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Nursing Know-How, Empathy Pull a Baby Through

Photo courtesy Shawn Studdard

Brooke and Kamryn Studdard arrived in this world on June 17, 2009, at Parkland Hospital, Dallas, TX, and both went straight into neonatal intensive care.

Brooke went home after 5 days. Kamryn stayed - and stayed.

It took major surgery, a ventilator to help her breathe, dopamine to stabilize her blood pressure, umbilical catheters to hydrate her and monitor her urinary output, Versed to sedate her, fentanyl to dampen her pain and, finally, methadone to wean her from the fentanyl, before Kamryn Studdard, after 48 days, joined her twin sister at home, on August 3 - on her mother Stephanie's birthday, no less, surely the most joyous of the 36 she has had.

Kamryn was born with a congenital malformation that happens once in every 3,000 live births. You might call her unlucky, unless you know that this condition results in death half the time, which means Kamryn is a very lucky little girl.

Her father, Shawn, feels lucky - especially for having nurses around.

"We were incredibly lucky they have a nursing staff every bit as good, if not better than the doctors," Studdard told ADVANCE. "I know it sounds crazy, but I truly believe the nurses did more to save Kamryn's life than the doctors did. Hour after hour they were involved, caring for her like she was their own. Nurses are every bit as important as doctors, in any institution." 

'Terribly Scary'
Thirteen weeks into the pregnancy, the Studdards saw on ultrasound that Kamryn's abdominal area didn't look normal. Their physician eventually confirmed it: Kamryn had a congenital diaphragmatic hernia (CDH).

"That day, our whole world turned upside down," Studdard said. "We had never heard of CDH before. The doctor said, 'Please don't look this up on the Internet.' We don't follow rules very well. That's the first thing I did when I got home. And it got terribly scary."

In CDH, the diaphragm fails to close by about 8 weeks' gestation. As a result of this defect, the abdominal organs (stomach, intestine, liver, bowel, and spleen) migrate into the chest cavity in utero, through the hernia, crowding and compressing the lungs and preventing them from developing.

"Picture a hole in there, where all the organs are pushing up through the diaphragm, into the lungs, pushing the heart," said Traci Bernard, RN, one of two primary day nurses Kamryn had throughout her stay at Parkland.

"Once surgeons get everything back in place, it takes a long time for the lungs to expand. She was lucky she had enough lungs to survive. Some babies don't have enough lung development to make it."

Abruptio Placentae
Knowing what lay ahead, "the entire pregnancy was about battling fear and denial," Studdard said. "My wife and I have very competitive spirits, whether in work, sports, or life. It really tested that competitive spirit. Whatever we were dealt, we were going to deal with it. But there were many nights of crying."

Delivery day finally came. "We had 28 people, not including Stephanie and I, in the room," he recalled. "There was a medical team for each baby. It was a C-section. At one point, the placenta had an abruption when they cut into the amniotic sac. It was like a horror movie. Brooke aspirated, so both our twins ended up in the NICU. But Brooke was never critical."  

Kamryn was intubated on high-frequency ventilation, as her lungs were only about 25 percent developed. Three days later, surgeons felt Kamryn's oxygenation was reasonably good and performed 90-minute surgery on her to repair the hernia.

"Every diaphragmatic hernia is different," Bernard explained. "They did end up using a flap to cover the hole. Kamryn was lucky. Sometimes the defect is so big they can't close it even with a flap. Other babies are so small there is enough of the diaphragm there to close by itself, without a flap."

Kamryn's first month was touch-and-go.

"She definitely was really sick for about three weeks," said Kamryn's other primary day nurse, Tamara Loving, RN. "She had some pretty rough days, but never got so unstable we had to go to ECMO (extracorporeal membrane oxygenation)."

Bernard recalled the newborn "really didn't like to be touched. We could only touch her every eight hours to monitor her heart and lungs. She didn't like loud noises or bright lighting, either. That high-frequency ventilator is gigantic and loud. Many times we put ear plugs on those babies."

Kamryn's subsequent addiction to her fentanyl drip "was another obstacle we had to overcome," she added.

Eventually, Kamryn "just turned the corner," Loving said. "We didn't do anything special. The next day she was always doing a little better. Her ABGs started getting better. We were able to wean her ventilator settings at three-and-a-half weeks. We went straight to room air with her, not CPAP."

Daily Correspondence

Actually, Parkland's nurses did many special things. One involved the Studdard's other daughter, Hollie, age 7.

Hollie was struggling with the concept that one of her twin sisters might never come home. "The realization probably didn't hit her until we took her to the hospital," Studdard said. "Only when a 7-year-old sees the vent, the tubes, the monitors can she understand. One day in the car she turned to me and said, 'Daddy, can I ask you a question?'" Studdard said. "Then in the sweetest voice in the world, she asked, 'Is Kamryn going to die?' So she understood it could happen."

Hollie rarely visited the hospital due to concerns about swine flu at the time. To ease her apprehension, Bernard, Loving, and other nurses mailed pictures of Kamryn pasted on construction paper, along with notes "written" by Kamryn, updating Hollie on her progress.

"It turned into an almost daily back-and-forth between Kamryn and Hollie," Studdard said. "I don't know if we would have gotten that kind of treatment anywhere."

First Holding
Three weeks after giving birth, on their wedding anniversary, Shawn and Stephanie Studdard reached a milestone: they held baby Kamryn for the first time.

"We really wanted to hold our baby, but she had wires and machines around her, so holding her was an event," Shawn Studdard said. "They had to move a lot of machines around. It was a pain in the butt, I'm sure, for the staff. But the nurses fought for it, and pressed the physicians for it. I don't think Stephanie and I could have persuaded them, because there are risks."  

Bernard recalled: "It was a warm, fuzzy feeling the day I got to hand Kamryn to her mom for the very first time. Normally, we don't let parents touch children while they are intubated. But we had a Logan's bow to stabilize the ET tube and hold it in place. I told the physicians her ABGs are stable, she's not on a lot of oxygen. She's ready to be held. And I was right. Mom loved it. She was overjoyed. She didn't want to leave."

Now mom holds Kamryn any time she wants. A tiny scar on Kamryn's abdomen is the only visible reminder of the whole ordeal.

"Amazingly, she is totally fine," Studdard said. "She's fairly close in development with her sister Brooke. With CDH, if they live, to have them do this well, to be discharged with no complications, it rarely happens. The physicians, surgeons, and nurses brought Kamryn along at just the right speed. Had we taken her to a different facility, the outcome may have been different."

Michael Gibbons is a senior associate editor at ADVANCE.  

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