Neonatal follow-up clinic promotes health in high-risk babies

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Behind a door in the basement of Humber River Regional Hospital’s (HRRH) Finch site, there is a clinic buzzing with ringing phones, busy staff and gurgling babies. In the waiting area, two families sit at opposite ends of the light blue room. One of the babies starts to cry so her father, 40-year Oscar Alvarez, picks her up and calls her name “Sofia,” then gently whispers to her in Spanish.

Across the room, whispers of a different sort. Kut Truong and his wife Tran Truong laugh, talking to each other in Vietnamese. Then, in broken English, Mr. Truong says “My daughter is named Sophya too, but different spelling; she has a ph and a y.”

These two babies share much more than just a name. Both were born at HRRH. Both were premature and both are now benefiting from a new Neonatal Follow-up Clinic at Humber River, designed to follow their neurological and developmental progression as they grow and to allow for the earliest possible intervention if problems are spotted.

“This is a multi-disciplinary program that focuses on prevention and care in the community,” says Beverly Philp, Director of the HRRH Women and Children’s Health Program.” By following these high risk babies closely, we will be able to intervene early and correct any problems they may have in their first years.”

HRRH’s Neonatal Follow-up Clinic serves children from birth to three years of age who were born premature or who suffer from an illness that may cause delays in their growth progress. They are cared for by a team of experts ranging from pediatricians to dieticians to occupational therapists, all of whom are based at the clinic.

“The most important thing is that kids in our community can access a clinic in our community,” says HRRH Chief of Paediatrics Dr. Narendra Singh. “The whole idea is that once these babies are discharged from our hospital or live in our community they can receive care at our clinic. No more trips across the GTA or downtown.”

Oscar Alvarez agrees. His six month old daughter Sofia was born at just 31 weeks, weighing only three pounds, after her mother Marcela fell in the family bathroom. “I was so scared, she was born so small,” says Mrs. Alvarez, who came to Canada from Ecuador five years ago. Sofia was so premature that she was transferred to an east end hospital and spent nearly a month in the Neonatal Intensive Care Unit. Sofia’s father says travelling back and forth everyday from the Scarborough hospital to their home in North York was hard. When this clinic opened they jumped at the chance to have Sofia treated closer to home. “It is nice,” says Mr. Alvarez. “We come here, they know the baby, they are good with her, we see the same nurse, the same doctor. It is much better.”

According to Dr. Muroog Al-Dabbagh, who runs the clinic, Oscar Alvarez has hit the nail on the head, “That is exactly it,” she says. “We are providing a continuum of care. We want to be able to follow the children right up until they start school. Many premature babies suffer developmental delays, so if we can intervene early we can work with them to help them catch up.”

Having seen the practice nurse, the Alvarez family now prepares Sofia to be assessed by Dr. Al-Dabbagh. In the first year of their lives, the children in the program visit the clinic every four months. In year two they visit twice. Every step of the way, they are tested and assessed, and follow up care is set as needed.

Today Dr. Al-Dabbagh gives Sofia a Cognitive Adaptive (CAT) test, an assessment that measures whether she is meeting the appropriate milestones for her age. Her parents are told that although she is in good health, Sofia is not crawling or grasping for objects as she should.

“We’ve identified a problem, now we fix it,” says Dr. Al-Dabbagh. Sofia is referred to the clinic’s occupational therapist. “This is what we are trying to do,” says Dr. Al-Dabbagh. “Now the occupational therapist will work with the family to get Sofia caught up. It is good they are able to get all the care they need here without having to worry about travelling anywhere else.”

As they bundle Sofia up warmly and prepare to brave the cold, Mr. and Mrs. Alvarez turn to say good-bye to the Truong family and the other Sophya. “Our daughter was born so small, so we know it will take time for her to catch up,” says Oscar Alvarez. “When we first brought her home, every sound, every movement, we were worried, but now that we have this clinic here we have more confidence as parents and we know that she will be fine.”