Kapiolani Medical Center for Women & Children is kicking off a 15-year project to rebuild its flagship Punahou Street hospital and more than double its size.

The plan, set to wrap up in 2025, represents the most ambitious makeover yet for the hospital, which hasn't had major renovations since 1976, when its medical tower went up. Hospital officials say the work is overdue, and add that though Kapiolani has some of the latest technological equipment, its facilities are becoming dated and cramped.

Kapiolani is a major player in pediatric and maternity health in the Islands. About 34 percent of all children born in the state — and 46 percent of children born on Oahu — are born at Kapiolani. And an estimated 70 percent of infants statewide who are in need of intensive care are treated there.

The expansion comes as Kapiolani is seeing more births and expects continued increases over the next two decades. Since 2000, the number of births at Kapiolani has risen by 19 percent — from 5,500 to 6,565 in 2008.

The increase has at times overwhelmed the neonatal ICU. Twice last year, the NICU was at 139 percent capacity, with 64 babies.

The construction will add 24 NICU beds and 12 obstetrics beds.

Once work is completed — over three phases — Kapiolani will have a new hospital tower, NICU and pediatric intensive care unit and a new parking structure. Over the period, the floor area of the medical center will increase from 280,000 to 600,000 square feet.

And the total number of beds at Kapiolani will increase to as many as 288, from 207.

"It's really building a replacement hospital," said Martha Smith, Kapiolani's chief operating officer. "From a technology standpoint, we're there. We've got the latest and the greatest. But we need more space. This will allow us to further our mission."

A key part of the work is aimed at transforming the neonatal intensive care unit at Kapiolani — the largest hospital in the Islands specializing in maternity and infant care — into a place where families have private rooms, rather than sharing an open ward.

"The units of old used to be open-ward concepts," Smith said in an interview. "Now, private rooms — in order to provide family-centered care — is what we're after. They allow for the families to be a part of the care of the child. They're family-centered."

PRIVATE NICU ROOMS

Carmella Hernandez, state director of the March of Dimes Foundation's Hawaii chapter, said the project will help families and could even speed recoveries, as new studies show that patients are more likely to thrive and get better faster if their families are involved in their care. Other experts also pointed out that the private rooms could help reduce spread of infectious diseases.

"Kapiolani is the best NICU around," Hernandez said. "The thing is the NICU is very crowded. The parents are trying to spend time with their babies and they're squashed in this little area." She said the private room concept is a first for Hawaii for NICUs, but is quickly becoming the industry standard as doctors understand the benefits of early nurturing.

"It's good for the parents and good for the baby," Hernandez said.

Dr. Venkataraman Balaraman, the director of neonatology at Kapiolani and the neonatology division head at the University of Hawaii's medical school, said the expansion will allow Kapiolani to meet a growing need. He pointed out that the census for the NICU at Kapiolani has been creeping up, as the number of babies born also increases.

He also said private rooms for patients will make a big difference.

"It gives a much more nurturing environment," he said.

Balaraman estimated that of the 60,000 patients Kapiolani sees each year, more than 14,000 are babies. Of those, about 8,000 are transferred from other hospitals for services.

The average stay for a baby in the NICU is 19 days.

The hospital expects to raise about one-third of the costs of construction through fundraising.

"It is an ambitious plan," Smith said. "But we tried to set it up in phases so that we could start and stop if need be. (The plan) literally replaces everything" at the hospital.

Kapiolani declined to release a cost estimate for the work because inflation and construction cost increases are expected to drive the pricetag up over the life of the project. But a filing with the state Department of Health says the second phase of work (to add NICU and obstetrics hospital beds) is expected to cost about $36 million and wrap up in 2017.

The first phase of work — expected to be completed in 2012 — will include the construction of a 16-level parking structure on Bingham Street. The second phase of work will include the demolition of the Bingham Street building, which dates to 1930.

In the final phase, an existing parking structure will be demolished to make way for the construction of a hospital tower, which will sport updated infrastructure and equipment and will "emphasize family-centered care." The new tower will also house expanded emergency and surgery departments on the lower three levels, and patient beds on five upper levels.

There will also be expanded office space for doctors.