Bakersville resident Stephanie Pitman drives two-and-a-half hours to Novant Health Hemby Children’s Hospital in Charlotte to access specialized care for her son. Nine-year-old Gabe — an avid music lover and horseback rider — has cerebral palsy and short gut syndrome, among other issues. He has sustained about 15 surgeries and now visits the hospital at least once a year.
“Gabe has some pretty specific medical issues. Having doctors and surgeons and specialists that are familiar with those specific needs, we just couldn’t find that close to home,” Pitman said.
Charlotte and surrounding areas need more space and providers for specialized pediatric care, said Dr. L. Eugene Daugherty, medical director at Novant’s Hemby Children’s Hospital and the pediatric intensive care unit.
Daugherty said a fast-growing population is driving a need for expanded pediatric care and dedicated facilities across the Charlotte region. Patients and their families also need more care options, he said.
The city’s largest pediatric centers are Hemby, a 76-bed hospital in Presbyterian Medical Center that has served 95 counties in the Carolinas, and Atrium Health’s Levine Children’s Hospital, a national top 50, 236-bed hospital at the Carolinas Medical Center campus.
“If you were to just take either Atrium and its pediatrics support or Novant and its support and just eliminate one of them, this city could not take care of pediatric patients adequately,” Daugherty said.
In response, Novant has been bulking up specialty pediatric care here, investing approximately $38 million each year. It continues to grow 16 subspecialties — planning for expansion in the Hemby neonatal intensive care unit, capitalizing on partnerships to advance cancer care and adding to capabilities in neurology. Novant is also investing in its clinical network to support specialty care.
Charlotte has now become Novant’s hub for pediatric services, well surpassing the headquarters market in Winston-Salem in terms of investment and specialties. The health system has no plans to slow down.
NEONATAL INTENSIVE CARE
Novant Health’s neonatal intensive care unit sees more than 19,000 patient days in a year. The unit is a Level IV NICU, the highest level of care in North Carolina. Providers can care for premature babies weighing as little as 465 grams, or 1.02 pounds, and as young as 22 weeks.
Gabe, for example, was born at 24 weeks, weighing 1 pound and 14 ounces; he spent about six months in the Hemby NICU.
“There’s a lot of advanced capabilities to be able to do that. Not many NICUs in the country can boast of that,” said Saad Ehtisham, president of the greater Charlotte market at Novant.
The unit offers comprehensive care, including respiratory therapy, nutrition, early intervention, physical therapy, support from social workers and pharmacy access, to name several. It has about 10 board-certified neonatologists.
In 2020, the unit cared for an average of 52 babies per day. However, it is only licensed for 38 beds. Novant is in the planning stages of a $5.6 million, 12-bed expansion that will relocate beds from Presbyterian Medical Center. Construction will likely start at the end of this year or the beginning of next year, said Diana Sutton, director of nursing at the Women’s and Children’s Institute.
The hospital expects the expanded space to deliver in 2022, Sutton said. It will have space for 12 total headwalls, which accommodate medical equipment and tubing. Novant plans to hire providers to accommodate the additional capacity, she said.
“Any construction project can be challenging, but really the space that we will be utilizing for the expansion is connected … to our NICU. It’s in a back hallway where we have office space, so it really will not affect any of the care that we’re currently providing,” she said.
Daugherty said the project will allow for more space and privacy as families bond with their newborns.
Sutton said the number of patient transports from community hospitals, including those in Novant's system, has grown by 20%. Earlier this year, Novant was asked to start providing care from neonatal nurse practitioners for Davis Regional Medical Center in Statesville and Lake Norman Regional Medical Center in Mooresville.
ONCOLOGY
Hemby’s pediatric cancer clinic is the only one in the Carolinas affiliated with Memphis, Tennessee-based St. Jude Children’s Research Hospital.
The St. Jude affiliation gives Hemby more access to research that physicians can then apply to clinical care, said Dr. Jessica Bell, a pediatric oncologist. Personalized medicine is growing, she said, with researchers analyzing patients’ DNA and how it relates to the cancer’s composition.
Bell recalled one patient diagnosed with stage-four neuroblastoma. Years after diagnosis, St. Jude researchers found the patient to be predisposed to cancer and at risk for other types. That patient now has full-body MRI scans each year to monitor any changes. Those could be life-saving scans.
“A child is definitely not a small adult. Their physical biology and the cancer biology is different, but then actually how you approach the problem has to be different because of how rare it is as an overall disease,” Bell said.
Close to 16,000 children in the U.S. are expected to be diagnosed with pediatric cancer this year, according to the National Cancer Institute.
The St. Jude-affiliated clinic is expanding into the entire second floor of its current building on Hawthorne Lane, marking the addition of nearly 8,900 square feet. It is adding exam rooms and infusion spaces.
Cancer patients, and others at Hemby, often work with child-life specialists, who help children understand procedures and offer distractions during painful treatments, among other responsibilities.
Daugherty said the distractions can decrease the amount of sedation required, which leads to faster recovery times. This month, Novant is launching virtual reality games for children to complete activities during procedures, Ehtisham said.
Families can use the Ronald McDonald Family Room at Caroline’s Corner to work, watch TV, eat, shower and do laundry.
Hemby is one of three organizations nationwide to participate in clinical trials with St. Jude and the Children’s Oncology Group, the world’s largest organization focused solely on childhood and adolescent cancer. Pediatric oncology at Hemby has about 30 open clinical trials, including partnerships, Bell said. Trials could look at leukemia treatments, bone marrow transplants or blood disorders, as examples.
Most trials take several years, Bell said. Patients can now stay in Charlotte to participate, although some do require visits to St. Jude in Memphis.
NEUROLOGY
Pitman and her son, Gabe, have also worked with the neurology team at Hemby. Dr. Shana Wallace, a pediatric neurologist, has known Gabe since birth. Pitman recalled how she worked with the family to help them understand periventricular leukomalacia, a type of brain injury in premature babies.
Wallace was able to help when Gabe started having seizures. The family and medical team are working to regulate those. His last seizure was in January.
Pitman said coming to Hemby is worth the drive, considering how familiar the staff is with Gabe. She described the hospital as a second home. Even new doctors have at least gone through his medical chart, she noted.
“Once we got here, we felt like that sense of calm. It’s OK. We’re here. They’ll help us. They’ll help Gabe,” Pitman said. “As a parent, that’s all you want. When your child is sick, you just want somebody that you can trust that will do the best for your child.”
Novant continues to build niche capabilities in pediatric neurology. Recent examples include a cleft palate and craniofacial program and a scoliosis and spinal deformity program for adolescents and adults. It is now developing a spinal oncology program, said Dr. Erin Kiehna, a pediatric neurosurgeon.
Kiehna filled a void when she arrived at Novant in 2017. As Novant’s first pediatric neurosurgeon, she can handle everything from brain tumors and epilepsy to traumatic injuries. She can also treat hydrocephalus, spasticity, spina bifida and congenital issues, to name a few.
Young patients had often been transferred to other facilities.
“You don’t have to go up to a place like Johns Hopkins or another medical center to receive what is state-of-the-art care,” Kiehna said.
Kiehna and her colleagues work on multidisciplinary teams to come up with best treatment options — including less invasive procedures that will improve future quality of life. She has seen patients across the Carolinas, with most referred from the surrounding region.
At Hemby, there are fewer layers, and patients have more direct access to doctors, Kiehna said. She can also communicate one-on-one with other doctors and can call them directly if treating their patient.
CLINICAL NETWORK
Novant leverages a local network of outpatient clinics to support specialty care. There are 29 specialized locations.
Novant saw a drop in pediatric patient volume due to Covid-19, but numbers are recovering. Ehtisham said parents were afraid to bring their children into the offices. The system had to shift its operating model to accommodate in-person and virtual care options. He said pediatrics saw a high adoption of virtual visits. The system logged more than 45,000 in 2020.
Despite Covid-19 challenges, the outpatient clinics are focused on a growth trajectory, said Stephanie Appling, administrative lead for the Children’s Health Institute in the greater Charlotte market.
The health system is adding two more providers in allergy and immunology, plus a food allergy desensitization clinic, and creating a cystic fibrosis clinic within pulmonology. It is recruiting a pediatric endocrinologist and could need another in years to come, Appling said.
Starting this year, Novant is launching growth hormone stimulation testing in endocrinology.
Novant continues to add to its pediatric development and behavioral health center, which offers services such as physical, occupational and speech therapy. It partnered with Thompson Child and Family Focus and Discovery Place last year to open a follow-up clinic for NICU patients.
Six pediatric specialties were offered at one location on Queens Road. As doctors joined to start new programs, those specialties outgrew the space. Pulmonology and allergy and immunology expanded to a Carmel Road office. Nephrology and cardiology will move into the same space at the end of the year, but that location has not been decided.
Those changes are making room for remaining specialties to grow in the original clinic space, Appling said.
“The last thing I want to do is tell a patient, ‘Oh, we don’t have that service. I think you’re going to have to travel to Raleigh or somewhere else in order to receive that care,’” Appling said. “That’s not fair to our patients. We really need to deliver the care here.”