Premature Baby Turns 2 After Traumatic Start

Juliana Vidigal was just shy of 26 weeks pregnant when she started bleeding and feeling abdominal pain. She immediately called her neighbor, who gave her a ride to a nearby hospital in San Francisco. The news wasn’t good.

“The doctor said, ‘Your risk for premature labor is 100%. You have to go to Stanford Medicine Children’s Health,’” Juliana says. “He gave me a shot to hold the baby.”

She knew what was likely happening because it had happened with her first son: Her placenta was separating from the wall of the uterus, a condition called placental abruption. However, with her first pregnancy, the shot of a medication 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. In less than two hours after arriving, I was having an emergency cesarean section,” she says.

An early delivery by emergency cesarean section

There was no time to lose. Both Juliana’s and her baby’s lives were at risk. With placental abruption, the baby is deprived of oxygen and nutrients. For mothers, the loss of blood can lead to shock. Juliana had a prompt and successful delivery by maternal-fetal medicine doctors (high-risk obstetricians) with expert help from obstetric anesthesiologists.

Baby John was quickly handed over to the neonatology team, who performed critical life-saving care, including medication and oxygen via a ventilator to move air in and out of his lungs, along with a blood transfusion. He weighed 2.5 pounds and was just 14 inches long.

“Our combined and well-coordinated care between high-risk obstetricians and neonatologists improves outcomes for premature babies, like John,” says William Rhine, MD, a neonatologist.

Once John’s health was stable, 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 advanced technology to care for fragile infants who need intensive support for their lungs, feeding, and nutrition to help them grow. The lungs are the last organ to develop during gestation.

“With premature babies, we are especially concerned with lung development. Today, we have a variety of technologies and innovations for respiratory support for premature babies, like a special bubble continuous positive airway pressure (CPAP) machine, which provides a continuous flow of humidified air to keep alveoli—the tiny air sacs in the lungs—open and growing,” Dr. Rhine says.

A top national hospital for neonatology care

Lucile Packard Children’s Hospital Stanford, the core of Stanford Medicine Children’s Health, is ranked in the top 10 in the nation for neonatology care. It specializes in caring for very small preterm babies. The hospital developed a niche and expertise over the years, led by Philip Sunshine, MD, who recently retired after spending the last 60+ years advancing care for preterm babies. He is lauded as the father of neonatology and helped set care standards for Stanford Children’s and the nation. At the start of his career, nearly half of all premature infants died. Today, more than 90% survive.

“Many of us were inspired by Dr. Sunshine. The models of care that were developed over his career are as different as night and day. John would have likely not survived 60 years ago, and today, his journey in the NICU was fairly straightforward,” Dr. Rhine says.

The NICU’s high-quality, innovative care is informed by world-leading research focused on early response to subtle changes in a baby’s health. The neonatology team views parents as core members of the care team.

“Every time we had a care meeting, they would bring all the specialists in the same room with me to discuss John. I loved that about Stanford,” Juliana says.

Doctors work closely with parents to improve outcomes for premature babies by promoting breastfeeding, skin-to-skin time, and bonding. Also, parents are invited to participate in the doctors’ care rounds.

“Parents are part of our team when we make plans for the day,” Dr. Rhine says. “And giving parents the opportunity to hold their baby, even when they are tiny, is a big focus of ours. We’ve long ago moved away from the idea that preemies are too fragile to hold.”

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 own strength by weaning them off of ventilators and tube feedings as quickly as possible.

“When I saw John for the first time, he was so tiny, and he had so many tubes. It’s such a contrast to who he is today. He’s running around, kicking balls, climbing, and meeting all of his developmental milestones. And he’s so smart,” Juliana says. “It means a lot to see him doing so well.”

The NICU nurses hold a special place in Juliana’s heart. When she had to leave to care for her older son, Kauan, she trusted them completely with John.

“They treated my son like their own,” she says.

A final hurdle: Laryngeal cleft

When John was 3 months old, doctors discovered silent aspiration, meaning that when he swallowed milk, some of it entered his airway. He wouldn’t cough or choke with feedings—that’s why it’s called silent aspiration.

“We take it for granted that when a baby is born, they are able to swallow and that when they do, milk will go down the esophagus rather than into the airway. Yet, we can’t take that for granted 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 with the Aerodigestive and Airway Reconstruction Center—the only center of its kind with an inpatient team to care for premature babies in the Bay Area, and one of the few in the United States—completed a swallow study and airway evaluation in the operating room and discovered that John had a laryngeal cleft. A laryngeal cleft is a condition where the airway doesn’t separate from the swallowing pathway as it normally should during development, resulting in an open connection between the two.

“The nuances of laryngeal cleft diagnosis and treatment in premature babies are best managed by our multispecialty team, including pulmonology, neonatology, gastroenterology, and experts from our Voice and Swallow Program. Premature babies often have multiorgan system management requirements, and it is important to avoid thinking of the laryngeal cleft as an isolated problem. The entire team counsels the family and provides care,” Dr. Sidell says.

The surgery to close John’s cleft went well, but repairing the cleft was not all that was needed. As expected, he had significant problems with his undeveloped swallowing mechanism. He needed a gastrostomy, or G-tube, to ensure that he received proper nutrition, something he still uses today.

After surgery, speech-language pathologists and occupational therapists with the Voice and Swallow Program, who specialize in swallowing disorders, worked with John to continue his interest in eating by mouth. After leaving the hospital, he was seen at the program’s outpatient clinic until the family moved to Florida. While John isn’t eating everything by mouth yet, he watches his parents eat, and he enjoys feeding them, which is a good sign.

“We expect his swallowing and feeding functions to improve with time through continued care,” Dr. Sidell says.

Turning 2 and going strong

The family recently celebrated John’s second birthday. He’s feisty and fun, always keeping his family on their toes. “He’s my little warrior. He is very energetic, and he does everything to the extreme,” Juliana says.

Even though time has passed and the family has moved to another state, she still clearly remembers her and John’s time at Stanford Children’s Health. She is grateful for all of the care they received.

“I have gratitude for everything, and for God choosing us to love and care for John, our little miracle,” Juliana concludes.

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