Juliana Vidigal was just 26 weeks pregnant when she started bleeding and experiencing abdominal pain. She immediately called her neighbor, who took her to a nearby hospital in San Francisco. The news was not good.
“The doctor said, ‘Your risk of preterm birth is 100%. You have to go to Stanford Medicine Children’s Health,” Juliana says. “He gave me an injection to hold the baby.”
She knew what was happening probably because it had happened with her first son: her placenta was separating from the wall of the uterus, a condition called placental abruption. However, in her first pregnancy, the injection of a drug that stops labor worked and she was able to continue the pregnancy for 34 weeks. This time was different. She started bleeding heavily and having contractions just four days later.
“I called my husband, Diego, and he came home from work, and we rushed down the freeway to the emergency room at Stanford Children’s Health. Less than two hours after my arrival, I had an emergency caesarean,” she says.
Early delivery by emergency caesarean section
There was no time to waste. Juliana’s life and that of her baby were in danger. With placental abruption, the baby is deprived of oxygen and nutrients. For mothers, blood loss can lead to shock. Juliana had a quick and successful delivery by Maternal-Fetal Medicine physicians (high-risk obstetricians) with the expert assistance of obstetric anesthesiologists.
Baby John was quickly handed over to the neonatology team, who provided essential life-saving care including medication and oxygen via a ventilator to move air in and out of his lungs, as well as a transfusion blood. He weighed 2.5 pounds and was just 14 inches tall.
“Our combined and well-coordinated care between high-risk obstetricians and neonatologists improves outcomes for premature babies, like John,” says William Rhine, MD, neonatologist.
Once John’s health stabilized, he was admitted to the Nest, a dedicated space in the neonatal intensive care unit for babies born before 29 weeks gestation. The Nest has state-of-the-art technology to care for fragile infants who need intensive lung, feeding and nutrition support to help them grow. The lungs are the last organ to develop during gestation.
“With premature babies, we are particularly concerned about lung development. Today, we have a variety of technologies and innovations for breathing support for premature babies, such as a special bubble-based Continuous Positive Airway Pressure (CPAP) machine, which delivers a continuous stream of humidified air to keep the alveoli – the tiny air sacs in the lungs – open and grow,” says Dr. Rhine.
A leading national hospital for neonatal care
Stanford’s Lucile Packard Children’s Hospital, the heart of Stanford Medicine Children’s Health, is ranked among the top 10 in the nation for neonatal care. She specializes in the care of very small premature babies. The hospital has developed a niche and expertise over the years, led by Philip Sunshine, MD, who recently retired after spending more than 60 years advancing the care of premature babies. He is hailed as the father of neonatology and helped set standards of care for Stanford Children’s and the nation. At the start of his career, almost half of all premature babies died. Today, more than 90% survive.
“Many of us have been inspired by Dr. Sunshine. The models of care that have been developed over her career are as different as day and night. John probably wouldn’t have survived 60 years ago, and his NICU journey today has been pretty straightforward,” says Dr Rhine.
NICU’s innovative, high-quality care is based on cutting-edge research focused on responding early to subtle changes in a baby’s health. The neonatology team considers parents to be essential members of the care team.
“Every time we had a care meeting they brought all the specialists into the same room with me to discuss John. I loved that about Stanford,” says Juliana.
Doctors work closely with parents to improve outcomes for premature babies by promoting breastfeeding, skin-to-skin contact and bonding. Also, parents are invited to participate in doctor’s care rounds.
“Parents are part of our team when we plan the day,” says Dr. Rhine. “And giving parents the ability to hold their baby in their arms, even when they are very small, is one of our priorities. We have long since moved away from the idea that premature babies are too fragile to be held. . »
When babies are too small to breastfeed, they receive their mother’s milk through a gavage tube, a temporary feeding tube that goes directly into the stomach. Neonatologists promote a baby’s strength by weaning them off ventilators and tube feeding as quickly as possible.
“When I first saw John he was so small and he had so many hits. It’s such a contrast to who he is today. He runs, hits balls, climbs and takes all the steps of his development. And he’s so smart,” Juliana says. “It means a lot to see him so well.”
NICU nurses hold a special place in Juliana’s heart. When she had to leave to take care of her eldest son, Kauan, she trusted them and John completely.
“They treated my son as their own,” she said.
A final obstacle: the laryngeal cleft
When John was 3 months old, doctors discovered silent aspiration, which means that when he swallowed milk, some of it entered his airways. He wouldn’t cough or choke on feedings – that’s why it’s called silent suction.
“We take it for granted that when a baby is born they are able to swallow and that when they do, the milk goes down the esophagus rather than the airways. Yet we cannot take this for granted. acquired with premature babies who haven’t had a chance to develop the complex function of swallowing,” says Douglas Sidell, MD, FACS, otolaryngologist.
To find the source of John’s aspiration, doctors at the Aerodigestive and Airway Reconstruction Center – the only such center with an inpatient team to care for premature babies in the Bay Area, and one of the few in the United States – performed a swallow airway study and assessment in the operating room and discovered that John had a cleft larynx. A laryngeal cleft is a condition in which the airways do not separate from the swallowing tract as they normally should during development, resulting in an open connection between the two.
“The nuances of diagnosing and treating laryngeal cleft in premature babies are best handled by our multi-specialty team, including pulmonology, neonatology, gastroenterology and experts from our Voice and Swallow program. Premature babies often have multi-organ system management requirements, and it’s important to avoid viewing cleft laryngeal as an isolated problem. The whole team advises the family and provides care,” explains Dr. Sidell.
Surgery to close John’s cleft went well, but repairing the cleft wasn’t all that was needed. As expected, he had significant issues with his undeveloped swallowing mechanism. He needed a gastrostomy, or G-tube, to ensure he received adequate nutrition, which he still uses today.
After the surgery, speech and language pathologists and occupational therapists from the Voice and Swallow program, who specialize in swallowing disorders, worked with John to pursue his interest in oral feeding. After leaving the hospital, he was seen in the program’s outpatient clinic until the family moved to Florida. Although John doesn’t eat everything by mouth yet, he watches his parents eat and he enjoys feeding them, which is a good sign.
“We expect his swallowing and eating functions to improve over time with continued care,” Dr. Sidell says.
Turn 2 and go hard
The family recently celebrated John’s second birthday. He is feisty and fun, always keeping his family on their toes. “He’s my little warrior. He’s very energetic and he does everything to the extreme,” says Juliana.
Even though time has passed and the family has moved to another state, she and John are still clearly remembered at Stanford Children’s Health. She is grateful for all the care they received.
“I am grateful for everything, and for God choosing us to love and care for John, our little miracle,” Juliana concludes.
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