Stanford Children’s Uses Advanced Neonatology Care and a Minimally Invasive Procedure to Save a Preemie

Meet the smallest baby to have been treated by our Preterm PDA Closure Program team

Twenty-one-month-old Theia Dudorova toddles around her house, proud that she’s just discovered how to walk. She’s got eight teeth, with one more on the way, and loves to show them off with constant giggles and smiles. Her mother, Anastasiia Tarasova, is only too happy to try to keep up with her. She counts her blessings that Theia is healthy, having had her extremely prematurely—between 22 and 23 weeks’ gestation, and weighing 500 grams, or a little over a pound.

Just a week after Theia was born, she experienced a life-threatening patent ductus arteriosus (PDA)—an opening in the connection between the main arteries of the heart and lungs. Thanks to the close collaboration between the specialized Preterm Patent Ductus Arteriosus (PDA) Closure Program and the top-10 nationally ranked neonatology team at Stanford Medicine Children’s Health, Theia was given a fighting chance and became the smallest baby whose PDA Stanford Children’s has ever closed using a minimally invasive procedure.

A ray of hope in a dark moment

When Anastasiia went into early labor and was brought to a local hospital, the medical team asked her if she wanted to transfer to Stanford Children’s because it has a Level IV Neonatal Intensive Care Unit (NICU) to care for critically ill newborns. “The first thing I did was search online for ‘Stanford NICU’ and saw a story about a little girl born at about 22 or 23 weeks, and I said, ‘Yes! Let’s go to Stanford,’” says Anastasiia.

She knew from firsthand experience how hard it would be for doctors to save her tiny daughter. Anastasiia’s second son had also been born very prematurely, when she was living in Russia. “We lost him,” she says. “So when early labor happened again, when we drove to the hospital, I was saying goodbye to her and telling her that I was sorry.”

When Anastasiia and her husband, Grigory, arrived at Stanford Children’s, the medical team told them they’d do everything they could to save the baby. “I didn’t even know it was possible to save babies so small, and I was shocked they could even try,” she says.

A life-saving decision

Theia was very sick when she was born. She immediately had a breathing tube placed to help her underdeveloped lungs breathe, and her temperature was difficult to regulate. Theia’s neonatologists at the Johnson Center for Pregnancy and Newborn Services worked side by side with pediatric cardiologists at Stanford Medicine Children’s Health’s Betty Irene Moore Children’s Heart Center and other pediatric specialists to manage her precarious health. Cardiologist Greg Adamson, MD, and neonatologist Anca Pasca, MD, cared for Theia during the first two weeks of her life. “I’m very familiar with preterm babies, but at just 22 weeks and 6 days, Theia was the youngest, smallest baby I ever took care of,” says Dr. Pasca. “She was right at the margin of viability.”

Dr. Pasca remembers discussing everything in extreme detail with Anastasiia and Grigory in the NICU, sometimes talking through Theia’s status hour by hour, when they didn’t know if she would survive. “I remember first meeting Anastasiia at Theia’s incubator, and she had a very calm demeanor—seemed in control and had a good understanding of what was happening. It was so impressive,” says Dr. Pasca. “I remember she said to me, ‘Do what you have to do; we trust you.’ She was probably very scared and tired but showed us trust and a love for her baby that was so inspiring to see.”

When Theia was 4 days old, fluid began pooling around her heart, interfering with its ability to pump out blood. Her blood pressure dropped dangerously low, and the NICU team couldn’t control it with medications. The fluid needed to be drained emergently. Theia’s condition was not stable enough for her to be moved to an operating room, so Dr. Adamson came to Theia’s incubator in the NICU and removed the fluid there. “It was fantastic to have him as a colleague that night,” says Dr. Pasca.

A novel method to fix preemies’ hearts

The next week, Theia had become unstable again—the result of the large PDA. Though it’s common for micropreemies like Theia to have a PDA, it isn’t usually an emergency. “It’s different for each baby, depending on the size of the baby, the size of the PDA, and how much blood is going through it,” says Dr. Adamson.

Unfortunately, Theia had the most extreme version of a PDA. “Her lungs were being flooded with blood, and not enough blood was getting to the rest of her body,” he says. This was starving Theia’s organs of vital oxygen, and she had injury to her kidneys and intestines. So while it is less common to close a PDA at just 12 days old, Dr. Adamson and Dr. Pasca determined that there simply wasn’t another option.

Dr. Adamson is an interventional cardiologist and a member of the Preterm Patent Ductus Arteriosus (PDA) Closure Program. Over the past few years, with improvements in device technologies, specialists like him have started to use a transcatheter method for treating the smallest babies with PDAs. Traditional PDA surgery requires making an incision in the side of the chest, deflating a lung, surgically clipping the PDA, and reinflating the lung—which carries the risk of several complications, especially with fragile babies.

When a tiny patient is a candidate for the cardiac catheterization method, an interventional cardiologist uses a PDA device designed specifically for premature infants, such as the Amplatzer Piccolo™ Occluder. Dr. Adamson used this less invasive method to perform the PDA closure on Theia. She was transported to the cardiac catheterization lab, where Dr. Adamson inserted a catheter in a vein in her leg, guided the minuscule device through her heart, and released it in the PDA, stopping the blood flow. The PDA closure device will remain implanted permanently.

Smooth sailing after a rocky beginning

Dr. Adamson credits the procedure’s success to “a combination of improvements in technology and growing experience in our field with performing procedures in smaller and smaller babies,” he says. The PDA Closure Program taps into the expertise of the Betty Irene Moore Children’s Heart Center team, which is known for caring for children with highly complex heart disease, and whose interventional cardiologists, led by Lynn Peng, MD, perform more than 1,200 catheterizations a year.

“It was unbelievable—they did something that was impossible before they tried it with her,” says Anastasiia. “I’m so happy they did it so well and that they got this experience so they can do it with other babies, too.”

It took five months in the NICU before Theia was healthy enough to go home from the hospital. “Getting a 22-week-gestation infant to where Theia is now is a major feat of teamwork by all of her providers,” says Dr. Adamson. “The heart procedures during the first week and a half of life were just the beginning—she still had enormous risks in other areas. It’s a testament to our NICU program—and also great luck—that she’s now a happy and healthy 21-month-old.”

Theia is now followed as an outpatient by members of the Cardiac and Respiratory Care for Infants with Bronchopulmonary Dysplasia (CRIB) Program at Stanford Medicine Children’s Health, which manages care for children like Theia who have lung and heart problems due to being born prematurely. In the multidisciplinary CRIB Program, cardiologists, pulmonologists, neonatologists, respiratory therapists, and registered dietitians come together to care for a baby with complex needs during their hospital stay or to track a child’s growth and development with regular outpatient assessments.

Luckily, the CRIB team hasn’t found any sign of further heart complications in Theia, and her lungs are improving at a great rate.

“Stanford [Children’s] is just an amazing place” says Anastasiia, reflecting on her and her daughter’s health care experience. “They gave us so much support. Here at Stanford Children’s, there is a very close coordination between doctors, nurses, and parents; and the Stanford [Children’s] team explained what was happening at every step. Also, nurses ask, ‘How do you feel?’ They really cared about us. Nobody can survive going through a NICU experience without this support, and I’m so thankful.”

Learn more about our Preterm PDA Closure Program and CRIB Program care for premature babies.