AGANA HEIGHTS, Guam — Navy Cmdr. Desirae Pierce has twice helped transform how naval hospitals care for their tiniest patients. Now, as U.S. Naval Hospital Guam’s lead for the innovative Neonatal Stabilization and Treatment (NeST) team, she’s enhancing care for newborns who need specialized medical support.

“We are increasing our ability to provide necessary and critical care for our smallest and most vulnerable beneficiaries,” said Dr. Paul Cordts, Deputy Assistant Director, Medical Affairs. “The progress the NeST Working Group has achieved in less than a year is a testament to the entire team, but particularly the team at Naval Hospital Guam.”

NeST is a specialized team of medical professionals comprised of a neonatologist, neonatal intensive care nurses, and respiratory therapists who stabilize premature babies and newborns with health complications until they can be transported to a facility with a neonatal intensive care unit.

While the island of Guam does not have an accredited NICU, Pierce, who is a neonatal nurse practitioner, and her team have significantly increased the hospital’s ability to care for newborns who need additional medical support.

Pierce explained that the NeST team has enabled a more nuanced approach to caring for some newborns who require specialized care. “Previously, an aeromedical evacuation was initiated almost immediately for newborns who required specialized care,” she said.

While the implementation of NeST does not delay evacuations, “the team is capable of providing stabilization care and treatment for longer durations of time for newborns” who are stable enough to receive care on island, if the anticipated length of their treatment is about 10 days.

This marks Pierce’s second tour advancing neonatal care within military health care. From 2013 to 2016, she helped establish the Special Care Nursery at Naval Hospital Camp Lejeune, eventually serving as its nurse manager. Now at USNH Guam, she’s helping to lead another transformative effort in neonatal care.

“In my 17 years of service, I have twice had the privilege of playing a direct part in advancing neonatal care within a Naval Hospital,” Pierce said. “The path has been arduous, but with the continued support of the hospital and the Defense Health Agency, the future of neonatal care where America’s day begins looks bright.”

Evolution of Care

The NeST program evolved from its predecessor, the Neonatal Stabilization Team (NeoSTAT) model, to expand specialized care for newborns born prematurely or with health complications. Recognizing Guam’s geographic isolation—more than 1,400 miles from the NICU at USNH Okinawa and nearly 4,000 miles from Tripler Army Medical Center’s NICU in Hawaii—the hospital augmented its capabilities to address the reality that aeromedical evacuations can take up to seven days to coordinate, plus 8-16 hours of flight time.

The impact is significant for military families stationed in Guam. For example, a baby born at 35 weeks of pregnancy who is experiencing respiratory distress can now receive treatment locally rather than requiring immediate medical evacuation. This means some families can remain together on the island during their baby’s treatment.

“Our priority is delivering the highest quality care to our service members and their families,” said U.S. Naval Hospital Guam’s Director Capt. Joel Schofer. “The NeST program demonstrates our commitment to enhancing our capabilities and ensuring our beneficiaries have access to safe, quality health care when and where they need it.”

Cutting-Edge Technology

The NeST team uses state-of-the-art equipment to provide specialized care to their tiny patients. Their advanced respiratory support system delivers nitric oxide generated from room air to help newborns with persistent pulmonary hypertension, a serious condition affecting oxygen and blood flow to the lungs. They also use specialized breathing equipment that delivers precise, tiny breaths to protect delicate newborn lungs, and an innovative cooling system designed to minimize brain injury in babies who experienced oxygen deprivation during birth.

“These devices allow the team to provide very specialized care that can minimize life-long consequences to the newborn.” Pierce explained. “The technology helps us deliver the highest level of care possible within our capabilities.”

The team recently achieved a significant milestone when they successfully administered a medication that helps premature babies breathe more easily by coating their tiny lungs with a substance similar to what full-term babies naturally produce. By delivering this medication through a special airway mask—a first for the hospital—they helped a premature baby’s lungs work better while avoiding the need for more invasive treatment.

Comprehensive Care Approach

“Staff develop a deep sense of commitment to providing the best care possible with the goal of improving patient outcomes,” Pierce said. “Neonatal patients don’t have the luxury of choosing the circumstances to which they are born into and every intervention made will affect the rest of that infant’s life.”

The team also provides education and training to other hospital staff, participating in emergency response drills and teaching life-saving resuscitation skills. This commitment to education extends to support departments like radiology, pharmacy, laboratory, and the blood bank, whose staff have enhanced their capabilities to support neonatal patients.

Looking to the Future

With USNH Guam anticipating a potential growth in deliveries by 2033, the evolution of the NeST program ensures military families and other TRICARE-eligible beneficiaries have access to the highest level of care.

“NeST is evolving into what we hope will be a self-sustaining group of NICU-experienced staff who are more permanent to U.S. Naval Hospital Guam,” Pierce said.

While Pierce is optimistic about the future, she wants expectant mothers to understand the scope of care available to them. The island of Guam does not have an accredited NICU and the naval hospital’s NeST program, while designed to ensure newborns have access to the best care possible until they can be stabilized or transported to a higher level of care, is not a NICU.

“The NeST team is enhancing U.S. Naval Hospital Guam’s ability to provide exceptional neonatal care anytime, anywhere—always,” Pierce said.

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U.S. Naval Hospital Guam is a 282,000 square foot military treatment facility that supports the joint forces and strengthens the island by projecting forward-deployed medical power, delivering high-quality care, and forging strategic partnerships. The MTF and its staff of nearly 700 offers a broad range of primary and specialty medical services in support of more than 27,000 beneficiaries.