NICU team's early decisions vital to baby's survival

In early January, Jess and Josh Klein enjoyed a night out at Ball Arena to watch the Denver Nuggets take on the San Antonio Spurs. Throughout the night, Jess, who was 29 weeks pregnant, noticed the baby moving and kicking in response to the exciting environment. And while the Nuggets fell to the San Antonio Spurs that night, the baby’s response to the noise and excitement had affirmed Jess that the baby was well and healthy.

So, when they had a quiet night at home the next night, Jess decided to take the opportunity to pay closer attention to the baby’s movement. She began to count the baby’s kicks. “I kept hearing you should do it and I’d never done it. She had been crazy moving that the morning and afternoon, so I thought it was a great time. But then she wasn’t being active,” Jess recalled. She tried different things to get the baby to move but felt in her gut that something was off. And, when she explained the situation to her OB practice’s nurse line, they agreed she should come to the hospital for evaluation.

At HCA HealthONE Rose, the medical team didn’t find a definitive reason for the baby’s distress. But Jess’ OB also had a gut feeling about the situation and soon, the team decided to deliver the baby via C-section. In the early morning hours of January 5, Greta was born, weighing in at only two pounds, 13 ounces. At first, she seemed OK. She was breathing on her own, was the right color and seemed healthy. But only hours later, things became more complicated when Greta’s team found that she was bleeding into her lungs. They decided to transfer her to the Level IV NICU at sister hospital HCA HealthONE Rocky Mountain Children’s. The largest in the region this NICU is highly equipped to care for infants’ most complex needs.

There, Greta was in good hands with a team of specialized neonatal experts. First, Jess and Josh met Dr. David Randolph who decided to administer IVIG, intravenous immunoglobulin. The treatment, which infuses antibodies into the body, is used to boost the immune system, treat autoimmune disorders, and prevent infections. This early decision ended up being critical for Greta’s survival. During the next few weeks, the team began to suspect Greta had a very rare condition called neonatal hemochromatosis (NH). The disorder, which is estimated to occur in one in one million pregnancies worldwide, causes liver failure in newborns and survival rates are generally low. “We learned that if we had waited to go in the next day, she likely would have been stillborn,” Jess explains. “We had a very small window of time and that gut feeling that I got, and the OB got were critical for her survival.”

Key decisions like the early administration of IVIG continued throughout Greta’s NICU stay. Another was made by Dr. Jay Patel who advocated for Greta to undergo a DVET procedure. Because Greta’s liver wasn’t functioning properly, she had very high levels of ammonia. And DVET, or double-volume-exchange-transfusion, removes all the blood and replaces it two times over with new blood, greatly reducing those dangerous levels.

Ultimately, Greta stayed in the NICU for 74 days. Medication was used to help repair her liver and she began feeding on her own. And despite initial worries about her brain function and potential disabilities, she began responding to stimuli, tracking movements, and eventually breathing on her own without help. She even came home without oxygen (a rare feat for preemies in Colorado). Now at four months old (1.5 months, adjusted), Greta is hitting her developmental milestones. While the family doesn’t know how she will be affected later, they have a plan in place with the medical team to follow up and support her miraculous recovery step by step.  Jess shares, “We believe Greta is put on this earth for a reason. There were so many coincidences and gut feelings — from my feeling to go in and the OB’s decision to deliver her; that first does of IVIG and then the DVET — these were life and death moments. She’s here for a bigger purpose and we are so excited to find out what that is.”