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Finding Closure When You Least Expect It

Christine Jaslar and Dawn Morgan

Christine Jaslar, a lactation consultant at the Hospital of the University of Pennsylvania, stared at the name Dawn Morgan on the list of new moms she would visit in HUP’s post-partum unit and wondered: Was it possible?

When Jaslar started working as a nurse 25 years ago in HUP’s intensive care nursery (ICN), a tiny baby named Dawn Morgan – born at 26 weeks gestation (14 weeks early) and weighing less than two pounds – had been her very first patient. For nearly six months, Jaslar was this preemie’s primary nurse, forming a bond not only with the infant but with Lorene, the baby’s mother, as well. When she was strong enough, Dawn was discharged to CHOP’s Seashore House for additional care.  

“She was the patient I would always wonder about. Is she well? Is she happy?” Jaslar said. “As a nurse you give away a little piece of your heart to some of your patients. Sometimes we get to discharge the infants directly from the hospital to home with happy tears and farewells. I never got that closure with Dawn.”

Jaslar was a little hesitant about approaching the new mom. Although Dawn was the right age to be her former patient – and had the same last name – she didn’t want her to be uncomfortable. “I asked, was she born at HUP? Did she spend time in the ICN?” And when Dawn responded “yes” to both, Jaslar told her “I was the one who took care of you every day…. can I give you a hug?” They were both tearful.  

Word about Jaslar’s incredible experience spread quickly throughout the ICN. “The stars had to align for me to work that day and get assigned to Dawn,” she said. Not surprisingly, the desire for closure –  knowing how life turned out for the tiny infants they cared for -- is common among ICN nurses. “There are babies you always wonder about, especially ones you’re so emotionally invested in,” said Elizabeth Kennedy, also a ICN nurse at HUP. “It’s those who have a rougher time -- rougher courses -- to keep alive. And then when they leave, you don’t really know.”

Kennedy herself randomly met the mom of one of her former preemies on a street in Philadelphia. “I was very uncertain about the baby’s outcome, but she told me the baby was 18 months old and doing well, meeting milestones,” she said. The mom then gave Kennedy a photo “that I kept on my fridge for months!”

ICN staff sometimes get to see former patients in the annual March of Dimes walk in Philadelphia, where the nurses have a booth. “One family messaged me ahead of time from New York asking ‘Are you doing the walk?’” said another nurse. “It’s nice to see they remember.”

But it’s not at all not surprising that families don’t forget their ICN nurses. “You do get that connection with parents,” Jaslar said. Plus, she added with a laugh, “We’re in a lot of their photos in the ICN – first bath, first bottle!”

ICN nurse Anastasia Goldman often muses about where life will lead her tiny patients. “Who are you going to be when you grow up?” she asks them. “A nurse? A president?” And she wonders if her interaction with them might have an impact on their path in life. Thanks to HUP’s Babies and Books program, a bookcase with a wide selection of children’s books is available for nurses, parents, even volunteers to read to the infants. “I was reading Secret Garden to one of my patients, chapter by chapter,” Goldman said. “Will she remember when she gets older? Will she be interested in literature?”

The day of the momentous meeting – which Jaslar called a “miracle” -- she not only discovered that the young mother was, in fact, her very first patient but also that the tiny infant she had cared for so long ago – and worried about -- was one of the lucky ones.

Today, approximately 75 percent of preemies born at 25 weeks survive and many of them do well neurologically, but in 1992, outcomes for extremely premature babies such as Dawn were not always as good. Even if infants survived, they were more likely to suffer from chronic lung disease, severe retinopathy of prematurity (leading to blindness), or neurologic problems, such as cerebral palsy, due to bleeding in the brain, all of which were more common occurrences back then. 

Since then, several factors have contributed to improving outcomes among early preemies, but, according to Michael Posencheg, MD, medical director of the ICN, the two discoveries that had the biggest impact on outcomes and survival rates are the use of artificial lung surfactant and antenatal corticosteroids.

Lung surfactant, normally produced in utero (starting around the 25th week of gestation), makes it easier for the alveoli – the tiny air sacs in the lungs – to expand with oxygen and also prevents them from collapsing when air leaves the lungs.  But babies born too early lack this essential substance. Giving artificial lung surfactant to these early preemies at birth and administering antenatal corticosteroids, which trigger fetal production of the surfactant among other things, to a pregnant woman threatened with an imminent early birth “made a tremendous impact on survival and preventing lung disease and bleeding in the brain,” Posencheg said.  Improving the baby’s ability to breathe by using forms of non-invasive respiratory support like CPAP has also decreased the use of ventilators. “Research has shown that babies born prematurely have better pulmonary outcomes if we limit time on the ventilator,” he said.

At the reunion, Jaslar also got to talk with Dawn’s mom on the phone, who clearly remembered her own baby’s time in the ICN. “She talked about our times together, specifically the countless days I was teaching her to place an nasogastric tube in the baby in the hopes she would go home from HUP.”

“Christine was always there to help me get through it, rubbing my back, giving me support and encouragement,” Lorene said. “She showed me how to do everything.”

Dawn was just as amazed at the coincidental encounter. “I can’t believe it’s you teaching me to breastfeed my baby!” she said to Jaslar, adding that her mom often spoke of the ICN staff.

Jaslar recalled talking with Lorene often about what the future held for the infant. “Would she walk? Would she have developmental delays? I didn’t know,” Jaslar said.

Happily, all her worries were unfounded. “It was actually a great relief. I could tell she was raised in a loving home. I could tell the relationship between her and her mom was close,” she said. “I sleep easier at night and my heart is happy now that I had the privilege to meet this beautiful young mommy.”

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