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I’d like you to think back to your

childhood for a moment, if you would.

If you’re like me, you probably had a

parent who stressed the importance of

a balanced breakfast each morning to

get you off to a good start for the day.

A similar principle applies in the world

of neonatal and perinatal care – in

short, giving babies a healthy start is an

important factor in influencing future

success and productivity throughout a

person’s life.

Getting mothers and babies the health care services they need

to make a strong start together is a key focus for members of

Virginia’s health care community engaged in perinatal, neonatal,

and pediatric care. While that never ends, Virginia has achieved

some encouraging results. For example, data released at the end

of 2016 showed the Commonwealth had achieved the lowest

early elective delivery (EED) rate in the nation. In recent years,

Virginia lowered its EED rate from 8 percent to 1.3 percent,

ranking the Commonwealth first in the nation in reducing

EEDs, according to federal Hospital Compare data. Virginia

previously had been ranked 24th in the nation on EED rate based

on Hospital Compare data released in 2014. Reducing EEDs

is important because research has shown that babies carried to

full term (after 39 weeks of gestational age) can improve birth

outcomes and have lasting positive effects on lifelong health.

Previously, conventional wisdom held that babies born between

37 and 39 weeks were generally as healthy as those carried to

full term. Alongside that came a trend toward early elective

deliveries. It is now known that babies are still developing in the

final weeks of gestation and that early deliveries which are not

medically necessary should be avoided. Virginia’s community

hospitals and health systems, the Virginia Hospital & Healthcare

Association’s (VHHA) Center for Healthcare Excellence, the

American College of Obstetricians and Gynecologists (ACOG),

the Medical Society of Virginia (MSV), the March of Dimes

(MOD), and other health care providers and stakeholders have

worked in recent years to reduce EEDs.

In addition to the focus on EEDs, health care providers in this

arena are also working to decrease primary, normal presentation

cesarean births, promote safe sleep environments, and a range of

other strategies to prevent prematurity and maternal and infant

morbidity and mortality.

Yet another challenge providers are confronting is the effect

the ongoing opioid crisis is having on mothers and babies. In

Virginia, opioid-related fatalities have become the leading

cause of accidental deaths, overtaking car crashes to earn that

ignominious distinction. And while we often associate this health

crisis with the adult population, it is also impacting very young

patients. Many babies born to mothers with an opioid addiction

can experience withdrawal symptoms due to a drug exposure

Hospital and Healthcare Association

By Joan Williamson, RN, MN, CPHQ, CPPS • Virginia Patient Safety Organization Director • Virginia Hospital & Healthcare Association

in the womb. This condition is called neonatal abstinence

syndrome, or NAS. Babies born with NAS can be prone to

involuntary behaviors atypical in infanthood such as reduced

quality and length of sleep following a feeding; increased muscle

tone, tremors, and convulsions; respiratory-related issues such as

sweating, frequent yawning, and sneezing; and gastrointestinal

issues such as excessive sucking, poor feeding, vomiting, and

loose stools. Often, these symptoms are relatively short-lived.

However, some research suggests that this condition could have

longer lasting effects on children’s development.

And unfortunately, the prevalence of NAS is growing. Data

shows the number of infants diagnosed with NAS quadrupled

from 2012-2016. Last year, more than 770 Virginia newborns,

out of nearly 96,000, were diagnosed with NAS. In other

words, 1 percent of Virginia babies born in 2016 exhibited NAS


In an effort to combat this public health challenge,

members of Virginia’s hospital community have joined with

VHHA, MOD, and ACOG to launch the Virginia Neonatal

Perinatal Collaborative (VNPC) to focus on improving birth

health for mothers and babies in the Commonwealth. VNPC is

initially prioritizing improvements in care for pregnant women

diagnosed with substance use disorders and infants impacted

by NAS. That work is being supported by the Virginia General

Assembly. During the 2017 legislative session, Delegate Chris

Stolle, an obstetrician-gynecologist from Virginia Beach,

successfully patroned House Joint Resolution 745 to raise

awareness for efforts to improve birth health by designating

the first week of July as Substance-Exposed Infant Awareness

Week in the Commonwealth of Virginia. That resolution was

part of a package of legislation introduced to address Virginia’s

opioid crisis. And Senator Siobhan Dunnavant, an obstetrician-

gynecologist from Henrico County, helped secure in the new

fiscal year state budget cycle that began July 1 funding to

support the establishment of VNPC.

The VNPC was formally launched at a State Capitol news

conference in late July featuring representatives from Carilion

Roanoke Memorial Hospital, Children’s Hospital of Richmond

at VCU, HCA Virginia Health System, Riverside Health System,

University of Virginia Health System and UVA Children’s

Hospital, and VCU Health System. These are just a few of

the stakeholders engaged with the Virginia Neonatal Perinatal

Collaborative, which exists to ensure that every mother has

the best possible perinatal care, and every infant cared for in

Virginia has the best possible start to life. We believe in an

evidence-based, data-driven collaborative process that involves

care providers for women, infants, and families, as well as state

and local leaders. We believe that working together now will

create a stronger, healthier Virginia in the future.

Wow! I think this is a perceptive observation. Personally, I would

rather read a short poem saying this kind of thing then listening to hours

of babbling from television commentators and personalities.

Language has power. We all still value it, but time is at a premium,

and we don’t want our time wasted. Finding ways to make each word

count as it tries to communicate an idea, a thought, a feeling, a whim is

important to all of us. Try poetry. You might be surprised at what you

can do.

Continued from previous page