Neonatology
Venkataraman Balaraman, MD

There were 831 admissions to the Newborn Special Care (NSC) last year with 284 Intensive level admissions and 547 intermediate level admissions. Average daily census in the NSC was 17. The neonatology division maintains a very close working relation with the Maternal Fetal Medicine group. Weekly combined perinatal meetings are held with the neonatologists, maternal fetal medicine specialists, pediatric surgeons, genetics counselors and residents, to discuss high-risk cases. In addition, there is once a month Fetal Board meeting with participation from Neonatologists, Pediatric Residents, Maternal Fetal Medicine Specialists, Obstetricians and Obstetric Residents.

In addition to our 24-hour in-house services in the NSC and Labor & Delivery at Kapi'olani Medical Center for Women and Children, the division provides 24-hour coverage of Level II neonatal services in Labor and Delivery and Newborn nursery at The Queen's Medical Center. We also provide telephone advice to Pediatricians all over the Pacific Rim in management of neonatal cases.

Neonatal Transport Services remain very active. The transport team participated in 196, 177 of them being incoming from other hospitals and neighbor islands to Oahu facilities and 19 outgoing. In addition, the division provides ongoing supervision and training for our highly qualified transport nurses and respiratory therapists.

There were 75 Neonatal Medical Follow-up Clinics scheduled last year. This clinic provides continuity of care for NICU graduates that require close medical follow-up for resolving medical conditions post-discharge. Of these clinics 26 also offered circumcisions. Over 175 visits occurred at the Clinics this year. The Neurodevelopmental clinic based at the Specialty Center had over 75 visits during the year. The physician who participates in the Neurodevelopment Clinic is Dr. Mari Uehara.

The Neonatal Developmental Follow-up Clinic provides services on the outer islands of Hawai'i, Maui and Kauai. A total of approximately Ninety patient visits occurred during the year. Unfortunately, the state funding for this clinic has ceased and starting July 2007, this clinic will stop seeing patients. Neighbor Island patients requiring Neurodevelopmental follow up are being referred to the Specialty Center to follow up with Dr. Uehara.

The Division has continued its affiliation with Kaiser Hospital in Moanalua. The continued close working relationship of KMCWC, Kaiser and Tripler Army Medical Center has evolved into the development of the Hanuola Program, a joint venture amongst the three hospitals and the John A. Burns School of Medicine to provide Extracorporeal Life Support to critically ill pediatric patients in the State. This program will formally move to KMCWC in July 2007. Dr. Mark Ogino will be director for the program.

Our accredited joint fellowship program with Tripler Army Medical Center is one of three military neonatology fellowships in the country. There were three fellows in our program in 2006-2007. Weekly fellows’ conferences are conducted to review case studies, morbidity & mortality, basic science lectures and clinical journal clubs.

The Division of Neonatology is involved in multiple research arenas. Clinical trials (severity of RSV infections in hospitalized patients, and prospective comparisons of Numax and Synagis in the prevention of RSV infections) are ongoing with research funding to Drs Balaraman, Kuo, and Neal. Basic science research is spearheaded by Drs. Neal and Iwamoto under the auspices of various NIH grants. Outcomes research in collaboration with the Center for Health Outcomes, Hawai'i Pacific Health Research Institute continues to progress with active involvement of Drs. Kuo, Iwamoto, Nakamura and Neal.

Community service is highly encouraged. Our activities include volunteer leadership roles in public service organizations, speaking at meetings, and providing and educational opportunities for community agencies and students in the health care field as they relate to neonatology.