This Thanksgiving, Erin and Nick Ciapponi are spending their holiday in the Pediatric Intensive Care Unit/Pediatric Cardiac Intensive Care Unit (PICU/PCICU) at UC Davis Children's Hospital. The Ciapponis will be seated at the bedside of their beautiful newborn baby boy, Guy, now a little more than 2 weeks old.
And for that, they are thankful.
Erin Ciapponi delivered her second child at Mercy Medical Center Redding, Calif., a scheduled Cesarean section at full term. Guy weighed in at a healthy 7 pounds, 14 ounces, but immediately after his birth his doctors realized that something was very wrong.
Their beautiful baby boy was experiencing breathing and lung difficulties. Doctors at Mercy diagnosed him with a life-threatening condition of newborn babies: persistent pulmonary hypertension of the newborn (PPHN).
When a baby is born and begins breathing air, the blood pressure in their lungs falls and a vestigial blood vessel that facilitates blood flow throughout their bodies while in the womb closes. But in persistent pulmonary hypertension of the newborn, the vessel doesn't close and rather than blood flowing through the lungs, the blood is directed away from the lungs, depriving the heart and other organs of oxygen.
While doctors at Mercy can successfully treat mild PPHN, they realized that the best place for a child like Guy to be treated was in the intensive care units at UC Davis Children's Hospital, where he could receive the complex medical care he required.
Erin and Nick were stunned when they first learned of their son's condition.
"We felt helpless," Erin said while seated with her husband in Guy's room in the PICU/PCICU.
Erin is a stay-at-home mother and was looking forward to bringing her son home to his older brother, Sam, who is nearly 2. Her husband, Nick, is a captain with the California Department of Forestry and Fire Prevention (CAL FIRE) Shasta-Trinity Unit.
Now, instead of taking Guy home, they were driving nearly 200 miles to UC Davis, while the UC Davis Children's Hospital Pediatric Transport Team flew their 1-day-old son to UC Davis. The team would provide their son with nearly the same level of care as an ICU during the entire trip, according to Debra Bamber, patient care services manager of both the pediatric transport team and PICU/PCICU.
Guy arrived at UC Davis on Nov. 7 and at first was admitted to the Neonatal Intensive Care Unit (NICU) and the care of Associate Professor of Pediatrics Ian Griffin, a neonatologist. Griffin recognized that the baby was continuing to struggle and decided to consult the Extracorporeal Life Support team housed in the PICU/PCICU. On the morning of Nov. 8 Guy was placed on extra-corporeal life support (ECLS) in the NICU and then was transferred to the PICU/PCICU. ECLS is similar to heart-lung bypass used in the operating room.
Guy would remain on ECLS from Nov. 8 through Nov. 14.
"Without ECLS, Guy would not have survived," said Laura Kenny, assistant patient care services manager and ECLS coordinator of the PICU/PCICU's ECLS. "His PPHN was so severe that it was not treatable with any of our other lifesaving capabilities. We reserve ECLS for only the most severe conditions affecting the heart and or lungs. Guy is a perfect example of that."
ECLS is one of the most advanced forms of life support available to patients experiencing acute failure of the cardiac and respiratory systems. In ECLS, a machine does the work of the heart and lungs, artificially oxygenating and purifying the blood and returning it to the body, allowing the patient's heart and lungs to rest and heal.
At UC Davis, ECLS is provided by a team of physicians, nurses and perfusionists trained to provide extra-corporeal life support. All patients on ECLS have a bedside nurse dedicated to the care of the patient and a second specially trained nurse committed to the management of the ECLS machine.
While Guy was on ECLS, dozens of wires and tubes, large and small, emanated from his tiny, fragile body. His isolette was surrounded by medical equipment -- the ECLS machine, monitors and other medical devices.
By Thanksgiving, most of those had been removed. His parents were able to pick him up and hold him. Soon, he will begin to learn to breastfeed, Erin Ciapponi said.
"Guy's prognosis is very good," said Robert Pretzlaff, professor and chief of the pediatric critical care medicine at UC Davis Children's Hospital. "We're glad we were able to be here for him and his family."