Crew from Dell Children’s braves storm to reach fragile newborn

April 2021


Zaylynn Arias came into the world with the odds stacked against her.

She arrived after just 23 weeks of gestation, 16 weeks shy of her due date and weighing only 22 ounces. The hospital where she was born two hours after her mother checked in was equipped and staffed for only Level 1 maternity care, appropriate for a normal delivery.

Born 16 weeks early, Zaylynn Arias is surrounded by tubes and medical equipment at a hospital in Marble Falls, Texas. The hospital was not staffed or equipped for high-risk newborns like Zaylynn. To oversee her care, a team from Dell Children's Medical Center in Austin drove about 50 miles through a winter storm.

As Zaylynn was being born on Feb. 17 in Marble Falls, Texas, the city and much of the state were in the grips of a rare, crippling winter blast that brought dangerous road conditions along with freezing temperatures. The weather caused widespread power and water outages. On top of that, like much of the nation, Texas was grappling with a pandemic that had stretched many hospitals' resources and staff to the brink for almost a year.

"She was really born within the context of as many challenges as you can possibly have," says Dr. John Loyd, division neonatologist chief at Dell Children's Medical Center in Austin, Texas. The hospital is part of Ascension.

Loyd led a three-person clinical team who made a 50-mile trip on ice-glazed, snow-slick highways through the winter storm to Baylor Scott & White Medical Center – Marble Falls. There, they took over direction of Zaylynn's care, stabilizing the micro-preemie until an air ambulance could be dispatched safely the next afternoon and whisk her away to Dell Children's. With its Level 4 neonatal intensive care unit, Dell Children's offers the most advanced care available for premature newborns.

As Catholic Health World went to press in mid-March, Zaylynn remained in the NICU in a medically fragile condition. And, while she will be in the NICU until after her due date, even if everything goes well, Loyd says that it is likely that Zaylynn will be able to go home with her mother acting much like a full-term baby.

"Our goal is to send her home breathing normally, feeding normally and gaining weight," Loyd says.

A transport team moves one-day-old Zaylynn Arias to the air ambulance that will take her to the neonatal intensive care unit at Dell Children's Medical Center in Austin. Winter weather prevented a NICU transport team from reaching the micro-preemie immediately after her birth.

"There's still a lot that we don't know," Loyd said in early March. Her lungs are not fully developed. "That means, they are having to do a lot of hard work they were not designed to be doing. That means swelling, scarring, challenges with development. But the chances are that (her mother) Kimberly will take her home doing those things, that she will grow up and go to school, and that she drives Kimberly crazy like my children drive me crazy."

Ready to roll
Loyd says when Zaylynn was born, the staff at Baylor Scott & White Medical Center knew instantly that they needed expert assistance to save the tiny infant. They called hospitals across the state with high-level NICUs in search of a transport team. Dell Children's, like the other hospitals, couldn't safely send an air or ground ambulance into the winter storm.

Loyd was alerted to the dire situation as soon as Dell Children's got the call for aid. "At that point I resolved to try and do what I could," he says.

This was in spite of having spent the night at Cedar Park Regional Medical Center on the outskirts of Austin assisting in the care of a fragile newborn and then putting in a full day at Dell Children's, where, because of the winter storm, some staffers were on call for as long as 72 hours and sleeping at the hospital. Unlike many surrounding homes and businesses, the hospital never lost power during the storm. It did have brief interruptions in water service.

Kelly Klaus, left, and, Nicole Padden care for Zaylynn Arias at Baylor Scott & White Medical Center in Marble Falls, Texas.

After talking with the care team in Marble Falls and consulting with other medical leaders at Dell Children's, Loyd packed his four-wheel-drive SUV with IV pumps, fluids, catheters and other supplies and hit the road. NICU transport team nurse Nicole Padden and hospital charge nurse Kelly Klaus joined him for the special mission.

"I probably could have had 12 nurses hop in the truck and drive out there with me," he recalls. "There was such a strong desire from the nurses to do what they could to help as well."

All-out effort
Because of the hazardous roads, it took the team about 2½ hours to get to Marble Falls, twice as long as it normally would. En route, Loyd reached the chief medical officer at Baylor Scott & White to arrange emergency privileges so he and the nurses could treat the baby. The group got to the hospital about six hours after Zaylynn's birth.

A transport team moves one-day-old Zaylynn Arias to the air ambulance that will take her to the neonatal intensive care unit at Dell Children's Medical Center in Austin. Winter weather prevented a NICU transport team from reaching the micro-preemie immediately after her birth.

At the time, Loyd put the chances for the baby's survival at birth under the extreme conditions at about 5%. He attributes the good prognosis he offers now to the quality of the initial care delivered by the staff at Baylor Scott & White and the NICU care from Dell Children's. Zaylynn's mother is doing fine.

Despite the rarity of micro-preemie births at Baylor Scott & White, staff inserted an IV into one of Zaylynn's tiny veins and intubated her to begin ventilation, Loyd says.

There was great relief though when the crew from Dell Children's arrived and went to work, making adjustments to the infant's breathing tube, ventilator settings and fluid intake, replacing the IV line and adding another one for additional monitoring and blood sampling. In photos from those first hours, Zaylynn is so tiny she is almost impossible to spot among the medical equipment surrounding and attached to her.

Loyd says the trio of clinicians from Dell Children's and those from Baylor Scott & White were emotional when they handed Zaylynn over to the care of the transport team on the air ambulance, which included Padden.

"The moment of us walking into the unit was a hugging, tear-laden moment of excitement and then that whole scene was repeated when the transport team arrived with the transport isolette and we knew we would be able to move her safely to Dell Children's," Loyd says.

The story has drawn extensive media coverage, including a segment on Good Morning America. The accolades for his team's effort feel especially gratifying given how difficult the pandemic has made the past year for health care workers, Loyd says.

"The circumstances were challenging but those challenges often bring clarity and the clarity that it has brought for me is just that this is why I went into health care and I know Kelly and Nicole would say the same thing."

Copyright © 2021 by the Catholic Health Association of the United States

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