Big neonatology in a small town after ten years

"In 2011, I joined a well-functioning urban-type maternity hospital with about 1 400 births a year," says neonatologist Milena Dokoupilová, MD. She accepted the offer from the owner of the hospital in Hořovice, Sotirios Zavalianis, as a great challenge to use her knowledge and experience gained during her 18 years at the perinatology centre at Apolinar. She was given the opportunity to build a completely new centre from the ground up, assembling a team of doctors and nurses. The first years were not easy at all, as it was very difficult to find staff due to the high specialisation of the field. The goal was to build a quality perinatology centre for intermediate care.

"We opened the first four intensive care beds within the observation box of the physiological newborn unit and started receiving babies born from the 33rd week of pregnancy in 2011. We worked in these spaces for 2 years, then due to the increasing number of births we had to expand the number of beds to eight. We created the physiological newborn observation box from another room in the sixth-grade ward to be able to take care of almost all the newborns who required intensive care after birth," says the head nurse.

At the same time, work began on the design of a brand new Neonatal Intensive Care Unit with 10 intensive care beds and 5 rooming-in beds for sick or immature newborns from the 30th week of pregnancy. Construction began in 2012 as a new addition to the existing building. "From the very beginning, due to the specialised care I was able to take an active part in all the designs and preparations, which certainly contributed to the excellence of the ward both technically and in terms of design," praises the head of the department.

And on 18 August 2014, the ward was inaugurated. In the same year, for the first time in the history of Hořovice Hospital, we received the status of Perinatology Intermediate Care Centre, which placed us among 27 maternity hospitals in the Czech Republic providing care for immature and sick newborns.

The intensive care unit is equipped with the most modern technology with the possibility of central monitoring of babies in the mothers' rooms. Modern incubators, warming beds, ventilators and other equipment provide newborns with high comfort even in more serious conditions.

We have tried to build a place that does not feel cold and sterile, but instead gives parents the impression of a home-like environment, comfort and peace. The situation when a child is born prematurely or with some problems puts a great psychological burden on the staff and the parents of the children. The needs of medium and slightly immature babies are different from those of babies in the lower weeks of pregnancy. Most just need quiet, warmth, lots of patience. Learning to suck, and most importantly, to be in contact with their parents. Our goal from the beginning was to involve the parents as much as possible, and especially as early as possible, just to reduce their feelings of fear and helplessness. We need to be supportive of them all and create the right environment. We have had completely unrestricted visits from both parents since we opened.

The cornerstone of any good neonatology is a well-functioning neonatal physiology unit. Ours has 24 beds. Currently, with the national decline in births, we are focusing more on creating family rooms so that both parents can be part of the newborn's care in the first hours or days after birth. In 2023, we became the best maternity hospital in the Central Region.

In the last 10 years, 16,908 newborns have been born at our maternity ward, nearly 3,000 of whom needed our intensive care unit. The smallest baby born and staying with us weighed 980 g, the largest 5700 g. The reasons why newborns come to the intensive care unit vary. In 60% of the cases, they are immature babies born before 37 weeks of pregnancy; in the case of premature newborns, they are mainly due to impaired postnatal adaptation, hypoglycaemia, hypoxia, infection or congenital developmental defects.

We have special cooperation with the Department of Paediatric Surgery at Motol University Hospital, where we admit newborns before or after various surgical procedures, mostly for congenital developmental defects. We also cooperate with the Perinatology Intensive Care Centres in Prague and Pilsen, from which we take regional patients for treatment. In ten years we have received a total of 302 newborns from these centres.

In order to provide comprehensive care, we care for our children in the neonatal at-risk clinic and in specialized outpatient clinics within the children's department, with which we work closely.

As we are interested in how our children who had a bit more difficult time at the beginning grow up, our department organizes a series of meetings under the leadership of the head nurse Mgr. Přádová, every year we hold a Garden Festival in the garden of Hořovice Castle. It is currently attended by three-year-old children who had the most difficult start in life.

We also participate in the national education of doctors and nurses by organizing the successful conference Days of Neonatal Case Studies, which was held at Zbiroh Castle for the eighth time in 2024. It is attended by over 200 participants from all over the country and Slovakia every year.

The intensive care unit at the hospital in Hořovice is celebrating its tenth anniversary. Thanks to the originally very modern and above-standard equipment, it has not lost its charm and many departments still come to us for inspiration.

"Building a quality team of nurses and doctors who, in addition to professional quality, have a lot of patience and love was very challenging, but we have succeeded. Without my head nurse, Mgr. Kamila Prádová, I would never have been able to do it. Every person in our team has an irreplaceable role and I appreciate everyone very much. My admiration and gratitude to all of them for making this happen somewhere in the fields," says Milena Dokoupilová, the head of the neonatal ward.