On Christmas Eve 2022, Sharni Saravanan was rushed to Mayo Clinic Health System in Red Wing. She was pregnant and bleeding, a terrifying combination. But doctors assured Sharni and her husband, Karthik Viswanathan, that she and their baby were fine.

This past year, Christmas Eve looked much different for Sharni and Karthik. There were no trips to the hospital, no worries about anyone's health.

And there was someone new joining the celebration: their son, Heeran, who was born at just 22 weeks.

His survival is a testament to his strength, his parents' love, medical advances, and the efforts of a devoted care team at Mayo Clinic in Rochester, Minnesota.

"Fifty years ago, premature babies born at 35 weeks might not have lived past a few days," says Dr. Christopher Colby, a neonatologist at Mayo Clinic Children's Center in Rochester.  "Now, thanks to new technology and scientific discoveries, even the smallest babies, born as early as 22 weeks, have a chance of surviving with an optimistic prognosis for their developmental outcomes."

From routine to high-risk

At a routine checkup in early January 2023, shortly after the Christmas Eve scare, an ultrasound revealed that Sharni's cervix was shortening, increasing the risk of preterm labor. She had a procedure called a cerclage, in which stitches close the cervix to prevent premature birth.

The procedure gave Sharni and Karthik's unborn child a chance to grow.

"Despite a 20% chance of survival, our baby exhibited strength and resilience with no signs of distress," Karthik says, noting that Heeran appeared "content inside his mother's womb."

While Heeran appeared content, Sharni was transferred to Mayo Clinic in Rochester, where a specialized team could monitor her now high-risk pregnancy.

Three weeks after the cerclage procedure, Sharni experienced premature rupture of the membrane — her water broke prior to 37 weeks gestation. She was given steroids to help her unborn baby's lungs develop more quickly, a treatment that improves survival and long-term outcomes in premature babies.

Three days later, Sharni went into labor and delivered her son. Heeran Karsha arrived on Feb. 2, 2023, weighing less than a pound. He was just 10.8 inches long.

"Everyone was so caring and supportive. A few of the nurses would check up on Heeran during the night shifts even if they weren't assigned to him."

Sharni Saravanan

"Infants like Heeran require intensive care from a large multidisciplinary team to provide lifesaving interventions," says Dr. Ray Stetson, a pediatrician and neonatologist who helped care for Heeran in the Neonatal Intensive Care Unit.

For Heeran, those interventions included treating conditions common in premature infants: patent ductus arteriosus, an opening between the two major blood vessels leading from the heart; periventricular leukomalacia, a type of brain damage; and retinopathy of prematurity, a condition in which blood vessels grow abnormally in the retina. He also had surgery to fix a hernia in his lower abdominal wall.

But Heeran (and his parents) received much more than that from his care team.

Caring for tiny patients — and their parents

In addition to expert medical care, Dr. Stetson says he and his colleagues provide "empathy, compassion, transparency and support for the infant's parents during hospitalizations that can last for many months."

That encouragement meant a great deal to Sharni and Karthik.

"Everyone was so caring and supportive," Sharni says of the NICU team. "A few of the nurses would check up on Heeran during the night shifts even if they weren't assigned to him. They also shared a lot of tips during the care time, which gave both of us a lot of confidence."

And when Heeran marked a major milestone — finishing his first bottle — "the whole unit was so happy that they took turns visiting him to tell him how proud they were," Sharni says.

Dr. Ellen Bendel-Stenzel was among the staff cheering Heeran on.

"It's impossible not to form a strong bond with our NICU parents as we celebrate every victory and mourn every setback with them during a prolonged hospitalization," says Dr. Bendel-Stenzel, a neonatologist. "Heeran was a rockstar preemie, beating the odds and rising in the face of adversity with his loving and supportive parents."

That love and support is critical to tiny patients, Dr. Bendel-Stenzel says.

"Over the years, we've learned that having parents actively involved and present in the care of their preterm infant improves both outcomes and the care we provide," she says. "Heeran's parents were an integral part of his growing and healing. They embraced their parental role in this process and were a joy to have on Heeran's healthcare team."

After 110 days in the NICU, Heeran was able to go to his new home in Rochester, where his parents moved to be closer to his care team. While he still receives some oxygen support, he's meeting developmental milestones — and delighting his parents.

"Heeran turns 1 in February, for which we are very grateful and proud," Sharni says. "He likes being held and to sit and listen to different sounds. He is very curious about new things and people."

Updates like that are gifts to the people who care for premature infants and their families. "The milestones met by Heeran and other children like him have positively impacted how I counsel expectant parents facing the potential of extremely preterm birth," says Dr. Jane Brumbaugh, a neonatologist. "Children born at extremely early gestations have the potential to thrive. The strength and resiliency demonstrated by these young infants bring me hope."

The post Born at less than a pound, 22-week preemie makes journey from NICU to home sweet home appeared first on Mayo Clinic News Network.

When Connor and Colson Kasper arrived at 32 weeks gestation, their mother, Alli Kasper, was better prepared than most parents for a stay in the Neonatal Intensive Care Unit at Mayo Clinic: She's the unit's interim nurse manager.

But her role had changed. She was now a mom, not a nurse. And her colleagues recognized that.

"Even though I was their colleague, everyone in the NICU treated me as my twins' mom and not their nurse," Kasper says. "The providers talked to my husband and me in plain language terms to ensure we both understood what was happening and what the plan was. The nurses were phenomenal and provided excellent care, kept me updated on any changes, and were genuinely kind and loving toward my babies."

That gave Kasper comfort.

"I had a sense of peace knowing my sons were getting the best care," she says.

50 years of caring

Fifty years ago, premature babies like Kasper's might not have lived past a few days. Now, thanks to new technology and scientific discoveries, even the smallest babies born as early as 22 weeks have a chance of surviving.

"We are commonly asked to consult with a mother who may be experiencing premature labor to describe care options for her newborn and family. The goal is to deliver a healthy baby with developmental outcomes optimized," says Christopher Colby, M.D., a neonatologist at Mayo Clinic Children's Center. 

The Neonatal Intensive Care Unit at Mayo Clinic began as a four-bed pilot project in 1973, spearheaded by the late Robert Feldt, M.D., a pediatric cardiologist, and Lloyd Harris, M.D., a pediatrician. The pilot was a success, quickly demonstrating the need for more space and personnel to care for the hospital's most fragile patients.

Fredric Kleinberg, M.D., was the original board-certified neonatologist at Mayo Clinic in 1977. Dr. Kleinberg credits medical advancements, including more sophisticated ventilation devices, with improved rates of survival at less mature gestational ages.

"Technology has come a long way since the days of using 5-foot-tall compressed air and oxygen tanks to help premature babies breathe," says Donna Hanks, who was a nurse in the Neonatal Intensive Care Unit for 43 years.

As Hanks notes, medical equipment has been refined to support newborns — some of whom weigh less than a pound at birth. These mechanical advancements include high-frequency ventilation and continuous positive airway pressure machines.

In addition to better equipment and new technologies, medication discoveries have improved the survival rates of premature babies.

"Administering the antenatal steroid known as betamethasone to the mother at least 48 hours before delivery has been demonstrated to improve survival and long-term outcomes for premature babies," says Stephanie Mavis, M.D., a neonatologist at Mayo Clinic.

Growing up

Mayo Clinic's original four-bed Neonatal Intensive Care Unit has grown to include two Neonatal Intensive Care Unit locations in Rochester, where 879 newborns received care in 2022.

A neonatal telemedicine service introduced in 2013 serves even more patients, placing a neonatologist virtually at the bedside of any newborn across the entirety of Mayo Clinic Health System. This service assists local care teams with the stabilization of critically ill babies and has supported nearly 1,000 newborns since its inception.

All of the tiny tots who receive care at Mayo Clinic are invited to an annual NICU family reunion, an event that has taken place for 39 years.

Kasper and her family attended this year's event, which she experienced as both a mother and a nurse. At the event, a former patient thanked her for taking care of him when he was a baby — a gesture that brought tears to her eyes.

"It makes the long and exhausting shifts worth it," Kasper says. "More than a gathering, the reunion is proof that our work in the NICU truly makes a difference."  

That's something she knows firsthand: Kasper herself was born at 32 weeks.

"My parents always raved about how amazing the nurses who took care of me were," she says. "I knew from a young age that I wanted to work in a NICU to give that same level of comfort and compassion to my patients' parents."

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Caring for a newborn is full of twists and turns. Feelings of joy and contentment one moment can turn to fear and worry the next. That's how Nicole and Corbin Burkard of Eau Claire, Wisconsin, felt after their third daughter, Ellie, was born in February.

"She was just perfect and looked like her older sister," says Nicole. "She just fit right in."

The new family of five was settling into a routine at home when Nicole and Corbin noticed something wasn't quite right.

A mother's intuition

"She was a pro breastfeeder but now she wasn't eating. I also had a hard time keeping her awake," says Nicole, a Mayo Clinic Health System nurse. "She wasn't peeing at all either. I felt like something was wrong."

When Ellie began to vomit bright yellow liquid, the couple took their 5-day-old newborn to the Emergency Department at Mayo Clinic Health System in Eau Claire.

Ellie was examined by emergency medicine physician Robert Tillotson, D.O.  

"If there is a significant change in a baby's behaviors within the first weeks of life, it's important to be evaluated right away," says Dr. Tillotson. "Ellie's sudden symptoms of profound drowsiness, lack of urination and bilious vomiting indicated that she could have intestinal malrotation."

Intestinal malrotation is a condition in which the intestine doesn't develop or rotate correctly in utero. Some of the intestines can be in the wrong location at birth. For some infants, malrotation leads to a twist of the intestine that causes the blood supply to be cut off. This is called malrotation with volvulus and requires immediate surgery.

"Asymptomatic malrotation occurs in between 1 in 200 to 1 in 500 live births and symptomatic malrotation occurs in only 1 in 6,000 births," explains Mayo Clinic pediatric surgeon Denise Klinkner, M.D. "The bowel can recover if the blood supply is restored within six hours. If not diagnosed promptly, infants could lose a significant amount of intestine, leaving them with complications like short gut, total parenteral nutrition dependency or possibly intestinal transplant. Prompt recognition and treatment are life-changing."

Headed to surgery

The Eau Claire team explained to the Burkards that Ellie would require emergency surgery at Mayo Clinic. The weather that evening grounded the medical helicopter, so Ellie was loaded into an ambulance for the 90-mile trip to Rochester, Minnesota. Nicole and Corbin followed behind in the family's car.

Once they arrived, the family met with Mayo Clinic Children's Center neonatologist Christopher Colby, M.D., who explained what they could expect with Ellie's surgery and recovery. Even though Nicole had years of health care experience, she was worried for her daughter. But she was reassured by the compassion and expertise of her colleagues.

"All the staff was just phenomenal," she says. "It made me feel like we were in the best possible place for Ellie."

A contrast study quickly confirmed the diagnosis, and Ellie's surgery began within one hour of her arrival in Rochester. Dr. Klinkner used Ladd's procedure to untwist and reposition Ellie's intestine and restore the blood flow. She also removed Ellie's appendix because its abnormal position could make acute appendicitis more difficult to diagnose in the future.

Ellie's surgery was a success, and she stayed in the neonatal ICU for five days to ensure her bowels recovered before returning home.

A positive outcome

Early identification and quick treatment led to a positive outcome for Ellie, says Dr. Klinkner.

"Ellie's mom is a registered nurse and an experienced mother, so she recognized the problem and brought her in early," says Dr. Klinkner. "New parents should watch for symptoms of intestinal malrotation in the first weeks of life when about 75% of cases happen."

Symptoms that should be evaluated promptly by a health care team include fever, low energy, poor appetite, swollen abdomen, vomiting green or yellow liquid, and little or no urine or bowel movements.

Six weeks after surgery, Ellie has recovered and is doing great. And her parents are recovering from this twist in her first month of life.

"She is perfect, and you can't tell anything even happened," says Nicole. "Everything went as smoothly as possible. It brings tears to my eyes when I think about her and our whole experience. We are so very thankful for the care that Ellie received."

This article originally appeared on the Mayo Clinic Health System blog.

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Beginning last year, more than 2,000 Mayo-owned iPads have been distributed across Mayo Clinic hospitals to support the Epic application known as Bedside. 

Bedside is a tablet-based application managed by Mayo Clinic's Center for Connected Care. The application functions as an inpatient online portal with a variety of features such as letting patients view their vital signs, their daily schedules and even photos and information about their care teams.

Watch: How pediatric patients can use Bedside

Family and Friends Option

During the COVID-19 response, some Mayo Clinic hospital patients have lost connections to their family and friends. Many patients have used their own smart phones or tablets to stay connected but not all patients have their own mobile devices.

Most inpatient units do have access to the Mayo-owned iPads used for Bedside. Recognizing the need to keep patients connected with loved ones, Mayo Clinic's Center for Connected Care, Nursing Department, and IT worked together to develop a way to let patients use these iPads as communication tools.

To meet this need, Zoom software was uploaded to all the Bedside tablets. Then, two use cases were discussed and implemented. "One use case is when the patient is stable and has the functional capacity to operate the iPad and use Zoom," says Julie Prigge, operations administrator for the Center for Connected Care. "The other is when the patient has limited functionality. In this case, hospital staff can facilitate a Zoom connection on behalf of the patient." 

This use of Zoom is activated through a non-HIPAA compliant domain. "This isn't any different than when patients use Zoom on their own devices. If Mayo staff are present during Zoom connections or any other conversations, they must ensure their own compliance with HIPAA," says Kim Pollock, Mayo Clinic nursing administrator. "While this use may not be HIPAA compliant, Zoom has taken great steps to protect users’ security." 

Provider to Patient Option

Uploading Zoom to the Bedside iPads also lets providers connect to patients in specific cases. When a Zoom connection is initiated by a Mayo Clinic provider, the provider uses the appropriately licensed technology to meet HIPAA guidelines. Patients can be assured that their privacy is being protected. An additional benefit of providers connecting with patients in isolation through Zoom on Bedside is the conservation of Personal Protective Equipment.

"It is vitally important that providers have the sense that care environments are safe," says Chris Colby, M.D., medical director for Bedside. "Using Zoom on the Bedside iPads reduces unnecessary trips in and out of a patient's room where the patient may have a highly contagious and infectious disease and maintains patient safety and connectivity with the care team."

"The current situation is challenging, but it has offered us the chance to be innovative in how we meet our patients’ needs," continues Dr. Colby.

Chad Weiler, a registered nurse who works in the Mankato Hospital in the intensive care unit agrees with Dr. Colby. He acknowledges that using Zoom on the Bedside tablets allows families to have a sense of being with their loved ones and the patients feel that their families are near them in this time of crisis. 

"I cared for a patient who was on life support and was not able to communicate with anyone because of the diagnosis," shares Weiler. "Zoom helped the patient’s son emotionally. He could see how ill his mother was. It helped him in making decisions and working with the health care team as to what his mother would want if and when it comes time to make hard decisions concerning continued care." 

Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding along with guidelines and recommendations may have changed since the original publication date. 

Check the Centers for Disease Control and Prevention website for additional updates on COVID-19. For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

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ROCHESTER, Minn. — Mayo Clinic Children’s Center again has been ranked as the top-performing children’s hospital in Iowa, Minnesota, North Dakota and South Dakota on U.S. News & World Report’s 2018–2019 Best Children’s Hospitals rankings.

Rankings of 118 of the nation’s pediatric centers identify the top 50 in each of 10 specialties. Only 86 children’s hospitals were ranked in at least one pediatric specialty in 2018. Mayo Clinic Children’s Center ranked as a top-performing children’s hospital in 7 of 10 pediatric specialties. These rankings demonstrate broad-based excellence and the effectiveness of the team-based approach that is the hallmark of Mayo Clinic care.

The overall rankings for each pediatric specialty are:

• Cancer (No. 26)
• Cardiology and Heart Surgery (No. 27)
• Diabetes and Endocrinology (No. 15)
• Neonatology (No. 13)
• Neurology and Neurosurgery (No. 21)
• Orthopedics (No. 31)
• Urology (No. 31) ─ two-way tie

“It is rewarding to see the efforts of our multidisciplinary team in Neonatology recognized in these rankings,” says Christopher Colby, M.D., division chair, Neonatal Medicine. “We had excellent performance in the quality and process domains in the U.S. News survey. The growth and support of the Fetal Care Center, along with the Teleneonatology Program generated a higher volume of newborns with complex medical and surgical conditions. Mayo Clinic is uniquely positioned to provide wonderful care to these babies and their families.”

“Our ranking among the top children’s hospitals reinforces our commitment to delivering quality care to children and their families not only through cutting-edge interventions, such as the Fetal Care Center, proton beam therapy for childhood cancer, and stem cell treatment for children with heart disease, but also through the integrated, multispecialty team approach for children with health problems of all kinds,” says Randall Flick, M.D., a pediatric anesthesiologist and medical director of the Mayo Clinic Children’s Center. “We are very proud of this ranking and credit our staff who continue to strive for excellence and improve patient care for the millions of patients we treat each year from around the world.”

Mayo Clinic, including the Mayo Clinic Children's Center, is most recognized as a top choice for patients and families by U.S. News & World Report and many other ranking organizations.

“It’s a privilege to be able to assemble teams of specialists of all types at the bedside of any child from before they are born, throughout childhood, adolescence and seamlessly transition into adult care,” Dr. Flick adds.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. Learn more about Mayo Clinic. Visit the Mayo Clinic News Network.

Media contact:

• Kelley Luckstein, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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Emergency telemedicine provides acute medical assessments to people who need immediate emergency care through video communications.  A Mayo Clinic medical specialist located at a distance from the patient connects via technology with local care teams to assess, diagnose and treat patients.  This type of care relies on the expertise of medical, surgical and allied health staff, as well as reliable, fast and secure technology.

This convergence enables Mayo Clinic to work with one vendor to create scalable, standardized services across Mayo Clinic’s nationwide telemedicine enterprise. Prior to this convergence, Mayo Clinic worked with numerous vendors as it grew its emergency telemedicine practice. This new strategy consolidates effort, while continuing Mayo’s strong clinical focus through the enhanced technical proficiency and ease of use for Mayo Clinic care teams.

“By combining the breadth and depth of Mayo Clinic knowledge and expertise with a standardized technology across the enterprise, we will be able to create a comprehensive, integrated, multispecialty emergency telemedicine program. Through this program, we can provide specialty consults and guidance for medical and surgical emergencies in adults and children,” says Bart Demaerschalk, M.D., a Mayo Clinic neurologist and the medical director of synchronous (telemedicine) services for the Mayo Clinic Center for Connected Care.

Also, according to Dr. Demaerschalk, this strategy provides a seamless patient experience and more opportunity for Mayo Clinic to grow its clinical service lines.  The initial telemedicine service lines to participate in this convergence are Telestroke and Teleneonatology. Mayo Clinic already provides care to more than 5,000 people per year through these service lines. The convergence enables Mayo Clinic to assist more patients across more sites.

MEDIA CONTACT: Carol Berteotti, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

“This is an exciting milestone for connected care at Mayo Clinic,” says Christopher Colby, M.D., chair of the Pediatrics Neonatal Medicine Division and telehealth director for pediatrics at Mayo Clinic. “We will now offer a technology platform specifically designed to deliver emergent telemedicine consultation.  Perhaps equally as important is that this will bring expertise from the Mayo Clinic enterprise together to develop world-class telemedicine across many service lines.”

The converged emergency telemedicine practice is one example of how Mayo Clinic’s Center for Connected Care is implementing its telemedicine strategy. The Center for Connected Care is committed to developing comprehensive telemedicine technologies and remote digital health solutions that meet the needs of one patient or many patients.

“Mayo Clinic provides an unparalleled experience as the most trusted partner for health care by connecting Mayo knowledge and expertise to anyone, anywhere, anytime to make the best health decisions,” states Dr. Demaerschalk. “Connected Care involves bringing together customers, technology, products and service line offerings.”

The first phase of this convergence will begin in late summer and continue through the first part of 2017.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/.

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Here's the Mayo Clinic Radio podcast.

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Listen to the program on Saturday, June 25, at 9:05 a.m. CDT, and follow #MayoClinicRadio.

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Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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Listen to the program on Saturday, June 25, at 9:05 a.m. CDT.

Miss the show?  Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Silent Heart Attack / Lone Star Tick / Swaddling and SIDS appeared first on Mayo Clinic News Network.