Taking home a new baby is nearly always a daunting experience for first-time parents. It is much more frightening for couples whose baby was born early and brought home after weeks or months in a neonatal intensive care unit due to prematurity or other reasons.
Prof. Michael Schimmel, a specialist in neonatology – care of the newborn – for 43 years, ran the neonatal intensive-care unit at Jerusalem’s Shaare Zedek Medical Center (SZMC) for 24 years. He went on pension in 2019 but decided not to devote all his free time to leisure.
Together with the Jerusalem Municipality, Schimmel established three centers to counsel parents of premature babies and others discharged from intensive care units. These are the only centers for counseling bewildered parents and following up on their infants in Israel – and the world.
He joined Israel’s first neonatology department, established in 1978 by the esteemed Prof. Arthur Eidelman, who settled with his family in Jerusalem after completing his medical degree at Yeshiva University’s Albert Einstein College of Medicine and specializing in pediatrics at Yale University’s School of Medicine. After neonatology was accepted as a sub-specialty in the US, Eidelman was asked to establish and set the standards and training programs at the SZMC neonatology department. Neonatology was recognized as a specialty in Israel in 1985.
When Schimmel, who spent two years specializing at Columbia University Medical Center, joined Eidelman, there were four beds for newborns; when he left, there were 65. SZMC delivers more babies than any other hospital in Israel and, apparently, any other medical center in the world, with around 22,000 infants born there annually. About 15,000 premature babies born before the 37th week of gestation (out of 40) or at a low birth weight are delivered in Israel in an average year.
Preemies face a number of potentially dangerous conditions, including lungs that have not produced enough surfactant, resulting in stiff, collapsible lungs and an oversupply of liquid, making it difficult for them to breathe. They are treated in neonatal units with synthetic surfactant.
The earlier the premature birth is, the longer the hospitalization is likely to be. Preemies can also suffer from apnea (momentary cessation of breathing); asthma; infections, hearing, dental, intestinal, and vision problems; and more. “The chronological age of preemies is different from the maturity of the brain,” Schimmel noted. “Every newborn is different.”
Supporting parents - emotionally and physically
Beyond the physical problems that could face the infants, the parents need emotional and physical support, as the challenges ahead are very demanding.
Schimmel, who continues to teach pediatrics at the Hebrew University of Jerusalem’s Faculty of Medicine and even does shifts at his former SZMC department, explained in an interview with The Jerusalem Post that parents of preemies can bring their infants after their discharge to any of several dozen of the capital’s tipat halav (“drop-of-milk well-baby) clinics.
“They are run by nurses, with visits by doctors who have to examine about five infants per hour. I examine newborns and sit with their parents to answer their questions and discuss their concerns for a whole hour at a tune,” he said.
He praised Ella Mano ben-Yosef, who is in charge of the municipality’s public health department, for agreeing to establish the three centers. He also got support from Dr. Stephen Reingold, the medical officer in charge of maternal and infant health at the municipality’s public health department, which is in charge of tipat halav clinics.
“We welcome the preemies and their families on Mondays near the Central Bus Station, where haredim (ultra-Orthodox Jews) are the residents; on Tuesdays at the Har Homa quarter in the southeast of the city, and on Wednesdays in Ramat Eshkol. Arabs from east Jerusalem come for consultation as well. “I am happy to see anybody who can speak Hebrew or English, or bring a translator, as it’s important to understand the nuances. As it is a municipal service, we can’t accept any preemie from outside Jerusalem.”
Some parents, he continues, “are hysterical, totally lost about how to care for the tiny babies – but at the end, they tell us that they received what they needed and leave with a smile.”
At the end of each session, he gives the parents a summary, with a copy to their health fund; some of the health insurers have excellent follow-up, but others are not so efficient. “We have received 850 newborns since we opened the centers. There are extreme cases. Just today, I examined a baby who had a surgical, nutritional problem, but I found that she has a risk of cerebral palsy; no doctor before recognized the problem. I try to see the whole person.”
He regularly urges all Jerusalemite women – including haredi women from the more extreme communities, including Mea Shearim – to vaccinate themselves against whooping cough during pregnancy and bring their infants for a complete round of vaccinations. Sometimes, the cause is hopeless. “One mother from the Satmar hassidic sect refused to get vaccinations. I told her that several babies died of whooping cough in recent months, but, unimpressed, she said that her rabbi was against the shots.
A few years ago, Schimmel and his son-in-law, pediatrician Dr. Asael Lubotzky, who was severely wounded in the 2006 Second Lebanon War, saved the life of their newborn daughter/granddaughter at SZMC. Schimmel has tried to attend all the births of his daughters and grandchildren. When the newborn presented respiratory distress, Lubotzky quickly took on the role of doctor and began administering cardiopulmonary resuscitation. Schimmel joined in, managing to stay calm, and the baby started to breathe independently; all was well.
There are only about 100 neonatologists in Israel. “It’s a very difficult specialty. Young doctors don’t want to go into it because of the pressure and long hours. I always took my cell phone to the bathroom and to my synagogue on Shabbat, fearful that it would ring when I was called up to the Torah. You’re completely ‘enslaved,’ but you’re happy. I wouldn’t have done anything else. My wife, Evelyn, commented on the eve of Passover, after I retired in 2019, that it was the first time after we married that I was on hand to prepare the Seder.”
He encounters former patients who were infants when he cared for them. There were 30-year-old twins at the Western Wall; I was told by their family that I had treated them. A woman who was born at her 23rd week of gestation survived and came to our department in her wedding dress to thank us. It brings me great joy when people I had treated when they were premature babies come back to visit when they reach certain milestones in their lives, such as birthdays, bar mitzvahs, and other happy events.”
AFTER FIVE years of running the unique clinics, Schimmel and his colleagues were certain they were successful and beneficial to families, but they wanted to prove it scientifically. He has just published a study in the prestigious American Journal of Neonatology, titled “Neonatologist at the Well-Child Clinic: A High-Risk Infant Follow-up Pilot Study,” together with Reingold and nurse Liora Yotvat.
“Adequate high-risk infant follow-up (HRIF) is essential for the transition to community care yet often remains fractured with suboptimal continuity and quality of care as well as insufficient caregiver compliance,” they wrote. “Our experience with high-risk infants in Israel suggests that many community pediatricians are not confident in caring for complex infants. Coupled with a lack of timely specialist follow-up visits, insufficient follow-up care is provided immediately after discharge.”
The study presented a simple, single-provider model that proved effective and is well received by caregivers. “We measured caregiver use and satisfaction with an HRIF visit, attended by an experienced neonatologist in a well-care setting, soon after discharge. Among the infants of these parents, 78% were seen in the first three months of life and 39% within one month of discharge. Nutrition (98%) and development (97%) were the most commonly discussed topics, followed by general health (95%), iron supplementation (93%), and head size (90%).
It focused on 100 Jerusalemite families. “It was important for me to ask open questions such as, How do you feel about taking care of your little baby after being at the clinic? The marks our team received were incredibly high: On a scale of one to five, we got 4.56 points. I remember vividly an older woman who came to me. She gave birth to a preemie after undergoing dozens of in-vitro fertilization treatments. She panicked when doctors and nurses told her that the newborn was not suited to her chronological age, but I examined the baby and found that in developmental age, she was 100% OK. The woman calmed down immediately.”
Schimmel tries to inform relevant groups about the clinics. “I lecture to tipat halav nurses and speak about the project to the national conference of pediatricians,” he said. He hasn’t had time to submit articles to Hebrew- or English-language medical journals published in Israel.
Two years ago, Schimmel wrote and published a moving Hebrew-language book titled Roeh Et Hanolad (“Seeing the Newborn”), which discusses cases behind the scenes of SZMC’s neonatal intensive care unit. He vividly describes events, experiences, and moral dilemmas that he faced while dealing daily with premature births, birth defects, multiple pregnancies, questions of life and death, and critical moments when difficult decisions were needed. He concluded that he was very pleased when the text was recorded as an audiobook for the blind.