Babies can develop complications so quickly that sometimes even fiveminutes is too long to wait for expert care.
So whether it's noonor 3 a.m., there is a doctor in the house at Carroll County General Hospital who specializes in infants and children.
The pediatrician might be in the nursery, the pediatric ward or the small room next to the nursery that has a desk, a chair and a bed for the overnight shift.
One year after starting an in-house pediatrician program, the hospital has worked up to 24-hour coverage.
Dr. Kenneth Broadbent, 34, the head in-house pediatrician, was hired ayear ago. He has since built a staff of two other full-time pediatricians -- Dr. James Wilde and Dr. Janelle Sandford -- plus about sevenothers who "moonlight," or work a few shifts weekly or monthly in addition to continuing their studies.
A Salt Lake City native, Broadbent graduated from the University of Utah and Duke University Schoolof Medicine in Durham, N.C. He completed his internship and pediatric residency at the Johns Hopkins Medical Center in Baltimore.
While larger hospitals all have in-house pediatricians, hospitals the size of CCGH rarely do, Broadbent said. But he said the trend is for more small community hospitals to create such positions. Employment ads in pediatric journals are showing up from all sizes of hospitals, he said.
"One problem with infants is their repertoire is limited forletting you know there's something wrong," Broadbent said. "They can't talk to you, and the signs for a serious infection are often the same as for a not-so-serious infection -- hard to wake up, fever. It'ssubtle things. That's one of the challenges of pediatrics -- to knowwho's sick and who's not sick."
One guide is the age of the infant or child. Certain ages are prone to certain illnesses, Broadbent said. An infant under 2 months old is susceptible to a group of infections that can be contracted during birth but not show up until days orweeks later.
Emergency physicians are trained to handle all ages and illnesses and injuries, Broadbent said. But infants and children are so much trickier to diagnose and involve so many variables that apediatrician can detect what another doctor might not.
For example, a mother recently brought her 3-day-old baby girl to the emergencyroom saying she had had a fever of over 100 degrees at home. But thebaby didn't have a fever when her temperature was taken at the hospital, Broadbent said.
"Everyone thought the child was all right," he said. "I wrestled with whether to work her up as if the fever were real. For a combination of reasons, I guess, I did, and we took a spinal tap."
It turned out the baby had meningitis and what is calleda Group B strep infection that is contracted during birth.
"I'm sure the child would have died during the night" had she not been admitted, Broadbent said. "I was very glad I did the spinal tap, but it was a judgment call. Would it have been different if I wasn't here? Maybe, maybe not."
In 1986, infant Brett Morris died at CCGH 19 hours after birth from a lung disorder. His parents sued the hospital andDr. Karl Green for malpractice, saying they didn't do enough to savethe baby.
A Carroll County jury in June found both the hospital and Green not responsible for the baby's death, after hearing testimony from various experts -- some saying the cause of death was preventable and others saying the baby would have died regardless of treatment.
Broadbent declined to comment on the case and said he intentionally has not become involved with it because it happened so long before he arrived.
"Our (CCGH's) view of what happened that night is the in-house pediatrician would not have made a difference," said Linda Harder, vice president for marketing, planning and public relationsfor the hospital. "But who can go back and reconstruct history?"
Getting an in-house pediatrician, she said, "was definitely not because of that death. We think everything was done for that baby that could have been done."
She said the main reasons for the staff pediatrician are to have someone available for Caesarean sections and to beable to care for more sick newborns without transferring them to larger hospitals and separating them from their mothers.
However, LaVonna Vice, attorney for the Morris family, said she believes the baby's death did affect the hospital's decision to have an in-house pediatrician.
"The time sequence is too obvious for it to be coincidental," Vice said. "I do believe that had a full-time pediatrician been on staff, the Morris baby would have received treatment in time to have prevented the death."
In the pediatric ward, hospitalized children still are monitored by the doctors who admitted them. Children who come through the emergency room with a serious problem or who don'thave a doctor, however, are likely to see the in-house pediatrician.