipment, there’s no space for the families,” said Dr. Estelle Gauda, head of Sick Kids’ neonatology division. “There’s just nowhere to breathe.”
Swaddled in animal-patterned blankets, tubes run through the pre-term babies’ mouths and noses, helping the tiny humans stay alive. Screens monitor their levels as nurses feed and assess their status. The room has been specially constructed to create quieter acoustics and softer lighting, in order to decrease stimulation for the miniature patients.
Born 24 to 25 weeks into pregnancy, these premature infants can weigh as little as one pound at birth. They’ve been transported here from all across Ontario, often because they need neonatal surgeries that only Sick Kids can provide.
Having six babies in one room is typical these days, she said, but that’s not the norm for neonatal care. At Mount Sinai and Sunnybrook, for example, each baby has their own room (with exceptions for multiples). Gauda said she’d like to see four babies in each room at Sick Kids, potentially by making other rooms available.
Hospitals across Ontario have seen a surge in infants needing high-level intensive care this summer, says the Ministry of Health, with Toronto’s level 3 NICUs — which care for the most seriously sick infants — hit hardest. While there’s been a surge in the past two months, Gauda said NICU capacity has been a “constant problem” at Sick Kids since she started at the hospital in March.
“(The NICU) is overcrowded. It’s not up to standard with respect to space around babies, as well as allowing the best environment that we can create to decrease the state of families,” said Gauda, who said they’ve been having continuous conversations about needing more capacity.
With better technologies, smaller and sicker babies are surviving more often, she said, but that means they often have to stay in the NICU for longer.
Some hospitals with lower-level NICUs are also often full, she said, so even if babies can be moved out faster, sometimes there’s nowhere for them to go.
“There’s just demand everywhere,” said Gauda.
Health ministry spokesperson David Jensen told the Star last week he’s not aware of what caused Ontario’s recent sudden increase in NICU demand, but says there is no publichealth issue contributing to the surge.
On Monday afternoon, there were 36 infants in Sick Kids’ NICU — two more than the government provides funding for.
Sick Kids has 42 physical NICU beds, but the ministry only provides funding to staff 34 of them. In the past two months, Gauda said Sick Kids has been treating about 38 NICU babies every day, and sometimes as many as 40. The unit has a flexible staffing model that can accommodate 38 babies at a time, sometimes by bringing in nurses from different units. They make it work, she said, but it can be stressful.
Sick Kids has had to move one baby to Ottawa in the past six weeks, she said, and at one point considered moving a baby out of province before they found space.
“We are trying to present the best face that we can, but we also know that behind the scenes there are a lot of things that are stressed,” she said.
Walking through the unit, Gauda points out the transport office, where calls “continuously” come in for babies who need to be brought to the hospital.
A spokesperson said Sick Kids offers “the most comprehensive set of critical-care services to the neonatal population in Ontario” — particularly those requiring complex surgery and sustained life support. Sick Kids is also the only hospital in Toronto that can do surgery on newborns.
Sick Kids received a one-time grant of $1.3 million in November 2015, in response to pressures from a growing volume of neonatal cardiac surgeries, said a statement from Megan Primeau, spokesperson for the Toronto Central local health integration network.
The statement said the current surge is mainly from non-surgical cases across all three of Toronto’s level 3 NICUs and that local capacity improved over the weekend.
Down the hall, Gauda points out another room, where babies who have had complications during delivery are undergoing “therapeutic hypothermia.” Their body temperature is cooled down for a few days to slow brain activity to help with recovery in case of potential brain injury. About 70 babies undergo this therapy each year, said Gauda, and just a few weekends ago, there were five babies in the sub-unit.
Over the past week, a surge in babies needing a high level intensive care has drawn concern from doctors and parents. On Monday, the Ontario NDP called on the government to immediately increase funding for the province’s hospitals in light of the “crisis in neonatal intensive care.”
Mount Sinai Hospital added two extra beds to its NICU over the weekend, and has plans to add two more by September. Sick Kids and Sunnybrook also plan on adding two beds to their NICUs.
Long term, Gauda said Sick Kids is in conversations and negotiations with the Ministry of Health about getting more resources for the neonatal unit. That might mean more money, she said, but it also could mean allocating money in different ways. It’s not just a Sick Kids issue, she said; the problems stem from demands across the province.
“Not only do we have to improve the capacity here, but we have to improve the capacity of the other level 2 nurseries and the other level 3 nurseries,” said Gauda. “It has to be a really orchestrated system that has to be in place.”
Sick Kids says that, on average, the cost per day for a bed in its NICU is $2,100.
The hospital says it hopes to rebuild its neonatal unit as part of its Project Horizon redevelopment plans, although that will not be complete for another 10 years.