Dr. Robert Cicco, associate director of the neonatal intensive care unit at West Penn Hospital, lays little Hailey Smith back into her bed after discussing sleeping positions with Dr. Mihail Stratulat and his wife Dr. Angelica Stratulat in the NICU at West Penn Hospital.
By Pohla Smith Pittsburgh Post-Gazette
While dignitaries from G-20 nations scoped out locations in advance of the September summit last week, two young medical residents from the little Eastern European nation of Moldova did much the same between lessons on how to better evaluate and care for neonatal babies.
The husband and wife team of Drs. Mihail and Angelica Stratulat, each 26 and respectively residents in neonatology and obstetrics at the Mother and Child Health Care Research Institute in the capital city of Chisinau, were here as the guests of Western Pennsylvania Hospital neonatologist Robert Cicco.
Hoping to help to bring neonatal care up to U.S. standards throughout their nation, they met Dr. Cicco at a symposium in Moldova and asked if they could come here to learn more.
"We need equipment. We need to learn to use it. We need a system to get the baby to the Institute and a system for when the baby goes home," Mihail Stratulat said.
To accomplish that, he said, would take "more money and another generation of doctors. The older doctors have to change their ways."
He said there is, for example, just one incubator-equipped ambulance available for transporting newborn babies with health problems in the entire nation, which is located between Romania to the west and Ukraine to the north, east and south. There are not enough incubators, and many mothers do not understand the importance of followup care for these infants. They may have been born premature or have a serious illness, injury or birth defect and can have many developmental issues.
The Stratulats were busy every waking hour before they left Sunday, cramming sightseeing, shopping, and other tourist activities in between their lessons.
After arriving late Aug. 3, the Stratulats spent Aug. 4 observing the examination of babies who returned for followups at West Penn's neonatal clinic. On Wednesday, they visited one of the neonatal hospital rooms, where Dr. Cicco showed them such things as the proper way to swaddle a neonatal infant and how to position them to insure their soft heads mature in a round shape without any flatness. They also observed more followups at the West Penn clinic and toured the neonatal intensive care units -- known as NICUs -- at West Penn and Allegheny General Hospital.
On Thursday they were with Allegheny General's Dr. Ron Thomas, a perinatologist, or obstetrician who specializes with women having high-risk pregnancies, like women who have had pre-term labor, toxemia or uncontrolled diabetes.
Dr. Cicco is an experienced teacher. Over the last 10 years, he has been visiting Romania and, more recently, Moldova, to teach hands-on neonatal care and to help design care systems.
In recent years, he said, "many of the kids in Romania were starting to survive who weren't surviving before. That became an issue for them so they asked us to come and do a symposium on how to do a developmental assessment on these babies."
That was in May 2008 and while there Dr. Cicco met two doctors who were doing neonatal followups in Moldova.
Then in September, he went to Moldova for 12 days as part of a month-long program of American doctors doing day-to-day rounds with doctors and nurses. While there, he met Dr. Stratulat's father, the head of neonatology at the Mother and Child Institute, who asked if he would visit Moldova again to give a session on developmental assessments.
"It turns out what was always happening in Moldova was much more advanced than Romania in terms of the followup because the two physicians who came when we did our symposium in Romania had set up a wonderful system of bringing kids back for assessment," Dr. Cicco said. "But they wanted to involve more doctors and nurses over there so they could learn what they had to do.
"We went though the same thing in this country where you kind of got the sense that you couldn't do a whole lot with the baby until it got older, when in fact there's a lot of instructions you can give to the mothers -- positioning you can do for the baby, and so forth, so they can better acquire their learning skills and their motor skills."
Dr. Cicco, his wife and West Penn developmental specialist Diane Shaffer traveled to Moldova for a weeklong seminar in February, and Dr. Cicco was impressed with what he saw.
"I know the history of neonatal care in this country. I've seen the neonatal care in Moldova and Romania improve many, many times faster than it was improving as we were going through our formative years of doing neonatal care in this country," he said.
"I would say when I first started going to Romania the care they were doing probably was comparable to what we were doing in the 1970s. Within five years it had advanced 20 years worth of what it had taken us to do.
"And that's not just involving the care of the individual baby," Dr. Cicco added. "It's setting up a system of care. There is in Moldova, without us doing much at all, a system of transporting babies into their [Mother and Child Institute] center. That is a difficult concept to get across, that different hospitals should cooperate with one another."
Still, he said, the standard of care in major hospitals in Romania is about where U.S. care was 15 years ago and it's about the same level in Moldova. But the level of care is "kinda back in the '70s" in the smaller centers.
Mihail and Angelina Stratulat are working on two projects funded by the Swiss government and the Janivo Foundation of the Netherlands that should help strengthen Moldova's neonatal program.
One project is to create a database of all neonatal patients, including those who die because of extreme prematurity.
The second project is a public education campaign including booklets and a Web site to inform parents of programs, hospitals and information on taking care of neonatal babies. "The parents need to know there's a value, a benefit to coming back and learning how they can enhance their baby's development," Dr. Cicco said.
Mihail Stratulat said mothers are beginning to understand.
"It depends on where the mother is from," he said. "If they're from the rural part of the country it's hard for them to understand and hard for us to explain, but if they're from the urban parts it's much easier.
"We've had a lot of success in this. At the beginning, the rate of followup was 40 percent of the mothers and now it's 80 percent."