Doctors warn province of crisis in neonatal ICUS

`The situation has become so critical that deaths of infants may soon follow'

In a system already working past capacity, some of the province's tiniest patients are at risk, according to a letter now on the desk of provincial health officials.

Hospital overcrowding strikes its lowest blow, with the capacity of neonatal intensive-care units (NICUS) approaching critical.

“These babies have nowhere else to be cared for and we believe the situation has become so critical that deaths of infants may soon follow,” said Dr. Mona Gill, president of the Edmonton Zone Medical Staff Association.

The Edmonton units have been frequently working at between 95 and 102 per cent capacity for 30 per cent of the time in the first three months of 2024.

“Practically, this puts babies at risk. The nurses are caring for too many babies at one time and this results in frail, underweight infants not being able to even eat on time,” Gill said.

Her letter, also signed by neonatologist Dr. Amber Reichert, landed Tuesday on the desk of Health Minister Adriana Lagrange and Athana Mentzelopoulos, CEO of Alberta Health Services.

Capacity and workforce are two words very familiar to Albertans looking at the provincial healthcare system crisis. The neonatal network is no different.

“We're just starting to get to a critical level with the NICU, so we're quite concerned,” Gill said.

“These are fragile, the most fragile of our patients, right? Tiny babies. And the other difficulty is having to also deal with — obviously parents are very stressed. They require very specialized care that really can't be delivered elsewhere.”

A safe occupancy level for a neonatal intensive-care unit is 75 per cent. Alberta's NICUS have been averaging 90 per cent during the last three years and for more than a quarter of the time they're at capacity or over, she said.

“Leading up to April, the capacity was nearing 100 per cent. Although many sectors of the healthcare system work well above 100 per cent, in the NICU in particular, bed closures really do impact babies,” she said.

It's been a slow burn, she said. “Every year, the capacity issue has gotten worse,” Gill said.

In Edmonton and Calgary, where there are specialized care centres, there are 260 funded NICU beds, she estimated.

There are about 50 additional beds that are in smaller centres.

It's not enough, she said. In 2016, studies showed 20 to 30 additional NICU beds were needed.

The timing was perfect for the planned south Edmonton hospital, with 21 new NICU beds expected.

“But that project has been cancelled. We really don't have a place to flex into, and (the stand-alone Stollery) is just in the planning phases,” Gill said. “We're going to hit the breaking point well before any kind of meaningful capacity has been made.”

Widely observed medical workforce shortages have an acute effect at the neonatal level.

“The second thing is just workforce; we know we don't have enough coverage overnight to actually take care of babies. And this is resulting in staff neonatologists having to work even more overnight shifts and not being available the next day,” Gill said.

A statement from Alberta Health Services said: “AHS has NICU capacity across the province, and our front-line teams continue to provide patients with the very best care possible.

“Every child that needs intensive care will continue to receive it,” said Kerry Williamson, a spokesperson for AHS.

“AHS continues to experience significant patient demand in our major urban centres, including demand for NICU services. However, capacity exists across the system.”

The statement gave a count of NICU beds around the province: 133 NICU beds in Edmonton Zone; 126 NICU beds in Calgary Zone; 17 NICU beds in Red Deer; 16 in Lethbridge; 10 NICU beds in Grande Prairie; and seven in Medicine Hat.