Stanford Medicine Children’s Health provides specialized and coordinated care for prematurely born children.
Like most babies, Maya Morales had a party for her first birthday, complete with decorations, cards, and some of the most important people in her life. The location, however, was unique—just like Maya’s story.
Maya’s birthday celebration took place in July 2025 at Lucile Packard Children’s Hospital Stanford, just outside the Level IV Neonatal Intensive Care Unit (NICU). The NICU at Packard Children’s, part of Stanford Medicine Children’s Health, offers nationally recognized care for critically ill babies with the most complex conditions. That is where Maya spent most of her first year of life. It wasn’t exactly how Maya’s parents might have imagined their daughter’s first birthday a year earlier. But Maya’s mother, Breanna Fockler, thought the celebration was perfect.
“It was the best first birthday that we could have hoped for Maya at that moment in time,” says Breanna. “Her care team genuinely made it special. Her doctors, nurses, and therapists all showed up for her. It was incredible. I can’t wait to tell her about it someday.”
Maya was born unexpectedly at 25 weeks’ gestational age, weighing just over a pound. As a micro-preemie, she spent the first 384 days of her life in a NICU. After 12 weeks in the NICU of the hospital where she was born, it became apparent that Maya needed a higher level of care. She was transferred to Stanford Children’s in October 2024, about three hours from the family’s home in Merced.
Receiving specialized care through the Stanford Children’s CRIB program
Babies born prematurely, as Maya was, often need breathing support for their underdeveloped lungs. The combination of oxygen therapy and young, fragile lungs puts preemies at high risk for bronchopulmonary dysplasia (BPD)—a chronic lung disease resulting from damaged lungs and airways. BPD can also cause other complications in the heart and lungs. Pulmonary hypertension (PH) is high blood pressure in the lungs and affects up to 40% of babies with BPD. Maya developed both BPD and PH. She also had a hole between the top two chambers of her heart.
The Cardiac and Respiratory Care for Infants with Bronchopulmonary Dysplasia (CRIB) Program at Stanford Children’s was developed for children like Maya. The program, which began in 2018, provides coordinated and multidisciplinary care for children born prematurely with BPD who may also have PH or congenital heart disease.
“There’s a challenging interplay that occurs between the heart and lungs, so that when one organ is sick, it is often reflected in the other,” explains Rachel Hopper, MD, pediatric cardiologist and co-director of the CRIB program. “Coordinated care is essential in these cases. With Maya, we had to walk a fine line between managing her pulmonary hypertension and monitoring her heart defect.”
During Maya’s time in the NICU, she underwent multiple advanced diagnostic tests and procedures, including cardiac catheterization and bronchoscopy.
“We used everything at our disposal to understand and monitor what was happening in Maya’s lungs and heart,” says Erik Jensen, MD, neonatologist and co-director of the CRIB program. “No two babies with BPD are alike. Those advanced diagnostic tests and procedures help us determine which medications and tools are most likely to be beneficial.”
The CRIB team included Dr. Hopper, Dr. Jensen, pulmonologist Michael Tracy, MD, and nurse practitioner Amanda Moy, NP. Over the course of Maya’s stay in the NICU, they tailored treatments and therapies as her health fluctuated.
“Most children with BPD have good days and bad days. They’ll take two steps forward and one step back, and that was true of Maya,” says Dr. Jensen.
Maya eventually made it home and continues to develop well. But there were periods when the team had to escalate her support and provide more aggressive therapies to address medical challenges.
“What sticks with me most is not the ups and downs. It’s how committed Maya’s family was to being part of the care team and weathering those challenging times with us,” Dr. Jensen recalls.
Multidisciplinary approach to micro-preemie development
Maya’s coordinated care went beyond the CRIB program. It also involved the Neonatal NeuroIntensive Care Unit (NeuroNICU) and pediatric rehabilitation services. The CRIB and NeuroNICU teams worked together to support each organ system and avoid chronic respiratory and cardiac issues. The rehabilitation team oversaw Maya’s developmental progress.
Still, she needed interventions to ensure proper development and reduce the risk of long-term complications of prematurity. The inpatient rehabilitation team’s work was critical to Maya’s development during her stay in the NICU. The team saw Maya more than 60 times during her hospital stay for physical therapy. They delivered occupational and feeding therapy to Maya more than 50 times.
The developmental team that handled Maya’s interventions included occupational therapist Lauren Hanna, OTD, OTR/L; physical therapist Jamie Proffitt, PT, DPT; and speech therapist Lisa Mulcahy, CCC-SLP.
“With premature babies, we need to address where they are developmentally and what they should be experiencing in utero at that time. Then, those interventions begin immediately,” explains Hanna, who also oversaw Maya’s feeding therapy. “We modify their environment, in terms of light exposure, sound, touch, and movements, to be as appropriate as it can be in an environment they should not yet be in.”
Maya’s developmental challenges were in line with those of other micro-preemies of the same age. But her respiratory journey was long and extensive, making therapeutic interventions challenging.
“There’s not always a blueprint to follow,” says Hanna. “So, we used research and collaborated with the CRIB team and NeuroNICU team to find ways to introduce exposures that Maya would need for long-term development.”
The developmental team used tactics such as feeding Maya with milk drops and wearing clear masks to expose her to facial expressions. They also adapted therapy to Maya’s respiratory conditions by co-treating. While Mulcahy worked with Maya on speech, for example, Proffitt positioned Maya so that she was supported from a respiratory standpoint. It enabled Maya to fully engage in the session with Mulcahy, while Proffitt observed how Maya’s respiratory system tolerated different positions.
Observing respiratory responses to activity is foundational to providing exceptional physical therapy for these babies. “It is important to see how my interventions impact her respiratory status to then regress or progress the activity,” says Proffitt. “My main purpose is to ensure optimal musculoskeletal alignment that is appropriate and optimizes neuromotor development.
“As a physical therapist, I am constantly observing how the body compensates or changes during a task to progress motor skills. With Maya, we added the challenge of speech while she was being challenged with alignment. That way, I could observe how the task needed to be modified to best meet her needs and ultimately help her progress her motor skills,” says Proffitt.
The developmental team communicated any behavioral signs of respiratory instability with the CRIB team as part of Maya’s coordinated care. The CRIB team took that feedback into consideration when determining the best next steps in Maya’s respiratory and cardiac care.
“The flow of information and interdisciplinary approach among the CRIB, developmental, and NeuroNICU teams were critical to Maya’s comprehensive care plan,” says Dr. Tracy.
Maya’s parents were also involved every step of the way, even though work and caring for Maya’s older sister meant that they could not always be at the bedside for weekly rounds.
“The collaboration with Maya’s family was invaluable. Their willingness to hear what we were saying and share their observations helped advance Maya’s care,” says Dr. Tracy.
The next phase of Maya’s journey
A few weeks after her first birthday, Maya went home. Her lungs have grown stronger, and as she continues to develop, she will need less respiratory support and medication. However, the first month was a learning curve for Breanna.
“It was nerve-wracking, terrifying, and a lot of trial-and-error,” admits Breanna. “But as we got to know Maya and she got to know us, managing her care has become second nature. We are excited to see Maya’s development and progress, and we always believed it would happen. It just needed to happen on her own time.”
Maya still has a long road ahead, and her relationship with Stanford Children’s is far from over. She does not have as many acute care needs, but she still needs aggressive early intervention to support her ongoing neurodevelopment. The CRIB team follows Maya with regular clinic visits and telehealth support, working closely with her local physicians.
“In some respects, the journey begins when you go home from the NICU,” says Dr. Tracy. “Maya will continue to have a close relationship with Stanford Children’s and the CRIB program so we can continue to help maximize her growth and development.”
Looking back, Breanna says she wishes she had pushed for a transfer to Stanford Children’s sooner. She’s just glad that Maya ended up where she needed to be.
“The team made us feel like she was loved and in good hands,” says Breanna. “Maya was at the best place she could be for the conditions she was battling. Knowing that, I felt comfortable giving them the keys to drive so I could focus on advocating for Maya and letting her know she’s loved.”
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