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A Baby's Perilous Journey

Welcoming One of the Smallest Babies Ever Born at Northwestern Lake Forest Hospital

Christie Krupka speaks in clear, definitive tones, every word articulated precisely. It’s hard to imagine that not long ago this self-assured young mom found herself in the middle of a nightmare, “losing it,” “flipping out” and “screaming” as she describes it. One evening, just seven months pregnant with her son Emmett, she began bleeding and struggling to remain conscious.

 

At the Very Beginning

The Krupka Family’s story began 16 years ago when Christie met her husband, Eric. Both Deerfield natives, they passed through high school without ever meeting but got to know each other soon after graduation. They dated for several years, married, moved to Vernon Hills and started a family.

First came Tierney (now age four), then Kelsey just 18 months later. The girls are a parent’s dream, with light brown locks, one with huge blue eyes, the other brown. They’re sweet, bright, shy—but pack plenty of spark and mischief. Christie sailed through these pregnancies. So when she became pregnant a third time, it was a matter of routine.

“We had this “back-to-back” baby plan, and wanted all along to have a third child,“ she says.“Everything had gone so smoothly before. I thought, I’ve got this down pat.”

 

At 20 Weeks

But at 20 weeks, Elizabeth Oh, MD, Christie’s obstetrician/gynecologist (OB/GYN) at Northwestern Lake Forest Hospital (NLFH), diagnosed her with Complete Previa, a condition in which the placenta completely covers the cervix and leaves no path out for the baby. The placenta—the baby’s lifeline to the mother—can also separate from the uterine wall.

As many as one in 200 women experience some form of Previa during pregnancy. It is uncommon, but not unusual, and most patients just take extra precautions.

“It meant I had to be careful, that’s all. There was a slight possibility of early labor, but I was sure everything would be just like my other pregnancies.”

 

At 29 Weeks

But nine weeks later, Christie was getting ready to leave for the church classes she teaches when suddenly things started to go wrong.

“It was a typical Tuesday night,” she recalls. “I was experiencing some bleeding, so I called Dr. Oh and she told me to get to the hospital immediately. Everything was fine, then all of a sudden it wasn’t.”

Christie called her neighbor about picking up Tierney and Kelsey, but had trouble dialing the phone number. Then the room faded around her, and Christie passed out in her bedroom from the blood loss. When she awoke, her mother, Lynn Elliott, was on the phone with the ambulance.

Christie managed to request that she be brought to NLFH. She had both her daughters there, loved the OB/GYN doctors in her practice and wanted the same “comfort and reputation” she had experienced before.

 

At the Hospital

When Christie arrived, Dr. Oh was waiting for her as well as Jill Holden, MD and Robert Hartman, MD, two other OB/GYN physicians affiliated with NLFH.

“The ambulance contacted our ER en route, and we pulled the team into place,” says Wendy Rusinak, RN, Director of Women’s and Children’s Services at the Hunter Family Center for Women’s Health, which includes the Waud Family Maternity Services and the Posy Krehbiel Breast Care Center. “We contacted the neonatologist, as well as Joseph Colligan, MD (the anesthesiologist), Dr. Hartman and the pediatric hospitalist on staff from Ann & Robert H. Lurie Children's Hospital of Chicago to assist Drs. Oh and Holden. Having the hospitalists on staff 24/7 to assist with high-risk births means we didn’t have to wait even a minute longer for extra support.”

Christie was connected to one of the advanced fetal monitors at the center. Perhaps because she was so anxious, Christie was still having “business as usual” expectations—not realizing the monitor indicated that she was already in labor.

“I thought, ‘they’re going to fix this. Maybe I’ll have bed rest before the due date,’“ she says. “So when I heard them say the OR was ready for my C-section, I really lost it and flipped out a bit. I started screaming, ‘the baby isn’t ready, the baby isn’t ready.’”

And Christie was right—Emmett was not ready. At nearly 30 weeks, he looked just like a smaller version of a full term baby (full term is 40 weeks), but his major organs were less developed. He was at risk for a host of serious complications such as respiratory distress syndrome, intraventricular hemorrhage, seizures, infection, chronic lung disease and heart and liver problems.

And that’s just the beginning. Babies born prior to 31 weeks are at increased risk for learning and behavioral problems as they get older. They’re also more likely to face conditions such as diabetes and heart disease when they reach adulthood.

 

At the Fetal Monitor

A nurse comforted her and held her hand while Christie remained connected to the fetal monitor. A physical examination confirmed that the placenta was compromised. The monitor also showed that Emmett’s heartbeat was within the range that would make it safe for the physicians to operate on Christie. That was good, because there was no stopping what had begun.

Advances in obstetrics and neonatology (the care of premature infants) have greatly improved survival rates and long-term health for premature babies—but only if there’s access to that technology. Fortunately for Emmett and Christie, Northwestern Lake Forest Hospital has advanced fetal monitoring equipment used in each and every delivery, a Level II+ Special Care Nursery and nurses specially trained in labor and delivery.

“Do fetal monitors save lives? Absolutely,” says Dr. Hartman. “They have revolutionized obstetrical care. Years ago, once we began a C-section, we lost all contact with the baby. In fact, before this technology, some babies were deemed ‘normal’ who were in fact compromised. Now we can provide care and deliver sooner, before they get in trouble.”

 

At 6:48 P.M., November 17, 2009

At 6:48 p.m., the assembled team delivered and stabilized Emmett. He was three pounds, eight ounces and 15 inches long. Worrying about Emmett had overwhelmed Christie and Eric, so they hadn’t considered how serious the situation was for her own health. She found out later that the physicians had worked on her for some time, saving her life and even saving her uterus, which was affected by the Previa and early delivery.

“There was a lot of blood loss,” Christie explains. “I ended up with a uterine catheter and three blood transfusions to help me pull through.”

According to Dr. Hartman, technology like the fetal monitors helped Christie to make it: “With constant monitoring, we can work faster, more efficiently. This wasn’t a typical cesarean section because of the size of the baby, and there was more inherent risk to the mother—her body just wasn’t ready to deliver yet. We had to work quickly.”

A bit later, the neonatologist came to see Emmett and talk with the Krupkas. Emmett could not breathe on his own and was connected to the ventilation machines that are a feature of the Level II+ Special Care Nursery. The special care nurses, neonatologist and respiratory therapy team monitored him for cerebral hemorrhages (brain bleeds), seizures and heart and lung functions. With his lungs not fully developed, respiratory distress was a significant concern. The physicians told Christie and Eric to have realistic expectations about what could happen.

Christie recalls those moments: “I had gone into surgery wondering, ‘will my baby make it?’ When I awoke, I thought ‘he’s alive,’ immediately followed by ‘what now?’”

 

At the Special Care Nursery

Emmett remained in the Special Care Nursery for seven weeks, while the three different pieces of technology helping him to breathe were gradually removed and he could handle “room air” without help.

His team resolved a heart murmur with medication, avoiding surgical intervention. He also grew bigger and stronger from nutrition delivered through a tube, then from syringes of breast milk inserted into his stomach. Eventually the nurses were showing Christie how to bottle-feed him carefully, slowly—so that the calories he was taking in wouldn’t be less than what he would burn just trying to eat.

“A baby trying to find the strength to eat was a foreign concept to me—but that in itself was an accomplishment,” Christie says. “And getting to actually hold him while the nurses gave him the syringes was heaven.”

 

At Home, at Last

The team did more than just save Emmett and Christie’s lives. They made an extraordinarily rough time more manageable by surrounding the Krupkas with specialized care—and compassion.

Christie recounts the staff’s personal attention: “We weren’t in happy picture-taking mode. But the nurses started a photo album, beginning with Emmett’s first hours and covering his entire journey. They changed his little outfits. They patiently answered calls at 3:00 a.m. They shared information. They helped us arrange things so that my daughters could see Emmett from the window outside. They understood how hard it was to leave a newborn behind every day. We weren’t just well cared for, we were cared about.”

Now, Emmett is at home with his family and doing well. Christie says he is a “magnet” for Tierney and Kelsey, who try to bring his giggles out. His parents are proud of their “little trooper” and thankful for the hospital staff.

“I never realized how much technology and expertise is available here to help babies like Emmett. And it was at our disposal without ever having to transfer Emmett from the Special Care Nursery to another hospital. Every mother deserves this kind of care.”