Care Plan

Ezra and I have consulted with many different centers regarding Emanuela’s postnatal care. We were unable to connect with a physician in the Palo Alto area to perform the amnioinfusions she requires. Due to this barrier, Stanford is no longer an option for her postnatal care.

We have decided to continue Emanuela’s postnatal care at the University of Minnesota, providing we are able to deliver there or transfer. There are several factors that made Minnesota stand out:

1. Minnesota has successfully dialyzed neonates with low birthweights, the lowest to date weighing 1400 g (~3 .1 lbs). Other regional centers have a cut-off of 2000 g (~4.4 lbs). This means they won’t consider dialysis unless she meets the 2000 g threshold, and she will not survive if she is born weighing less than 2000 g. For reference, Emanuela is currently 31 weeks and measuring roughly 1000 g (~2.2 lbs). Most babies at 31 weeks weigh approximately 1450 g (~3.2 lbs). We anticipate she will have a low birth weight, regardless of when she comes. A team with experience in dialyzing low-birth weight babies is crucial for Emanuela, especially since she has no innate kidney function.
2. Minnesota cares for 2-3 babies/year with long-term dialysis needs, as opposed to <1 baby/year at other regional centers. From our research, they are the most experienced regional center at performing long-term dialysis in babies.
3. Minnesota has an Aquadex machine, which can filter her blood if complications arise from peritoneal dialysis or if she is too small for catheter placement at birth. The other centers in the area do not have an Aquadex machine, so there would be no back-up plan should complications arise from peritoneal dialysis.

In addition to the points listed above, Minnesota is within driving distance from Omaha, where we are currently receiving amnioinfusions. Plan A is for her to tolerate the amnioinfusions until about 37 weeks, at which point we will cease infusions and transfer up to Minnesota for delivery and postnatal care.

If complications arise and she is born prior to 37 weeks, we will request a transfer to Minnesota. If her respiratory status is good, she should be able to tolerate a transfer to Minnesota.

If she is born prior to 37 weeks and is in poor respiratory status, we will continue her care in Omaha. Transferring with poor respiratory status would be too dangerous.

We are thankful we have a plan going forward. We do not know what the future holds for us, but we find solace in a God who is sovereign over all things.

“For you created my inmost being; you knit me together in my mother’s womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well.”

Psalm 139:13-14