Amazing Kids, Amazing Stories: Gabriel's Story
|For more pictures of Gabriel, see the slideshow at the bottom of this page|
Baby Gabriel: Storming Back After a Rough Start
Already the parents of two healthy children, Sydney, 5, and Sam, 4, Melissa and Michael Kampka of Pardeeville, Wisconsin had no reason to suspect anything would go wrong when their third child, Gabriel, entered the world on July 24, 2014. Melissa's routine ultrasounds and prenatal testing revealed nothing unusual and his growth during pregnancy was excellent.
And yet, there was this nagging feeling.
"I remember feeling very panicky during Gabriel's pregnancy," Melissa said. "I always felt him kick and knew all of the tests were fine, but I just thought something might not be right." Her motherly instincts would prove to be prescient.
Because Gabriel's movement slowed as she approached full term, the doctors made plans to induce Melissa's delivery – plans that were quickly scrapped. Melissa went into labor and five hours later gave birth to her third child at Meriter Hospital in Madison.
Melissa had a routine delivery, but within minutes, it was clear this baby was in trouble. Gabriel's appearance was very ashen, his heart was racing and his blood pressure was alarmingly low. Furthermore, his belly was markedly distended – a sure sign of an intestinal obstruction.
Five hours after birth, Gabriel – clearly in need of the highest level of neonatal care – was transferred by CHETA emergency transport ambulance to UW Health's American Family Children's Hospital. Gabriel's parents would join him there in the new Level IV Neonatal Intensive Care Unit (NICU), once Melissa recovered from delivery.
Physicians Huddle as the Clock Ticks
It was not long before physicians filled Gabriel's room. They came from multiple pediatric specialties: neonatology, surgery, cardiology, radiology and anesthesiology. As they talked through the situation and narrowed the list of possible complications, results from Gabriel's intestinal images pointed toward a twisted small bowel.
"I suspect the problem is in the abdomen," said UW Health pediatric surgeon Peter Nichol, MD, "and the only way we're going to sort this out is in the operating room."
Julie Kessel, MD, a seasoned UW Health neonatologist, agreed with Dr. Nichol, but pointed out that there are babies whose entire intestine gets twisted in utero without getting as sick as Gabriel.
Suspecting a possible heart abnormality, Dr. Kessel ordered an echocardiogram. Within two hours, the results confirmed her hunch; an anomaly with Gabriel's coronary arteries was affecting blood flow to his heart.
J. Carter Ralphe, MD, chief of pediatric cardiology immediately requested a cardiac catheterization to more precisely image Gabriel's heart.
"So he needs a catheterization today, but he also needs an abdominal operation today," said Dr. Nichol. "That is the only way we can identify the cause of his bloated belly. Time is not on Gabriel's side right now, so we need to get moving."
Knowing that Gabriel would need pediatric cardiac anesthesia for the catheterization, Dr. Nichol quickly phoned the pediatric cardiac anesthesiologist on call, Maria Fabbrocini, MD.
"Since Gabriel is so unstable, let's take advantage of our new hybrid lab and do both procedures in the same place," said Dr. Fabbrocini, referring to UW Health's new facility (and the only one in North America) that allows children to have surgery and invasive imaging procedures safely done in one place, sparing the risk that comes with moving an acutely ill child throughout the hospital.
Taken to Surgery at 12 Hours of Age
Exactly 12 hours after birth – baby Gabriel, connected to countless tubes and monitors while accompanied by a parade of medical carts – left the NICU for the hybrid lab where he would undergo emergency abdominal surgery, followed immediately by a heart catheterization performed by Luke Lamers, MD, a pediatric interventional cardiologist.
Hour by hour, Melissa and Michael sat, waited and thought about what just hit them.
"We knew that our world was turned upside down, but we had to wait until the surgery was over before we had some answers," Melissa said. "It meant a lot when the nurses came out again and again to let us know what was happening. It also gave us a chance to let family members and friends know that Gabriel was born, but we were now at American Family Children's Hospital with some serious unexpected problems."
Seven hours later, Gabriel returned to the NICU following his surgery and catheterization. Physicians informed the Kampkas that their son emerged from surgery – alive, out of danger, but with three medical challenges:
- Gabriel's small bowel was twisted, which explained the massive bloating of his belly.
- Gabriel was born with cystic fibrosis (CF). Dr. Nichol knew this once he found Gabriel's small intestine filled with thicker-than-normal meconium, the in utero stool that babies pass in the first 24 hours of life. His condition – known as meconium ileus – affects about 20 percent of all babies born with CF. Because of its toxic characteristics, the meconium killed off part of Gabriel's bowel and launched a shutdown of his other organs. Dr. Nichol removed about 30 centimeters of "dead" bowel and attached a temporary ostomy and mucus fistula outside of his body to allow feces to pass until his bowel was surgically reconnected seven weeks later.
- Gabriel's left coronary artery did not develop properly – This is due to a rare heart condition known as congenital atresia of the left main coronary artery. While something that would need attention later on, the heart compensates for the defect in this situation. Fortunately, Gabriel was not at all endangered by his heart condition.
For Melissa and Michael, it all seemed too much to take in at once.
"When we were still at Meriter," Michael remembers, "we knew there was a problem, but we just told ourselves that it would be an easy fix and then we'd be on our way home."
Melissa, a self-described "Type A" personality, said it was hard coming to terms knowing that the hospital would be her family's primary home for a while.
"I'm a pretty methodical planner," she said. "I even plan our meals out at home, so spending week after week here took some adjustment, even though we knew that Gabriel was absolutely in the right place."
Slow and Steady Progress
Hour by hour, day by day, things started to look up. Gabriel's ashen appearance was gone after surgery. On day five, his parents held him for the first time. By day eight, Gabriel came off his ventilator and finally did something most parents take for granted only minutes after birth. He cried.
"Gabriel's first cry made Michael and I cry tears of joy," Melissa said. "We recorded that cry on our phone and played it for anyone who would listen."
As days turned into weeks, the Kampkas began their crash course in cystic fibrosis, a chronic disease that causes the body to create thick mucus that blocks the lungs, frequently causing infections and breathing problems.
"CF will be a challenge for Gabriel and for us as a family, but we have been so blessed by all of the phenomenal people at this hospital," Melissa said. "It won't be as easy without having that nurse call button to push, but we do feel well prepared to start this new chapter in our lives."
On October 20, 2014, Gabriel's 88th day of life, he was finally discharged from the hospital to his real home – the Kampka house in Pardeeville. The 70-mile round trip is one the Kampkas know they will make often, but they also feel incredibly lucky to live so close to a leading pediatric medical facility.
"Caring for Gabriel is something all of us – even his ‘big' brother and sister – will do together," Melissa said. "This is the hand we are dealt, but we are so grateful for everyone at the Children's Hospital who worked so hard to give us our baby back. We'll learn as we go through it, but there will be no shortage of love for this little guy."