Practice Management and Professionalism

NICU Care in the Aftermath of Hurricane Katrina: 5 Years of Changes

Barkemeyer BM (Louisiana State Univ Health Sciences Ctr, New Orleans) Pediatrics 128:S8-S11, 2011^§

Abstract

Background

Hurricane Katrina caused more than 1800 deaths and over $80 billion in damage along the Gulf Coast in August, 2005. A neonatal physician at University Hospital in downtown New Orleans before, during, and after Hurricane Katrina hit that region recounts how neonatology care was accomplished under trying conditions and how it evolved thereafter. The hospital cared primarily for inner-city indigent families.

The Neonates

All neonatal intensive care unit (NICU) patients at University Hospital survived both the storm and the evacuation. The two sickest NICU patients were premature infants with progressive chronic lung disease dependent on high-frequency ventilators. With no reliable power and running water the morning after the storm, these infants had to be transported through floodwaters by canoe and fire truck to Children’s Hospital, then to a third hospital when Children’s closed. One infant was eventually hospitalized in Fort Worth, Texas before being lost to follow-up. The other spent 3 months in Baton Rouge, Louisiana before returning to New Orleans. This infant was briefly hospitalized for a viral respiratory infection in the spring of 2006. One child was born preterm 4 days after Katrina made landfall to a mother hospitalized before the storm with threatened preterm labor. The equipment used to care for her was powered by a portable generator, and no routine services (blood gas determinations, laboratory studies, and radiographs) were offered. After 8 hours, she was transported along with 30 other NICU and well infants to Baton Rouge. Reuniting infants and families was challenging because of the city’s evacuation and relocations to areas other than New Orleans.

The Hospital

Both University and nearby Charity Hospital closed because of flood damage, so temporary emergency medical care was provided at other sites. Only after several months of repairs was full-service health care resumed. The first newborn infant after Katrina was delivered at University Hospital in February 2007. As patient volume grew, neonatal care was upgraded stepwise from level 2 to level 3. Over the next 3 years, delivery numbers plateaued at one fourth the volume pre-Katrina. In July 2010 the hospital closed obstetric and neonatal care services because of lack of patient volume and state budget cuts. In addition, many indigent residents did not return to the city and other area hospitals were preferred sites for obstetrics when University Hospital closed.

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