From molecular discoveries to health policy applications, Drs. Maureen Groer and William Sappenfield have built impressive careers working to improve perinatal care.

Many parents may never understand how the health of their children begins long before birth, but USF Health’s Maureen Groer, PhD, and William Sappenfield, MD, MPH, are both passionate about translating research into better health care and outcomes for mothers and babies.

Dr. Groer, who holds a PhD in physiology, is a pediatric nurse, family nurse practitioner and the Gordon Keller Professor at the USF College of Nursing. She works primarily at the micro level – examining the molecular mechanisms underlying immunology, biology and behavior and how the “crosstalk” among these systems may affect the health of infants and their mothers.

USF College of Nursing’s Maureen Groer, RN, PhD, FAAN, a nurse physiologist with more than 35 years experience, studies underlying biobehavioral mechanisms affecting the health of infants and their mothers.

Dr. Sappenfield, a pediatrician and epidemiologist, is professor and chair of Community and Family Health at the USF College of Public Health, director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies, and co-director of the Florida Perinatal Quality Collaborative.   He works at the macro level – joining a variety of stakeholders to distill population data about diseases and their risk factors, treatment patterns and socioeconomic conditions into meaningful policies and practices to improve the health of mothers and babies.

USF College of Public Health’s William Sappenfield, MD, MPH, is a pediatrician and epidemiologist working with stakeholders at the local, state and national levels to improve the quality of perinatal care.

Linking the gut microbiome of premature infants with long-term health

The beneficial balance of trillions of bacteria, viruses and other microorganisms in the digestive tract – known as the gut microbiome – has become a hot research topic. Dr. Groer is particularly interested in the link between the gut microbiome in premature babies and their long-term health. Increasing evidence shows that the interaction of microbe populations and controlled inflammation in the gut plays a critical role in developing a healthy immune system. Other studies point to a gut-brain microbe connection with neuropsychiatric illnesses, such as autism, and attention deficit hyperactivity disorder.

In full-term healthy infants a “signature” gut microbiome – influenced by diet, where someone lives and other environmental determinants — is typically established by age 3.  But when infants are born too early, the proper evolution of the gut may be disrupted by various factors, including delivery by Cesarean section (C-section), physiological immaturity of the baby’s organs, and extended time in the neonatal intensive care unit (NICU).

While the NICU provides lifesaving supportive care, babies who spend their first weeks or months there, instead of living at home, receive multiple antibiotics, undergo stressful invasive procedures, interact less with their mothers, and typically ingest more formula milk than breast milk, which would transfer the mother’s own beneficial gut bacteria to the lactating infant.

The USF College of Nursing Biobehavioral Laboratory that Dr. Groer oversees is one of the top wet labs for nursing science in the country.

The National Institute of Nursing Research recently awarded Dr. Groer a $2.7 million, five-year grant to study how DNA extracted from the gut microbiome of preterm infants may be influencing their growth and development. The discoveries by USF and others may ultimately help devise ways to modify the mix of bugs in the premature baby’s gut to create the best microbiome possible for long-term physical and mental health.

“We don’t yet have the science to develop tailored probiotic treatments, but I think that’s the future,” Dr. Groer said. “This research might lead to early diagnosis and treatment of chronic bowel diseases, ways to reduce allergies and autoimmune diseases, and even new ways of preventing depression and anxiety.”

Dr. Groer with Adetola Louis Jacques, MD, a maternal-fetal medicine fellow in the Department of Obstetrics and Gynecology, collaborate on data for a manuscript. Dr. Groer works with researchers across several disciplines.

Continuously funded by the National Institutes of Health for the last 15 years, Dr. Groer works with colleagues in nursing, medicine, anthropology, developmental psychology, microbiology and other disciplines. Her work has contributed to a better understanding of the biobehavioral mechanisms underlying mother-infant interactions, including the growing body of evidence about the extensive health benefits of breastfeeding.

“To attract the kind of research funding we need to launch and support big studies, nurses need to understand metabolism, genomics, microbiomics and proteomics,” Dr. Groer said. We need this type of data-driven laboratory environment to contribute to the next generation of science, which is molecular.”

Using the power of meaningful data to help transform perinatal care quality

Even though he is a board-certified pediatrician, Dr. Sappenfield decided to embark on a career of public health research and practice instead of entering a traditional medical practice following his residency. He earned a master’s of public health degree from Harvard and completed postdoctoral training in preventive medicine and applied epidemiology at the Centers for Disease Control and Prevention (CDC).

“I fell in love with public health, because it was a way I could impact the health of children and families on a population basis, not just one child at a time,” Dr. Sappenfield said. “Knowing I can work with others to make a true measurable difference in lives of mothers, children and families gives me all energy I need to get up every day and go again.”

Dr. Sappenfield outside the Lawton and Rhea Chiles Center for Healthy Mothers and Babies, which he directs. The statewide center is based at the USF College of Public Health.

One of Dr. Sappenfield’s key academic achievements to help transform quality of care for pregnant women and newborns has been co-founding and co-directing the Florida Perinatal Quality Collaborative (FPQC) with John Curran, MD, professor of pediatrics and an associate vice president at USF Health.

The FPQC provides leadership and technical assistance to public and private partners across the state, often joining perinatal quality collaboratives in other states to launch health care quality improvement initiatives. Physicians, nurse midwives, nurses, public health professionals, hospitals, advocates, policy makers and payers voluntarily and collectively work together on select evidence-based initiatives to make measurable improvements in Florida’s maternal and infant health outcomes.

“Most of the initiatives we’re funded to do at $100,000 to $200,000 per year have been saving millions of dollars in costs while also improving health care and the quality of lives of mothers and babies,” Dr. Sappenfield said.

For example, one of FPQC’s first successes was its participation in a March of Dimes-supported, multistate pilot project to reduce escalating rates of early elective deliveries – inductions of labor and C-sections without a medical reason before a baby reaches a full 39 weeks gestational age.  Babies delivered before full term are at higher risk for serious complications, including respiratory distress, brain injuries, learning disabilities, and breastfeeding problems.

Dr. Sappenfield works with colleagues at the Chiles Center.

A recent demonstration project to reduce potentially deadly central-line associated infections in newborns saved an estimated $8 million over 18 months by avoiding infections, reducing hospital stays, and preventing deaths, Dr. Sappenfield said. Using hospital-specific data monitoring and hands-on training, the FPQC helped 18 Florida NICUs establish practices proven to reduce infection, including rigorous catheter insertion protocols and techniques for maintaining a sterile environment.

A new project to start in September focuses on improving the use of antenatal steroids, medications shown to safely reduce complications for premature babies when given at the optimal time to women at high risk for preterm deliveries. A second initiative expected to launch in November targets hypertension (high blood pressure) during pregnancy, one of the leading causes of pregnancy-related illnesses and deaths in Florida.

“With quality improvement, we’re trying to take what we’ve learned (works) from research and put into place systems and practices to make sure everyone gets those benefits,” Dr. Sappenfield said.

Dr. Sappenfield, a pioneer in applying epidemiology to issues affecting maternal and child health, has worked in the field for more than 30 years. “There’s never been a more exciting time than now,” he says.

Dr. Sappenfield is optimistic about the potential to make even greater advances in maternal and child health.

“I’ve been working to try to improve the health of mothers and babies for 30 years, and there’s never been a more exciting time than now,” he said. “Everyone is willing to work together to make a difference in the lives of these mothers and babies.”

Photos and video by Sandra Roa, USF Health Communications

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Closely huddled by attentive residents and students, USF physician Charles Edwards, MD, performs his daily rounds of patients inside Tampa General Hospital. Dr. Edwards is a hospitalist and as such, he and his team care for hospitalized patients until they are well enough to be discharged. Patient stays range anywhere from 12 hours to many months.

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Regardless of stay length or ailment, these in-house doctors known as hospitalists lead a team of other specialists such as physical therapists, nurses and pharmacists, to best provide safe and efficient patient care.

“We see every type of patient at this hospital so it’s hard to say that there is a typical pattern and that’s one of the unique challenges for a hospitalist,” said Dr. Edwards.

During patient visits, Dr. Charles Edwards takes time to connect with his patients to learn about their lives and individual challenges that may effect health outcomes.

The hospitalist role is fairly new in medical practice, just two decades since the position first began to appear. Its purpose was to eliminate needless transportation time for primary care doctors so they could focus more on office visits and so that the hospital can provide immediate personalized care to their patients. Currently there are 34 USF Health hospitalists working at Tampa General Hospital.

“We are here, we are here 24 hours a day. Available immediately to see patients, if needed,” said Dr. Edwards who takes pride in connecting with his patients, “though [my care] may not continue, while they’re here [I’m] going to care for them as much as their primary care doctor does.”

On a typical morning you’ll find Dr. Edwards and his team reporting on their patients’ progress with details about medication, mental status and sleep or eating patterns. They will see between 15 to 20 patients throughout the day. However, patient care involves more than bedside visits. For physicians like Dr. Edwards, responsibilities extend into his personal life and he is passionate about it. He might read more about the symptoms of a patient he’s not sure about or catch up on the latest from his favorite medical journal.

Residents and students evaluate patients’ progress with Dr. Edward’s guidance.

Dr. Edwards’ profession is not just about patient care, it’s an “innate curiosity about medicine,” and a balance of at least four other roles. In addition to being the director of the Division of Hospital Medicine, vice-chairman for Clinical Operations in the Department of Internal Medicine and chief of staff at TGH, he is also an associate professor at USF Health’s Morsani College of Medicine.

Patient records are updated as Dr. Edwards and his team complete morning rounds.

“Without a doubt teaching is my main inspiration,” said Dr. Edwards. “The one thing I can do and enjoy, [is to] go around with my students, residents and my team to see our patients.”

Many doctors were inspired to pursue their profession by personal reasons, or wanting to do something important in life. Dr. Edwards had these reasons, but his active role as an educator is a daily reminder of the benefits of his kind of work.

“I’m constantly around other people who are learning,” said Dr. Edwards. I constantly have to try and teach younger physicians and that’s one of the best ways to learn, is to teach. They certainly keep you on your toes.”

Dr. Charles Edwards and his team provide non-surgical patient care throughout Tampa General Hospital.

Aside from his patients, mentorships and dedication to keep up with medical advancements, Dr. Edwards has his mind set on the future of hospital medicine.

“We’re constantly looking for ways to make the hospital safer,” said Dr. Edwards. He’s referring to the main challenge his profession faces: The transition of patient care.

Caring for patients has a multi-level set of tasks that include bedside visits, medical charting, preventing infections, avoiding unnecessary tests, not delaying patient stays, and the continuum of patient care beyond their hospital stay.

“One of the things that you must do is make sure you understand the challenges a particular patient is going to face when they’re discharged so that you can try to best address them,” said Dr. Edwards. “But it is often a source of anxiety when patients leave the hospital.”

The final stage of Dr. Edwards’ care involves updating the patient’s records and sharing the hospitalization charts with the primary doctor. Patient medical information is private and protected by federal HIPAA laws, which limit how hospitalists and primary doctors can exchange records.

Medicine, as most professional fields, has been increasingly harnessing the powers of technology. The transition of patient care is eased by the standardization of electronic health records and USF Health’s Physicians Group patients will benefit even more with its transition to EPIC– the same EHR used at TGH, thus providing a stronger continuity of care. With a unified records system, interdisciplinary caregivers can access thorough medical data about a patient. Hospitals, clinics and physicians can share details about their patient’s outcome and will help relieve the worry that hospitalists have when treating or discharging patients. But for Dr. Edwards, the best assurance has a personal touch.

“Technology will certainly play a big role in improving the transition of care in the future, but there’s no substitute for good old-fashioned verbal communication with fellow colleagues.”

Story and multimedia by Sandra C. Roa, USF Health Office of Communications.