After 23 weeks of an uneventful pregnancy, Colleen McManus knew something wasn't right when she woke up that June morning.
"I was feeling a lot of pressure, as if the baby was really bearing down," she remembers. Ms. McManus's husband, a physician himself, urged her to call her obstetrician, Josine Veca, D.O., a member of the faculty obstetrics practice at New York Methodist Hospital. "Dr. Veca told me to keep tabs on how I was feeling throughout the day, be sure to keep hydrated, and to check in with her later. So I had a big glass of water and set off into my morning."
After the medication was discontinued, Ms. McManus's breathing improved, but then the contractions came back and the baby started to show signs of severe distress. "I knew we needed to get the baby out in order for both of them to have the best outcome possible," Dr. Veca remembered. At 24 weeks, five days of gestation, Zaynah Clare Salameh entered the world via an emergency cesarean section. While Ms. McManus was put under intensive care to recover from her surgery and respiratory distress; little Zaynah was rushed to the neonatal intensive care unit (NICU). "There was so much going on at the same time, I couldn't keep up. I am so used to being in charge and making decisions, but in this case, I just let go and got out of the way. I felt secure because everything was being expertly managed; the continuum of care-from obstetrics to pulmonolgy to surgery to neonatal intensive care-was a well-oiled machine," says Ms. McManus.
There was no way she could have prepared herself for what the day had in store.
"By mid-morning, I was getting concerned; the pressure was increasing. I called Dr. Veca and she directed me to NYM's Advanced Women's Imaging and Prenatal Testing Center, for a sonogram. As a vice-president here at NYM, I work at the Hospital campus, so technically, I only needed to take the elevator down four floors, but it felt like the longest trip of my life; I was so nervous that something might be wrong with the baby." The sonogram revealed that the baby was just fine, but Ms. McManus was in pre-term labor.
Dr. Veca immediately admitted Ms.McManus to the labor and delivery unit, started her on medications that slow down contractions, and placed her in the "Trendelenburg" position, in which the body lies flat with the feet higher than the head. However, Ms. McManus reacted to the medications by developing severe pulmonary edema. "She went into full respiratory distress," recalls Anthony Saleh, M.D., a member of the Division of Pulmonology and Critical Care Medicine. "She was on 100 percent oxygen and could barely breathe."
"One of the greatest risks with babies born so prematurely is that their lungs aren't fully developed," says Madhu Gudavalli, M.D., chief of neonatology. "Zaynah, remarkably, was able to breathe on her own. Babies in her condition usually require assistance with breathing from birth, yet all she needed was a little assistance from the nasal prongs of a CPAP (continuous positive airway pressure) machine. At one pound, 12 ounces and 13 inches long, Zaynah was a feisty little girl!"
"I knew we had a good NICU at NYM, but I had no idea just how comprehensive the services are," says Ms. McManus. The 24-bed NICU at NYM is classified as Level III, which means that it is staffed and equipped to care for the sickest newborns, including those born extremely prematurely and those requiring and recovering from surgery. It is staffed by full-time board-certified neonatalogists and specially trained registered nurses who, in addition to caring for the tiny patients, are dedicated to helping parents cope with difficulties during their infant's hospitalization.
"What impressed us most about the NICU was the sense of pride and ownership the staff felt about each and every baby on the unit. Although there were a number of neonatalogists who worked with Zaynah, there was absolute consistency of care and continuity across the medical staff. When we, or any parents, would call in for an update, the nurses knew exactly what was going on with the baby at all times. Zaynah spent four months in the NICU, and my husband or I was there the whole time. The NICU staff treated each and every family with incredible compassion and competence.
"They also realized that even though the baby was the one in the NICU, the entire family was experiencing the hospitalization, which was especially helpful for my husband who was comfortable in the role of the physician, but new to the role of the father, especially the father of a patient. There is a dedicated social worker for the unit who helps orient the families, and provide support throughout their children's time there."
After four months in the NICU-37.5 weeks post-conception, Zaynah was finally able to go home. She is now a healthy, happy, joyous one-year old. Zaynah's pediatrician, Ilya Bialik, M.D., chief of general pediatrics, reports that, "In my 25 years of practicing medicine, I have never seen a child who was born that prematurely, do so well. Developmentally, she is even surpassing babies who were born at full term, and she needs no interventions whatsoever. Thanks to the combination of NYM's advanced medical care, dedicated parental involvement and the will of one strong little girl, she is thriving!"
Read more real life patient stories in the 2011 NYM Annual Report.