Asheton

A Tiny Miracle

The snow was falling in Chapel Hill, N.C., that winter day in 2002, blanketing the town in more than six inches of the white stuff, and Matt and Tiana Ayotte were driving in it. Tiana, just 23 weeks pregnant, was feeling “not quite right,” and the couple wanted to get to UNC for a quick check up just to be sure everything was okay. They wondered as they drove, would they make it back home in this snowstorm or have to stay the night at the nearby Carolina Inn?

They needn’t have worried about getting home that night. The diagnosis and potential prognosis that came to light over the next few hours at N.C. Memorial Hospital was sobering. Tiana was in pre-term labor. The parents-to-be, expecting the arrival of their first child in May, had neither decorated the baby’s room nor even bought a crib, but they weren’t going anywhere. Tiana was under strict instructions: she would not be getting out of bed or leaving the hospital until their daughter was born.

The maternal fetal medicine experts staved off delivery 14 critical days—the difference between life and death for tiny Asheton, who was born in January, 15 weeks premature, weighing a mere 1 pound, 5 ounces. Like many micro-preemies, Asheton had myriad medical issues, including a hole in her heart and chronic lung disease. She had multiple blood transfusions and later endured eye surgery for retinopathy of prematurity.

After Tiana’s discharge from the hospital, the new parents rushed back and forth from home to the neonatal intensive care unit (NICU) at Memorial Hospital daily, spending as many hours as they could with Asheton, who in the early days confined to an incubator. They soon learned she would be transferred to the Newborn Critical Care Center (NCCC) in the brand new N.C. Children’s Hospital. The news both excited and frightened the new parents.

“The move made us nervous, as you can imagine—moving babies that are so sick and with so much equipment and alarms,” recalls Matt. “So I asked, ‘How do you make that move?’ The response was, in fact, they use little battery packs, kind of like Die Hard car batteries. A complete medical team and battery operated mechanism would travel with each child. We put our faith in the doctors and nurses and simply trusted they knew what they were doing, and it all worked out wonderfully. We owe everything to those clinicians.”

Asheton was the first occupant of Pod C, bed 28 in the new NCCC, where she spent the remainder of her inpatient stay—107 days in all. After months in the hospital, Asheton’s discharge came as a welcome, yet somewhat sudden surprise.

“You're looking at this tiny infant who’s hooked up to IVs,” says Tiana. “We were into April, at which point she’s not intubated, she’s still on oxygen, she’s starting to gain weight. Then they start saying you should begin helping bathe her, change her diapers. And after four months, they just said those amazing words—she’s ready to go home. There were still ongoing things that needed to be managed and done, but 107 days after she was born, we all left the hospital together.”

Asheton was discharged from the hospital on May 2, 2002, her original due date, and carried to the car by the very same nurse who helped deliver her. The symbolism is very meaningful to the Ayottes, even a decade later.

“The people make all the difference,” says Tiana. “Somewhere else, you’re not going to get the kind of people that hand draw decorations for the incubator, sing to a restless baby withdrawing for morphine, have that same thoughtfulness and true caring and compassion. I really believe those little things had a lot to do with the outcome.”

Ten years old this January, Asheton shows no outward signs of being born so early. Despite some asthma-related issues and eyeglasses, her recovery is miraculous, a fact her parents attribute to her tough-as-nails personality and the extraordinary medical attention the family received along the way.

“You can put tremendous confidence in the care team at North Carolina Children’s Hospital,” says Matt. “You know there are many good hospitals, but teaching hospitals like UNC have super subspecialists—even pediatric ophthalmologists that focus soley on issues related to prematurity. We were so, so fortunate to be at UNC. Any other place would not have been able to handle this.”

And though she was too young to remember her NICU experience, Asheton feels the same gratitude towards the Children’s Hospital and has taken on the cause of helping premature babies. Just this past year, in fact, her lemonade and cookie stand and Halloween for Hope project raised enough money to purchase a new medi-wagon for the hospital. It’s something that makes her parents really proud.

“We don't think about what could have been,” says Tiana. “We think about what’s here. We try not to take things so seriously. It’s real joy watching her day to day, the bounce of her step. She’s a very happy child. She goes through life. She bops along.”

Then & Now: a look at Neonatal-Perinatal Medicine at UNC

Dr. Wayne Price, chief of the Division of Neonatal/Perinatal Medicine at UNC, marvels at the differences in newborn critical care, then and now, in the 10 years since the Newborn Critical Care Center at N.C. Children's Hospital welcomed its first tiny patients.

“We used to call the old NICU the submarine,” recalls Price. “It had a very low ceiling; babies were packed in like sardines, very cramped, no windows. It was a major breath of fresh air to move out of that space and into the Newborn Critical Care Center.”

And, according to Dr. Price, with the new bricks and mortar of N.C. Children’s Hospital came a new focus on care. The extra space allowed caregivers to invite families to rounds and include them in the daily plan and goals, leaving them better informed and more confident about their child’s care. Parent education became more readily available, and the hospital began placing an even greater emphasis on quality improvement, implementing the same precise techniques used in factory assembly lines and piloting. There was a new emphasis on skin-to-skin contact, also known as “kangaroo care,” which couldn’t have taken place in the old NICU due to the sheer lack of space.

“We all felt a huge difference in the many opportunities we suddenly had to provide higher quality care, both for patients and their families,” says Price.

Although there have been few successes in preventing prematurity in general, the outcomes of micro-preemies like Asheton have improved tremendously over the past 10 years thanks to research and technological advances. Use of the ventilator has decreased and its technology has advanced to be gentler and therefore less damaging to the lungs. Vitamin A has improved developmental care, and the importance of human breast milk has also played a big role in the improved prognosis for premature infants.

Learn more about neonatal-perinatal medicine at N.C. Children’s Hospital.