JEANNA DUERSCHERL The Roanoke Times

Denise Pollock, a registered nurse at Lewis-Gale Medical Center, has been working in the nursery for 32 years. A spokeswoman for HCA, the company that owns Lewis-Gale, said the number of babies being transferred in the past three months has more than doubled.

JEANNA DUERSCHERL The Roanoke Times

Nurse Denise Polluck handles newborn Abigail Shinault on Wednesday at Lewis-Gale Medical Center in Salem. In April, the hospital announced a $2.5 million renovation to its maternity wing.

Lewis-Gale Medical Center plans to seek state permission to add neonatal services as it continues to vie for a larger slice of the maternity market in the region.

The Salem hospital, which is owned by the national for-profit HCA Inc., has told the Virginia Department of Health that it intends to file an application to add a neonatal intensive care unit with eight specialty bassinets to its hospital.

The NICU would be used to treat babies born with complications such as those who are born prematurely, have a low birth weight or have other health complications that require specialized care.

Lewis-Gale's top local administrator, Victor Giovanetti, said there is a need for more neonatal services in the regional market, at Lewis-Gale and among the larger, four-hospital HCA network in Southwest Virginia.

But Carilion Clinic, which operates a 60-bed NICU at Roanoke Memorial Hospital, hasn't seen a need for additional neonatal services.

"Since we are only at 77 percent capacity, we have the capacity to take more patients," Carilion spokesman Eric Earnhart said.

For 2010, the average daily census in Carilion's NICU is 46 and the average stay is 24 days, Earnhart said.

Currently, babies born at Lewis-Gale who require NICU services must be transferred to another hospital. Many are sent to Roanoke Memorial, although some are sent to other hospitals including Duke University Health System or University of Virginia Health System.

"It is clinically and emotionally challenging to have the mothers and babies separated," said Giovanetti, president of HCA Southwest Virginia. "We think it is inherently important that we provide that speciality care to keep them together."

Last year, 17 babies were transferred to an NICU after being born at Lewis-Gale. That doesn't include mothers who were sent to another facility that had NICU services prior to giving birth.

The number of babies being transferred in the past three months has more than doubled, HCA Southwest Virginia spokeswoman Nancy May said. She would not provide exact numbers.

Much of the growth in transfers is attributable to an overall growth in babies being born at Lewis-Gale as the hospital added three new obstetricians to its medical staff in March, Giovanetti said.

In April, Lewis-Gale announced a $2.5 million renovation to its maternity wing. At the time, Giovanetti said there were no plans for an NICU to Lewis-Gale. That changed, he said, with how quickly the maternity expansion plans were taking hold.

"This is appropriate to meet the demand being placed on us by patients and physicians," he said.

Carilion's Earnhart would not directly take a position on Lewis-Gale's interest in adding an NICU, saying he has not seen the application. But he did point to two published studies that showed the infant mortality rate was lower at larger facilities when compared with smaller settings.

Rebecca Arbuckle, who heads the women's health program at the Chicago-area consulting firm Sg2, said there is evidence that shows the staffing ratios in an NICU make a difference in baby outcomes. Because of that, her firm recommends smaller NICUs that make sure they can run near capacity.

Earnhart also pointed to state regulations for expanding NICU services that indicate preference is given to the expansion of existing centers over creating new programs.

A recent state staff report recommended that the commissioner approve a new NICU at a smaller hospital in Stafford County despite an NICU being located 9 miles away at a larger hospital in Fredericksburg. However, both hospitals are owned and operated by the same entity, Mary Washington Healthcare, unlike competitors Carilion and HCA.

This is the first step in a long process that Lewis-Gale has to go through to operate an NICU. The next step is to submit a detailed application. While Lewis-Gale has a year to file the application, Giovanetti said he plans on filing it by July 1.

After a review process, Virginia's health commissioner could decide by December, at the earliest, to approve or deny the request. Giovanetti said once his hospital has permission to proceed, it would take about seven months to construct the NICU.

Giovanetti would not provide a cost estimate for the project.

Arbuckle said many hospitals do not make money on obstetrics but that an NICU is often the service where hospitals can begin to make a profit. But she said there are other reasons to concentrate on maternity services.

"It may be valuable to reach those women," she said. "Women are the number one decision-makers for themselves and their families."

Arbuckle added that many women rely on their obstetrician for referrals.

"That varies on transiency of the market, but the idea is if we get them for delivery, they'll come back for life," she said.