COLUMBIA - More babies will die if more hospitals in South Carolina are allowed to build neonatal intensive care units, Medical University Hospital physicians told the state health department board Thursday.

"We know there are other hospitals that want to open Level III NICUs," said Dr. Rita Ryan, medical director of the MUSC Children's Hospital, during a public meeting at the S.C. Department of Health and Environmental Control in Columbia. "Children will be harmed by that."

Level III NICUs are designed to treat the smallest, sickest newborns. There are currently five hospitals that qualify as high-level regional perinatal centers in South Carolina: Spartanburg Regional, Greenville Hospital System, Palmetto Richland, McLeod Regional Medical Center in Florence and Medical University Hospital.

Other hospitals send their most vulnerable newborns to one of these specialized facilities.

Ryan, and other physicians who spoke before her, worry that slackening DHEC restrictions that regulate which hospitals can house these high-level NICUs will result in more NICUs at smaller hospitals around the state. That would divert patients away from MUSC and the other regional perinatal centers, but it also would impact the number of low-birth-weight babies that each hospital treats.

Studies show that as the number of patients drops, so does the level of staff expertise, said Dr. John Cahill, an MUSC neonatologist who also spoke at the hearing.

"Do it well, do it often," he said. "(Infant) mortality goes up if the hospitals start handling fewer VLBW (very low birth-weight) babies."

No changes to the perinatal regulations have yet been proposed, but a working group is studying the issue.

Dr. Pat Cawley, executive director of the Medical University Hospital, said regional perinatal centers are particularly anxious about any future changes, because DHEC's Certificate of Need program, which regulates new hospitals, hospital expansion projects and expensive medical equipment purchases, is currently bogged down in legal limbo. The fate of the decades-old Certificate of Need program is uncertain and is currently not enforced by the health department.

"There's a lot of worry here," Cawley said. "It's an unknown."

This unknown makes the specific perinatal regulations that much more important, Ryan said.

"With or without a (certificate of need), we want the perinatal regulation to be strong," she said, "because we don't know what will happen."

Meanwhile, for the first time in more than 20 years, the state health department board voted unanimously Thursday to move forward with sweeping changes to the hospital licensing regulation that governs everything from hospital food and housekeeping services to how many fire drills hospitals are required to organize each year. The changes mainly align South Carolina's code with national standards.

All these proposed changes must be approved by the Legislature. The measure to update the hospital licensing regulation already has broad support from the South Carolina Hospital Association.

"It's been a very long process - many, many months working on this regulation," said Gwen Thompson, chief of DHEC's Bureau of Health Licensing, before the public hearing at DHEC Thursday.

The perinatal section of the regulation that establishes rules for NICUs was left untouched Thursday.

DHEC Director Catherine Templeton told the board it could revisit the NICU rules later.

"The whole of this regulation addresses so much more than perinatal," Templeton said. "There's so much to clean up."

The DHEC board also voted to make broad changes to the regulation governing retail food establishments in the state. It was the first time the health department has drastically changed those rules in more than a decade.

The new restaurant regulations will also require approval from the General Assembly, which reconvenes for 2014 on Tuesday.

Reach Lauren Sausser at 937-5598.