AUG. 20, 2003 | The start of a major new service by the University of Arkansas for Medical Sciences (UAMS) to Arkansas physicians who deliver babies could be “a turning point in the history of public health in Arkansas,” a leader of the Arkansas Medical Society said today.

Brenda Powell, M.D., of Hot Springs, an obstetrician and secretary of the AMS, praised UAMS and the Arkansas Department of Human Services (DHS) for their new three-way partnership to launch ANGELS, the Antenatal and Neonatal Guidelines, Education and Learning System, for obstetricians and family practice physicians who deliver babies.

UAMS, DHS and the state medical society today announced the launch of the unique new service for obstetrical care providers in Arkansas. UAMS and DHS leaders said the program has the potential to reduce the number of babies born in Arkansas with severe medical problems – and save the state millions in prenatal care and long-term care for those children. The service is the first of its kind in the nation.

ANGELS could “establish Arkansas as a national leader in the cause of reducing low birthweight,” Dr. Powell said.

Curtis L. Lowery, M.D., director of ANGELS, called low birthweight “a very serious public health problem.”

“Babies born at less than 5 pounds are at serious risk of severe and long-lasting health problems. These health problems can compromise their ability to grow and develop and can place enormous and permanent burdens on their families, and society, to care for them,” he said.

DHS Director Kurt Knickrehm commented that DHS serves 1 million Arkansans each year, paying for half of the state’s births through the Medicaid program. Children born with serious health complications represent a significant financial responsibility for the state, he said.

“Since the state Medicaid program pays for nearly half of all births in Arkansas, we have a heavily vested interest in keeping moms and babies healthy,” Knickrehm said.  “As the state’s largest insurer and as stewards of public dollars, we must strive to ensure that our services have a positive impact on people’s lives while reducing the cost to the State.”

UAMS high-risk pregnancy experts and the DHS Arkansas Medicaid program collaborated to obtain federal Medicaid funds for the project, which will involve the state’s obstetrical providers in developing best practices for high-risk cases and assist them in transferring pregnant women with extremely high-risk cases to UAMS before giving birth.

Judith McGhee, M.D., medical director for Arkansas Medicaid, told reporters that DHS began planning ANGELS with UAMS after determining that when high-risk babies are born at UAMS, they tend to have fewer complications. “When that kind of data comes out, you have to do something about it,” Dr. McGhee said. “Even small and fragile babies … can grow up to have healthy and happy lives,” she said.

 UAMS Chancellor I. Dodd Wilson, M.D., said in announcing ANGELS, “the University of Arkansas for Medical Sciences has a proud history of assisting and fostering expanded health care services around the state. For at least two decades, one of the tangible services we have provided is assistance to obstetricians and family practice physicians across Arkansas when they have had high-risk obstetrical cases.  UAMS has the only board-certified maternal-fetal medicine specialists in the state – these are the specialists with the greatest expertise in high-risk obstetrical cases. We have been very proud of our strong relationships with the state’s obstetrical providers and pleased that we could provide assistance to them when they requested it.”

“We anticipate considerable savings for the state from reducing the number of medically fragile babies – and that doesn’t consider the savings in pain and suffering by the children and their families,” Dr. Lowery said.

“The Arkansas Medical Society (AMS) is pleased to support this innovative program to deliver the newest information about maternal-fetal medicine to obstetrical providers in the state,” Brenda Powell, M.D., of Hot Springs, secretary of the AMS, said.

Hope and Jimmy Goodwin of Vilonia, Ark., whose quadruplets were born six weeks prematurely, two of them with twin-twin transfusion syndrome, praised the UAMS maternal-fetal medicine program for saving their babies from serious difficulties at birth. “Matthew, Lauren, Elijah and Gabriel are 14 months old now and doing very well,” Mrs. Goodwin said.

The “ANGELS” service will include clear guidelines for diagnosing and treating high-risk pregnancies, continuing medical education for Arkansas obstetricians and family practice physicians, and procedures for referring pregnant women with severe medical complications to UAMS for specialized care. Obstetrical and neonatal health care providers will have around-the-clock access to experts in high-risk pregnancy at UAMS.

“The Arkansas Medicaid program has made it possible for UAMS to work even more closely with obstetrical care providers across Arkansas,” Lowery said. “This is an enhancement of the great relationship UAMS has enjoyed with Arkansas’ obstetricians and family practice physicians. Thanks to the Arkansas Medicaid program, we’re able to work with local obstetricians to create a triage system that we believe will become a national model.” Triage is the process of ranking patients according to the severity of their illnesses and assigning them to different levels of care.

The guidelines for obstetricians will reflect “evidence-based medicine,” the term for medical procedures that are based on the results of large scientific studies of particular treatments. The maternal-fetal medicine specialists in the UAMS College of Medicine will summarize and share the results of significant studies with Arkansas’ obstetricians and family practice physicians.

“This program is just one part of the evidence-based medical approach the Department of Human Services is taking to improve the health of Arkansans,” Knickrehm said. “We are excited to work with UAMS to create a model other states can follow.”

“Practicing physicians often don’t have the time to read the hundreds of medical articles published each month and adapt their methods in response to what they learn. They spend all of their time taking care of their patients,” Lowery said. “We’re going to give them the essential information they need in a practical format that will allow them to identify and treat high-risk pregnancy cases and manage newborn care in a state-of-the-art fashion.”

Lowery predicts the service will reduce the state’s costs for Medicaid-covered pregnancy care and long-term care of children born with serious health problems such as prematurity, low birth-weight, birth defects or brain damage. The number of women in Arkansas who are eligible for Medicaid coverage of prenatal care has increased from approximately 14,800 last year to approximately 22,200, thanks to an expansion of the Arkansas Medicaid program funded by part of the state’s share in the nationwide tobacco settlement.

The Arkansas Medicaid program currently pays for full-time nursing care for about 134 medically fragile children, many of whom have health problems as a result of high-risk pregnancies, at an annual cost of $13 million.

UAMS will evaluate the ANGELS system by analyzing costs and outcomes for patients of participating physicians.

UAMS already provides advice and assistance to Arkansas obstetricians through a network of interactive video connections that allow physicians and their patients in nine Arkansas communities to consult UAMS specialists. The Reproductive Genetics Program at UAMS assists more than 2,000 patients annually with amniocentesis, genetic counseling, high-risk ultrasound, fetal echocardiography and video-based clinics. UAMS also provides continuing medical education classes for obstetricians as well as many other physicians.

Lowery is an associate professor in the Department of Obstetrics and Gynecology in the UAMS College of Medicine. He is a prominent researcher in maternal-fetal medicine and has pioneered a device to measure fetal brain activity. His device, called SARA, is a unique scanner that detects fetal brain activity in response to flashes of light transmitted through the mother’s abdomen. With refinement, SARA may help physicians detect and prevent fetal brain damage resulting from maternal hypertension, diabetes, and other conditions. 

Hope Goodwin of Vilonia, Ark., whose quadruplets born at UAMS survived despite complications, praised the UAMS high-risk obstetrical program Wednesday at an announcement of the new “ANGELS” program. (JohnPaul Jones) Click on photo for larger view.


Curtis L. Lowery, M.D., director of ANGELS (left), and Kurt Knickrehm, director of the Arkansas Department of Human Services (JohnPaul Jones) Click on photo for larger view.


Brenda Powell, M.D., of the Arkansas Medical Society, predicted ANGELS would be a “turning point” in public health in Arkansas. (JohnPaul Jones) Click on photo for larger view.


Helen Kay, M.D., chairwoman of the Department of Obstetrics and Gynecology in the UAMS College of Medicine (JohnPaul Jones) Click on photo for larger view.


This little girl observed the announcement of ANGELS closely. Her parents, Jessica and Bill Parkinson of Little Rock, attended the announcement to show their appreciation for the high-risk obstetrical care at UAMS. (JohnPaul Jones) Click on photo for larger view.

Helen H. Kay, M.D., Is New Professor and Chair of Obstetrics and Gynecology JULY 10, 2003 UAMS Joins March of Dimes in Campaign against Premature Births MARCH 25, 2003 UAMS Device May Help Prevent Fetal Brain Damage SEPT. 6, 2002 UAMS Scientists Confirm Link between Premature Birth and Later Learning, Behavioral Problems AUG. 13, 2002

Excerpts from Curtis Lowery, M.D., director of ANGELS: "Babies born less than five pounds..."1:02 Excerpts from Curtis Lowery, M.D., director of ANGELS: "We hope to ensure that every woman..."1:03 Excerpts from Kurt Knickrehn, DHS Director: "Half of the births in this state..." :37 Excerpts from Brenda Powell, M.D., Arkansas Medical Society: "This is an invaluable service to physicians...":47

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