Article: Bedside Surgery for Twin Preemies
Reprinted from Community Connections, Spring, 2011
A delicate cardiac procedure at Alta Bates Summit treats tiny infants and reassures their parents.
The last gift that Rob Stiles was expecting for Father's Day was the birth of his tiny, premature son and daughter. His wife, Elaine, wasn’t due until late September, but that morning, Sunday, June 15, 2008, she started having contractions. By 1 p.m., she and Rob had checked into Alta Bates Summit Medical Center, and that night their twins—1-pound, 14-ounce Madeline and 2-pound Milo—were delivered at 25 weeks by emergency C-section. "From that point on," Rob says, "life was a roller coaster."
Doctors monitored Madeline and Milo for a condition called patent ductus arteriosus (PDA), a problem that’s more common in premature infants. "The ductus arteriosis is a blood vessel that connects the aorta and the pulmonary artery," says Alison Brooks, R.N., clinical nurse specialist in the Alta Bates Summit Newborn Intensive Care Unit (NICU). "Every infant has this vessel open before birth," she explains, "and in most newborns it closes a few days after they are born. If the vessel doesn't close—called a patent ductus arteriosis—it can put a strain on the heart by pumping too much blood into the lungs."
"Most of the time," she adds, "medication is enough to cause the PDA to close." In the case of little Madeline Stiles, however, medication had narrowed it but hadn’t closed it completely. By June 30, doctors decided that the tiny, 2-week-old preemie would need heart surgery to close her PDA.
"I was still recovering from my C-section and the sudden shock of becoming a mom," Elaine remembers, "and I was really nervous about Maddie's procedure." It was a help, she says, when she learned that the surgery would be done right in Maddie's own nursery bed in the Alta Bates Summit NICU.
"In the past," explains neonatologist Amarjit Sandhu, M.D., medical director in the NICU, "we used to have to transfer our babies to Children’s Hospital Oakland for PDA surgery. Now, we bring their surgical team right into our NICU and do it here." As a result, he says, "we don’t have to put a tiny and sick baby through the risk of a transfer, and families don’t have the extra stress of having to get used to another facility."
For Rob and Elaine Stiles, that was great news. "We were really happy about not having to transport Madeline," Rob says. "I was more nervous about going to another hospital than I was about the PDA surgery itself, especially because Milo would still be over at Alta Bates Summit."
Madeline’s July 3 procedure was the first bedside PDA surgery performed in the Alta Bates Summit NICU. Everything went very well, thanks to the close medical collaboration of Children’s Hospital and their pediatric cardiologist, Ziad Saba, M.D. The team consisted of pediatric anesthesiologists; nurses; and Olaf Reinhartz, M.D., chief of cardiothoracic surgery. The team performed the ligature right in Madeline’s room, which the hospital staff turned into an operating room for the procedure. "It was such a great feeling," Elaine says, "that so many people were working so hard to help our baby."
A few weeks later, while Madeline was recovering, Rob and Elaine found out that Milo, too, would need to have ligation surgery. Although medication had closed his PDA, doctors detected a murmur in his heart; cardiac ultrasound confirmed it had reopened. On July 28, the neonatal surgical team returned to the NICU and performed the bedside ligation procedure on Milo. His recovery, Rob notes, was even smoother and quicker than Madeline’s because he was 25 days older and a pound heavier when he had the surgery.
Since then, Dr. Sandhu says, the surgical team has performed more than a dozen of the bedside surgeries at Alta Bates Summit. "The process is working very well," he states, thanks to the outstanding team from Children’s Hospital. "It's a collaboration that benefits Alta Bates Summit families," he says, and it reflects the hospital’s commitment to cardiovascular excellence.
Looking back on the experience—which they chronicled in their blog, miloandmadeline.blogspot.com—Rob and Elaine feel that Milo and Madeline "got the very best care they possibly could" at Alta Bates Summit. "The nurses and doctors were always available to talk to us," says Elaine. "They took our concerns and wishes seriously and followed through. It's a very progressive, family-friendly environment—they gave us every opportunity to be with the twins and participate in our babies' care."
That hands-on training helped once the twins arrived at the family's Alameda home—Madeline on October 4 and Milo two weeks later, on October 17. Since then, Rob states, "life has changed in every possible way." As the parents of twins, Rob and Elaine's hands are always more than full, but the best news is that both kids are healthy and growing fast.
“The first time I held Milo," Elaine recalls, "I picked him up and put him on my chest, and I started to cry. I didn’t understand until then how tiny he was, and it made my heart hurt." Now, Maddie is 16 pounds, healthy, and very observant, and Milo, at 14 pounds, is a "flirt baby" with big smiles and an even bigger laugh. Although the twins sometimes give each other a hard time, they hold hands when they’re next to each other.
"Despite the difficult circumstances of their birth and how much we've all had to face together," Elaine says, "we’re so thrilled to have our babies with us and take such joy in seeing them every day."