Neonatologist champions follow-up clinic for NICU graduates

Hannah R. Fischer, M.D., plays a critical role in making a neonatal intensive care unit (NICU) stay safer for babies, and helping NICU graduates thrive and get the care they need.

When Hannah R. Fischer, M.D., neonatologist with Norton Children’s Neonatology, affiliated with the UofL School of Medicine, was doing her pediatric residency, it was in the neonatal intensive care unit (NICU) where she found her calling. Despite the long and difficult days, she couldn’t wait to get up in the morning and see her tiny patients and their families.

“I thought that was a really good sign that this is something I should be doing for the rest of my life,” Dr. Fischer said.

Dr. Fischer found her way into medicine after majoring in biotechnology as an undergraduate student at the University of Louisville.

“As I learned more and more, I became fascinated with medicine and medical school —becoming a doctor just made sense,” Dr. Fischer said. “And then, pediatrics was just a really natural place for me to enjoy and explore.”

Passion for making NICU stays safer for babies

Dr. Fischer now plays a critical role in making a NICU stay safer for newborns. As director of quality improvement and safety for the UofL School of Medicine Division of Neonatal Medicine, she researches ways to improve the quality of NICU care.

When a child is born early, their brain and organs are still developing. Any infection,  procedure or medications needed can affect how the child develops and functions later in life.

“It’s the care that we give every single day, every time we touch that patient, every decision we make big or small, that is going to impact their outcome,” Dr. Fischer said. “And that’s where my love and inspiration come into play with quality improvement. It’s looking at health care delivery and how we can optimize every patient interaction to get the best outcome.”

Dr. Fischer points to the division’s work with central line-associated bloodstream infections (CLABSIs). Babies born early often have a central line, an intravenous (IV) tube for giving fluids and medicines. Those central lines are crucial for care but are a potential entry portal for infections.

“There are no new antibiotics or new ways to prevent [CLABSI] except what we do every day with making sure we keep things very sterile, wash our hands, and carefully manage that line, getting it out as soon as we can,” Dr. Fischer said. “In doing that, we’ve decreased our CLABSI rates to unbelievably low levels and prevented infection and complications in our babies. We can help these children thrive through the rest of their lives.”

Other quality improvement efforts include decreasing unplanned extubations. This is when a child is on a ventilator and the tube helping the child breathe accidentally comes out. The team also is working on increasing the amount of breast milk babies in the NICU receive.

“Mom’s own milk is almost like a medicine for babies. It helps their immune system, helps them fight infections, helps them grow and develop,” Dr. Fischer said. “And our moms are faced with a huge uphill battle with providing breast milk. They’re stressed their baby is in the NICU. They weren’t supposed to have a baby yet. And so there’s some standardized things we can do to help prioritize giving that baby breast milk and helping them get breast milk through the time that they go home.”

Helping NICU graduates in a multidisciplinary follow-up clinic

Dr. Fischer also sees babies as part of the Norton Children’s Neonatal Follow Up Program, a multidisciplinary clinic for babies who have graduated from the NICU and need continued care after discharge.

Norton Children’s Neonatology, affiliated with the UofL School of Medicine

The most fragile babies get quality care at top-rated neonatal intensive care units that work in collaboration with Norton Children’s Maternal-Fetal Medicine.
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“It’s really important that we support them in those first years of life,” Dr. Fischer said. “The goal of the neonatal follow-up clinic is to help them grow and develop like they’re supposed to. We do developmental assessments at every visit. And if we find that a baby is having difficulty in an area of development, then we help get them into early intervention services, which might be physical therapy, occupational therapy, speech therapy, feeding therapy — anything that’s going to help them achieve goals as they are learning about their world.”

NICU graduates visit the follow-up clinic based on their unique needs. According to Dr. Fischer, some babies will be followed for the first year of life, while others may be followed up to three years. The clinic is available to NICU graduates in Louisville and across Kentucky, as Dr. Fischer and the NICU Follow Up team often travel to outreach clinics in Paducah, Bowling Green and Owensboro.

According to Dr. Fischer, being able to see these children thrive is her biggest motivation.

“When I was a fellow, we went to a delivery of a baby who was what we call ‘at the edge of viability.’ The baby had less than 1% chance of living because they were going to be so small and premature,” Dr. Fischer said. “The mom said, ‘Do what you have to keep my baby alive,’ and we did. We kept talking to mom about what the chances were, that this is not looking good. But we kept pushing through, and that little baby survived. He went home from the NICU on oxygen, and I continued to see him in follow-up clinic.

“Five years later, his mom had another baby in the NICU, not quite as premature as him. The family saw us in follow-up clinic with the younger child, and the older child was there, too. He came over and was playing with my stethoscope and I said, ‘Do you want to listen to your heart?’ So, I let him listen to his heart, and this little kid that we didn’t think was going to survive looked up and said that he wanted to be a doctor one day. My heart just melted. It was beyond belief he was even here, doing all the things a 5-year-old should do, having big dreams.”