How a rural hospital, Dell Children's team stepped up to care for baby born prematurely during winter storm
Kimberly Arias held her gender reveal party on Valentine's Day. The Marble Falls mom-to-be found out she was having a girl. She was six months pregnant with a due date of June 9.
But just three days later, as Central Texas was deep into a week of snow, ice, power outages and water disruptions, Arias started cramping at 2 a.m. on Feb. 17. "They would come and go," she recalled. "Some were way worse than others."
The pain wouldn't go away. She consulted her sister, who is a nurse, and it became clear she needed to wake up her parents and take a very precarious drive on icy roads to Baylor Scott & White Medical Center-Marble Falls to be checked out.
Within hours she would deliver 1-pound, 7-ounce Zaylynn. At 24 weeks' gestation, Zaylynn would have a 50% to 60% chance of surviving if she had been born in a hospital with the highest level of neonatal intensive care unit, such as Austin's Dell Children's Medical Center of Central Texas.
Arias delivered at the Marble Falls hospital, which isn't designed to care for premature babies.
Its staff is trained to do everything it can to keep a mom pregnant until a medical team from a higher-level hospital can reach them to take over care after delivery and transfer the baby to its neonatal intensive care unit. If it can't delay labor, the Marble Falls hospital staff works to keep premature babies, like Zaylynn, alive maybe an hour or two before the NICU team can get there and take the baby to a higher-level NICU by helicopter.
But with Central Texas iced over, STAR Flight, Travis County's medical helicopter, was grounded. Hospital after hospital in Dallas, Fort Worth, Houston, San Antonio, Temple and Austin all said there was no way to send a team trained in premature babies to help.
For the next 30 hours, the Marble Falls hospital staff worked to keep Zaylynn alive while scrambling to find a hospital with a higher-level NICU that could send a team to transfer Zaylynn to its care. A NICU team from Dell Children's answered the call, driving through the ice to reach Zaylynn and take over her care, waiting for the weather to clear long enough for STAR Flight to be able to take off in Austin, land in Marble Falls and fly her to Austin.
‘Everything was so fast’
By the time Arias checked in at the Marble Falls hospital at 10:45 a.m., her pains had become more regular, happening every two to three minutes. The staff tried to hydrate her in casedehydration was causing the contractions, but once nurses started to examine Arias, they found she was bleeding as well.
An ultrasound revealed that Zaylynn was in the birth canal, and Arias was fully dilated.
"I panicked," Arias said. "I was scared. It's too early. ... This isn't even when she's supposed to be born. I was freaking out. ... Everything was so fast."
Arias, though, had an angel in the hospital that day. Labor and delivery nurse Meredith Schubert had spent nine years working in a neonatal intensive care unit before moving to Marble Falls in 2015. She was the only nurse at the hospital with such experience, and she was working that day, unable to leave because of the ice.
Schubert knew what to do, what supplies to grab, how to handle a 24-week-gestation baby and how to try to stabilize such a little baby.
With her was nurse Launi Miller, who took over care of Arias while Schubert was gathering everything they had on hand for a premature baby.
They also knew the situation on the roads. It was icy and below freezing. Schubert had been in the hospital since Monday, unable to go home because of the weather. Already that day, they had tried the National Guard to see if its vehicles could help reach a critically ill patient, but it was too dangerous.
Obstetrician Krystal Murphy had been iced in at her house, but, going very slowly, she made it to the hospital at 12:15 p.m.
"We did everything we could to mom to try to minimize labor from progressing," Schubert said. They gave Arias a dose of steroids to help Zaylynn's premature lungs, but it probably didn't reach her long enough to really make a difference.
Zaylynn arrived at 12:55 p.m.
"As soon as she was born, she attempted to cry a little bit," Schubert said. "We knew when she came out and looked as good as she did ... that was promising."
Schubert knew how to handle a baby this small — keep her still, lay her flat, do minimal interventions — enough to keep her breathing and keep her heart rate up, but not to move her too quickly and risk a brain bleed.
The team in Marble Falls used FaceTime to get guidance from Temple's Baylor Scott & White's McLane Children's Medical Center.
Zaylynn's heart rate was good. Dr. Curtis Copeland, a family practice doctor, and Dr. Scott Knepper, an emergency room physician, began working on her. They gave her oxygen with a face mask designed for premature babies. Knepper was able to get the smallest intubation tube into Zaylynn, which is no small feat. A ventilator could now do the work that Zaylynn's premature lungs couldn't. The doctors also inserted a line to give her glucose and fluids.
"She's probably the smallest living baby we've had here," Schubert said.
Miller stayed with Arias, talking to her about what was happening with her baby and trying to reassure her.
‘Everything I could to get there’
Even though the official transport team at Dell Children's had to decline making the trip because of the weather, individuals were willing to try.
Dr. John Loyd was the neonatologist on call at Dell Children's. He had spent that week driving his 2005 Ford Excursion up and down the hills of Austin to bring staffers to the hospital when they couldn't drive themselves in the ice.
"That thing is a tractor," he said. "That's the real hero in this." He felt he could make it safely to Marble Falls.
"There was a sense of urgency," he said, because of Zaylynn's size. The first few days with a baby that little "are so critical. I was concerned enough about how she would do, I was going to get in my car."
He went to the nursing administrator at Dell Children's to get permission to bring two nurses with him, as well as equipment. Dell Children's gave him the green light. Nurses Kelly Klaus and Nicole Padden volunteered.
"They insisted on coming with me to help Baby Arias," Loyd said. He then called the team in Marble Falls to ask if they still wanted him.
"Yes, please come," Schubert remembers thinking.
"I had previous experience with Dr. Loyd," Schubert said. That he would drive on icy roads to Marble Falls to help a baby in need "did not surprise me one bit."
Loyd said he did it because "I would not be able to sleep without doing everything I could to get there."
Before the Dell Children's team left, Schubert let them know what supplies and medications she had and what she thought they might need. The Dell Children's team packed a monitor, fluid pumps and different umbilical lines to get medications into a newborn.
The trip took an hour and a half. There was some sleet and, of course, quite a bit of ice on the road, but Loyd and the Excursion got them there safely.
During the drive, Loyd worked with Marble Falls hospital administrators to get the Dell Children's team emergency hospital privileges. "We're coloring outside the lines a bit," he said, "to figure out how to best take care of a little, tiny baby."
‘In good hands’
When the Dell Children's team arrived at 8:30 p.m., they found Zaylynn in good care. The team in Marble Falls had supported her breathing, maintained her heart rate, kept her warm and kept her blood sugar up.
Caring for babies this premature is difficult because they are so fragile, Loyd said.
"There are so many different things that can go wrong that the (Marble Falls) team was not in a position to try to manage," he said. "They had served her far and above their expertise and training to get her as far as they could those first hours."
The Dell Children's team made some minor adjustments and hooked Zaylynn up to monitors so they could watch her blood pressure and more efficiently support her. They turned her room at the Marble Falls hospital into a miniature NICU and prepared to stay for as long as it would take to safely get her to Dell Children's.
"We weren't leaving without her," Loyd said.
It snowed the next morning, and that made getting Zaylynn to Austin even more precarious.
Then the weather started to clear. The Dell Children's team heard that STAR Flight was flying, but there were calls before Zaylynn.
They figured they would have another night ahead of them in Marble Falls, but then at 2:45 p.m. on Feb. 18, STAR Flight called to say it was picking up the official transport team and equipment at Dell Children's and heading their way.
The helicopter arrived in Marble Falls at 3:35 p.m.
"It was total relief on both sides," Schubert said.
Because newborns as small as Zaylynn are so fragile, rough rides can change things quickly, and that is why hospitals prefer to use helicopters instead of traveling in ambulances on bumpy roads.
As the team moved Zaylynn into a transport isolette — an enclosed crib to protect her from drafts and germs — her heart rate dropped. They pulled her out, put her back in her original isolette and waited for her to recover, thinking she just got cold too quickly.
Loyd said babies this young have thin skin and lose heat and fluid easily.
After 30 minutes, they tried again to move Zaylynn into the transport isolette. This time she was stable.
When STAR Flight left the helipad with Zaylynn and the transport team, Schubert said she felt "totally happy tears" rolling down her face.
"I have never cried when a patient has left or when I put a baby on a helicopter until Thursday," she said. "It was a relief knowing she was in good hands. We had done everything we could do to give her a good chance."
'A long ways to go'
The team at Dell Children's called Arias when they had safely arrived with Zaylynn.
"It was really tough," Arias said of watching her baby leave Marble Falls to be flown by helicopter to Austin. "I was scared during that whole process."
The Dell Children's team told her the helicopter had everything it needed onboard to be a mini NICU, Arias said. "That calmed me down a lot."
Arias was released from the hospital Feb. 19 and visited Zaylynn in Austin the next day.
"She's was doing really good," Arias said. "They were telling me she's a very happy little one. She's a little feisty thing. They were trying to do stuff with her, and it seemed like she was pushing them away."
Arias said she prays for her baby: "That's what I can do, be here to support her."
Loyd said Zaylynn will be at Dell Children's at least until her original due date in June, "if everything goes just perfect," and maybe a few weeks longer.
"The goal for her is to get her to go home acting like a regular baby, eating food and breathing on her own," he said. "We have a long ways to go."
The team in Marble Falls "presented us with a baby with a real chance for survival," he said. "I cannot speak too highly of the job they did. They were just unbelievable."
Schubert said being stuck at the hospital as the one nurse who had NICU experience is a clear sign to her that "God intervened with us that day."
Nicole Villalpando writes about health care for the American-Statesman. She can be reached at firstname.lastname@example.org.