Having a baby comes with so many emotions: happiness, excitement, anxiousness, fear, uncertainty, joy. And that’s all before you even get to the delivery room!
Preparing for a new baby means thinking about the future, anything from what the baby will look like to where he or she will go to school. What happens when the delivery doesn’t go quite as you imagined? The neonatology team at Memorial Hospital Shiloh’s Family Care Birthing Center is here for you and your baby.
The only Level II E Nursery in the area
Memorial Hospital Shiloh is home to the only Level II E Nursery in the Metro East, which means that in addition to full-term babies, we can care for those as early as 30 weeks, as small as 2.75 pounds, and those on assisted ventilation. Neonatologist Dr. Shawn O’Connor is chairman of pediatrics and neonatology medical director at Memorial Hospital Shiloh.
“Neonatologists are pediatricians who specialize in the care of babies born either premature or with illness or injury at time of birth—that could be either shortly after birth or born with. So our job is as intensive care physicians for these newborns,” said Shawn. Yes, Dr. O’Connor is on a first-name basis with the families he cares for and his team at Memorial.
In 2020, Elena Luna and Finn Bibbee were born at Memorial Hospital Shiloh and cared for by the neonatology team. Although their circumstances were different, their initial newborn care was the same they would have received at Barnes-Jewish Hospital or St. Louis Children’s.
Elena born at 30 weeks
Kayla Kite gave birth to Elena on February 5, 2020. She was born at 30 weeks and five days weighing 4 pounds, 4 ounces, and she was 17 inches long. Elena was Kayla and her boyfriend Gaston Luna’s first child.
In late January, Kayla went to Memorial, where she found out she was leaking amniotic fluid. She was transferred to Barnes for five days and released on no restrictions.
“Within 24 hours, I was back at Memorial in active labor,” she recalls. “I got there at 5:45 I think, in the morning, and my contractions were about two minutes apart.”
Kayla credits Jennifer Laubscher, a nurse at the Family Care Birthing Center, for helping her through her labor and delivery. “Jen was my nurse that day, and she was super awesome,” Kayla said. “She was there and just talked me through it.”
When Elena was delivered, Kayla got to hold her long enough for the umbilical cord to be cut, then she was taken to the Level II E Nursery.
“Sometimes when we look at little babies, we think they operate like little, mini adults, but they don’t,” Shawn said. “A baby born 10 weeks premature has a lot of things that have to happen that would have happened over the next 10 weeks in the womb.” In Elena’s case, she would need help breathing, staying warm, and eating.
“Elena’s lungs were immature, so we have to support that immaturity while her lungs continue to develop and grow rapidly after she’s born,” Shawn explained. “She would have been on respiratory support for a while, but that is something that for most babies gets better relatively quickly.”
“At 30 weeks, the other thing people take for granted is just staying warm,” Shawn said. “You don’t have the muscle mass and the body fat to keep yourself warm. For babies born as small as Elena, we have to regulate and monitor their temperature actively. They’re connected to special devices that monitor their temperature and adjusts an automatic heater in the humidified environment to keep their body normal temperature for them. Slowly, over a matter of weeks, we bring that temperature support down as they maintain their temperature to transition to them doing it all on their own.”
Finally, Elena had to learn to eat. “Babies learn to eat starting at about 34 weeks in the womb,” Shawn said. “So Elena’s brain wouldn’t even developmentally be able to understand the concept of eating for another month.” Elena was fed through a tube and worked with speech and occupational therapy every day to help her develop the oral-motor skills she needed to eat on her own.
“The thing that really becomes frustrating for moms and dads is that we have to let their babies learn how to eat,” Shawn said. “And as they start to figure it out at their own pace, we slowly allow them to take more by mouth and less by their tube. They have to be able to do it all by mouth before they’re able to go home.”
After a seven-week stay in the Level II E Nursery, Elena got to go home. When Kayla looks back at the experience, she remembers how great the neonatal staff was. “I was very particular,” she said. “She had to be handled a certain way, so I’m really glad they actually accommodated that. With having tubes in the mouth, it built up a lot of dryness around her lips. That was one of my biggest pet peeves, and they knew that. And I knew she wasn’t the only baby in there, but they still made sure to just give her that little extra, and they knew that meant a lot to me. They were excellent with her.”
“Our families get comfortable with the nurses who are caring for them, because it’s just a small group that from days to nights is able to give that continuity of care for that newborn,” said Natosha McEvers, MSN, RNC-OB & LRN, nurse manager at the Family Care Birthing Center. What sets Memorial’s neonatal nursing team apart? “Really just the fact that they are truly committed to providing the best care for every patient who comes in, both moms and newborns, and to involve them,” Natosha said. “They like to see the success of the families being able to really bond and grow as a family.”
Finn was full term with a rare diagnosis
Katrina Johnson was induced two days after her due date on December 11, 2020, and although she doesn’t recommend getting induced, she admits it ended up being for the best. She gave birth to Finn on December 12, and he weighed 7 pounds, 10 ounces and was 19½ inches long. Finn is Katrina’s and Michael Bibbee’s “first child and best child,” according to Katrina.
“When we were being induced on the 11th, Finn’s cord had been wrapped around his neck,” Katrina said. “So we had to do an emergency C-section instead.”
“Finn had respiratory failure in the delivery room,” Shawn said. “And it was way more pronounced than it should have been for a baby who is full term. The significant difficulty he had in the delivery room is likely related to maternal medicines. And this is one thing moms and dads beat themselves up over again and again. I cannot stress this enough that it’s not anybody’s fault. Moms have to take their medicines. If you’re on a prescribed medicine, that’s the reason I’m there is to take care of those side effects after delivery.”
After getting his respiratory distress under control, the next step was to get Finn to take a bottle. “When he was doing the bottle feedings, he was a very sleepy baby, taking a long time,” Katrina recalls. “As parents we were antsy to get him home, and we would love to take him home before Christmas!”
“Finn had six weeks of practice eating from 34 weeks to 40 weeks, so it’s not surprising that he kind of forgot because he came out sick from a breathing perspective,” Shawn said. “By a week, he should normally have been eating his food great, but he wasn’t. We still had to make sure he got his nutrition, so he was getting his food by mouth and working on his NG feedings, which is a tube that goes in the nose and down to the stomach.”
Katrina said that around December 28, Finn seemed to really be getting the hang of eating, and Shawn confirmed he was taking 80% of his food by mouth by this time. However, the night of December 27 he had to go back on the warmer. On December 20, Finn wasn’t on the warmer, so the fact that he needed to be on it seven days later was odd. “Babies don’t usually do that,” Shawn said.
Shawn ordered special testing for Finn to make sure he didn’t have a thyroid problem. The test came back abnormal but borderline, so they repeated it a few days later. “Again, it was borderline enough that he likely had hypothyroidism, which was likely the cause of his inability to maintain his temperature,” Shawn said. “It was likely contributing to his inability to not eat as well. One of the things we’re always taught is that babies who have one problem sometimes have more than one problem.”
Next, Shawn and his partner Dr. Hayley Friedman performed a cortisol test. “Cortisol is the hormone that you and I release when we’re stressed,” Shawn said. “A baby who’s not eating, a baby who’s not keeping his temperature well, that could be his inability to mount that stress response that you and I take for granted.”
After the cortisol test, Finn’s levels were undetectable. “I knew what that meant,” Shawn said. “What we do after that is inject a special medicine that should cause the body to make cortisol. If it doesn’t, it tells us where the problem is.” While it should have caused a big response in Finn, it didn’t.
Shawn called Katrina and Michael in and explained that in addition to the deficiency in Finn’s thyroid pathway, he also had a second deficiency in the cortisol pathway. Finn needed special medicine, which was all available at Memorial Hospital Shiloh. However, when starting those medicines, some babies can get very sick.
“So I made the decision that Finn needed to go down to my colleagues in Children’s,” Shawn said. “Not because we couldn’t do what we were planning to do at Shiloh, but because he could be better monitored there in case he were to have a problem. He also needed an MRI of his brain, because I was worried about how his pituitary gland was functioning. If you have one hormone missing, that’s one thing. If you have two hormones missing, that’s probably not the thyroid and adrenal gland. There’s probably something wrong with how the brain is communicating with those.”
“When we were at Children’s, it was a really good, peaceful time, because we knew exactly what we were there for,” Katrina said. “We were there to see different specialists, do different tests, get medicine, then get out of there.” After Finn started cortisol and thyroid replacement medicine, he was eating by mouth and in an appropriate time frame. And he was very close to having a diagnosis.
“Finn was diagnosed with septo-optic dysplasia, which is an extremely rare disorder of early brain and eye development,” Shawn explained. “Symptoms for babies like Finn were low blood sugar; jaundice, which he had a little more pronounced; and then some problems with hormones. When we saw Finn’s brain MRI, we saw the part of the brain that connects the left half to the right half wasn’t completely formed correctly. That happens in 30 to 80% of babies with this condition. The other thing that would have clued us into this, which Finn didn’t have, was cleft palate. If he had the cleft palate, it would have made the diagnosis much easier, because that’s something you can see with your eyes.” It usually takes a few months to diagnose septo-optic dysplasia, but Shawn diagnosed Finn within three weeks.
“It was a huge blessing in disguise that we got to be in the NICU for 27-28 days, because this got caught and we have the medicine we need, and we’re in contact with the right people,” Katrina said. “Michael and I also got a lot of hands-on learning of how to be parents from nurses and people who work with babies all the time.”
“It was great to be surrounded by lifelong professionals,” Michael agreed. “And if I ever meet Dr. Shawn again, I will kiss him on the mouth!”
Home away from home
Memorial Hospital Shiloh isn’t just a home away from home for parents, Shawn spends a lot of time there too. “This is our family,” he said of his patients and their parents. “Sometimes I spend more time with that family than I do my own, especially when they’re really sick. Except they’re going to leave me, but they’re no less family, because I am just as invested in making sure your kid is healthy. But I have to do it correctly, even though it might take us a little while, we will get there one day at a time.”
How are Elena and Finn now?
“Elena’s doing good!” Kayla said. “She’s so sassy! She’s very dramatic. She’s feisty. She’s very strong willed.” Elena is also in physical and occupational therapy, and Kayla reports the therapists say she is performing really well.
Finn is also thriving. “He’s on a schedule already, which is something that’s tricky for most people, but we took him pretty much from the NICU, which is a schedule all the time,” Katrina said. “He sleeps really good, so that’s nice. He eats really good.” And at six weeks, Finn was already rolling over from his tummy to his back.
Memorial Hospital Shiloh offers a boarding program for parents who want to stay at the hospital. “We are lucky in Shiloh that we have great support from the hospital administration to provide rooms, potentially on a different floor, for the moms and dads who have babies staying in the special care ICU,” Shawn said. “They can stay in the building 24/7 if they choose, so they could come in and visit their baby anytime day or night.”