Many uncertainties surrounded the birth of Keira Pressley in a New York hospital on Oct. 14. One week before, her mother, Ileana Valle, had pre-eclampsia at her 28-week checkup and was immediately hospitalized.
Complications meant Keira would have to be delivered two and a half months early by Caesarean section, weighing just 2 pounds. Delivered in week 29, she developed anemia and breathing problems.
But one thing was certain. Valle and husband Keddy Pressley, of Bronx, N.Y., did not want their daughter to undergo any blood transfusions. Valles beliefs as a Jehovahs Witness wouldnt allow it.
However, the hospital said it could not guarantee it would honor those wishes and refused to care for Keira without the option of a transfusion. Calls made to several other hospitals were met with similar responses.
Then Valle remembered a family member had been treated at Englewood (N.J.) Hospital and Medical Center, known internationally for its transfusion-free treatment since its bloodless program started in 1994.
She remembers hearing the words that Englewood would welcome Keira. “It took my heart and breath away,” she said. The infant was transferred when she was 2 days old.
Ileana couldnt go in the ambulance because she was still admitted to the hospital she gave birth in recovering from her C-section, so Keira was welcomed by Englewood nurses Regina Gynegrowski, RNC, and Ann Nestman, RNC.
“They came to us because were famous for being bloodless, but honestly its our standard of care for all the babies in the NICU,” said Gynegrowski, who works on Englewoods bloodless team.Upon discharge, Ileana Valle, holding daughter Keira Pressley, stands with her mother, Mary Valle.
Englewood nurses are trained to inject anemic babies with a medication called Procrit (epoetin alfa) for cycles of 10 days in a row. They also give high doses of iron dextran through an IV and give multivitamins with iron as well as folic acid. These steps help babies start to make their own red blood cells.
Much thought is given to blood counts and when to draw blood. Nurses try to time blood draws so they can get results with the least amount of blood.
Having a bloodless program requires patience by the healthcare team, but there are benefits. Bloodless treatment carries a lower risk of infection, is less expensive and hospitals dont have to worry about a patients blood type.
Patience comes into play when a patients blood count drops or vitals change, a point at which many hospitals transfuse. But Englewood physicians are comfortable waiting and monitoring longer than is typical to see if blood counts reach the emergency level, Gynegrowski said.
In Keiras case, nurses were key in making sure she knew Ileana was her mom even though she wasnt the primary caretaker at first. That meant showing Valle how to breastfeed such a small infant. While Valle was recovering in the previous hospital, she had been pumping milk that nurses had been giving Keira through a feeding tube.
As soon as Valle was able to spend time with Keira at Englewood, nurses helped her with skin-to-skin bonding, said Nestman, who works in the NICU.
“I learned really what it was to be a mom and care for a preemie from them,” Valle said. “I even learned how to change her incubator bedding. I said I wanted to do it all.”
Keiras condition improved quickly and, after almost seven weeks, she was discharged at 17.5 inches and almost 4 pounds. As of late March, her mother said she was a healthy 14 pounds and 23 inches.
Nestman said her experience as a nurse at the hospital has opened her own mind to the benefits of bloodless treatment.
“I can honestly say in my own life I have re-thought blood transfusions,” she said. “If down the road I would need a blood transfusion, I would go the [bloodless route] myself.”