Abby's First Month   — Abby's Mommy

Born January 11, 1999

As many of you know, we almost lost Abby. She was born at 6:13 pm on Monday, January 11th. She got 9's on her APGAR's and for the first couple of hours, all seemed well. At about 8:30 pm, the new nurse was concerned that her color was not as good as it should be and she was taken to the nursery to get "pinked up" with some oxygen. We did not feel at this point that there was anything serious to worry about.

After a 1/2 hour or so, it became apparent to the nurses in the nursery that Abby was in some respiratory distress. A pediatrician was called in and a chest x-ray was done. Air on an x-ray shows up as black and Abby lungs were milky white. This was the first time we were concerned that something was seriously wrong.

They were unable to get her oxygen saturation to a safe level and it was decided that she needed more specialized care that could be provided at the hospital where we were. After being intubated (a tube is inserted into the trachea to the base of the lungs), she was air evacuated to Phoenix Children's Hospital.

I and my dad got to PCH a few minutes after Abby arrived. Abby got to PCH at about 11:30 pm and was immediately put on a high-frequency ventilator. The neonatologist (newborn baby specialist) said that Abby's illness was caused by either a heart problem or an infection. After an echocariogram showed no heart problem, it was determined that Abby had a severe infection...probably Group B Strep. After some blood tests, it was determined that Group B Strep was the culprit and Abby was put on antibiotics to eliminate the infection.

Because the infection had put Abby in severe respiratory distress, the neonatologist felt that ECMO (extracorporeal membrane oxygenation) was necessary to save her life. ECMO is similar to the heart-lung bypass machines that are used during heart bypass surgeries. The ECMO machine allows the lungs to "rest" and not do the work of blood oxygenation. Phoenix Children's Hospital has been doing ECMO for about 13 years and about 300 babies have been treated with ECMO...it is done as a last resort if a ventilator cannot provide sufficient respiratory assistance. Getting a baby on ECMO requires a surgeon to insert a catheter (also known as a canula) into either the jugular vein (called VV) or both the carotid artery and the vein (called VA) and then into the heart. The VV is less problematic and this was the type that Abby was on.

Because Abby had been oxygen deprived for a period of time in the initial stages of the infection, the doctors were concerned about brain injury. About 3 days into ECMO, the daily head ultrasound did indicate that there was a brain injury. Because blood moving through the ECMO machine must be thinned with a drug (heparin) to prevent clotting in the tubing, the doctors became very concerned that if bleeding in her brain occurred that it could not be stopped.

An ECMO machine works like this: unoxygenated blood drains by gravity from the baby and into an artificial lung where it is oxygenated. It then is warmed and pumped via tube compression back into the body. The ECMO machine that Abby was on pumped 400 cc's per minute with 150 cc's being what is called "idle". Babies are generally on ECMO for an average of 5 days and it was indicated to us that due to the severity of Abby's infection, she would be on longer. However, the potential for brain hemorrhaging forced the doctors to try and take her off sooner than they would have liked. On the 16th, they started to wean her off the ECMO, bringing the volume down by 10 cc's per hour. At about 2:30 pm on the 17th after reaching idle, Dr. Dan "the ECMO man" pulled the oxygen tube from the ECMO machine and Abby was on her own...with the assistance of a ventilator.

The subsequent ultrasounds did not indicate any additional brain injury and over the next several days Abby began to look like the baby we had those first few hours after birth. Over the next two weeks, Abby would become more stable and alert. She came off the ventilator at the end of week 3 (thanks Roy) and would spend the next week learning to eat. Up to this point, she had been either IV fed or tube fed. ECMO has the effect of putting most the vital organs like the kidneys and liver in a "sleep" state. They would need some time to get fully functioning again. The neurologist was very optomistic about the results of the MRI that was done on Abby's brain a few days before we were able to leave. Although the MRI did detect a brain trauma, it is minor and not nearly as bad as it could have been and not even as bad as the earlier (and less detailed) ultrasounds had indicated.

Once she was eating enough on her own to gain a bit of weight back, we were able to bring her home. On Tuesday, February 11th, we left PCH with Abby. A happier day we cannot recall. As a precaution, we brought her home on oxygen through nasal prongs. We expect to be on the oxygen for at least a few weeks. She had her first pediatric visit on Friday, February 12th and is doing well.

"Thank you" seems so inadequate in expressing our gratitude to the doctors and nurses at PCH who gave us our little girl back. They all are wonderful, caring people. Like any group of people in these situations, there are a few that stand out. Dr. Allare, Jill, Alicia, Diane, Linda, Roy, Nancy, Dr. Gutierrez, Dr. Schwer, Dr. Spraig and Dr. Kaplan...a special thanks to you for your caring and expertise. Your presence was very comforting and we will never forget you. We are also grateful for the nurses and doctors at Pheonix Baptist who noticed something was wrong and initiated the care that Abby needed.

We acknowledged that it was God's will that Abby survived. Many people who saw how sick Abby was, are amazed at how well she responded to the help that was given her. We are certain that God's hand healed Abby and we give praise to Him and are thankful that He chose to glorify Himself in this way. We thank all those whose prayers and thoughts were with us and Abby.