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Facing high-risk pregnancy, mother turns to M Health experts for care

Diagnosed with Tetralogy of Fallot and duodenal atresia, newborn Aliza Hasday underwent surgery at University of Minnesota Masonic Children’s Hospital.
Reena Kanodia’s daughter, Aliza, was diagnosed with Tetralogy of Fallot and duodenal atresia before she was born. Aliza required emergency surgery immediately following her birth.

On the second day of her young life, doctors wheeled newborn Aliza Hasday from the Neonatal Intensive Care Unit (NICU) to an operating room, where she underwent stomach surgery to repair a congenital defect.

Five months later, Aliza was back in surgery—this time to repair her heart.

For her mother, Reena Kanodia, the surgeries were the culmination of months of clinic visits, scans and growing concern. Reena, a Twin Cities resident, never expected that she would have a high-risk pregnancy, nor that the first two weeks of her daughter’s life would be spent in the University of Minnesota Masonic Children’s Hospital NICU. But the expert care she and Aliza received at the hands of a UMN Health care team provided her with a sense of security at a very difficult moment.

“I had fantastic prenatal care, which included close monitoring of the health of both myself and my baby as well as a care coordinator to connect all the dots between the extensive care team. We also had dedicated, attentive nurses in the NICU, and our surgeons were awesome,” Reena said.

Mounting concern
Reena’s first warning came during her routine 20-week ultrasound in early 2013, which turned up irregularities. Her medical provider referred her to another Twin Cities health provider for additional ultrasounds, which found a large hole in Aliza’s still-developing heart, among other heart abnormalities and duodenal atresia, which is a blockage in the stomach. A local cardiologist diagnosed Aliza with pulmonary atresia, a rare congenital heart defect, but Reena sought a second opinion from University of Minnesota Health Pediatric Cardiologist Shanthi Sivanandam, MD.

Sivanandam correctly diagnosed Aliza’s heart with Tetralogy of Fallot, a similar, though less severe, condition than pulmonary atresia. Tetralogy of Fallot and duodenal atresia are often signs of Down syndrome, so Reena requested an amniocentesis—a procedure that involves the sampling of fluid and tissue from the amniotic sac surrounding the fetus. That sample was then used to test for a variety of abnormalities in the unborn baby. Conducted just before the Aliza’s 22nd week of development, the test came back negative for Down syndrome or other chromosomal defects.

A complicated birth
Reena and her husband were relieved to see the negative test results, but Reena’s baby still faced numerous challenges.

Working with a care team from the University of Minnesota Health Maternal-Fetal Medicine Center, which specializes in fetal diagnosis and treatment, Reena and her unborn child began intensive monitoring. Because of the duodenal atresia, doctors believed the baby would be incapable of digesting fluids taken in within the womb. The build-up of those fluids could trigger a premature labor. But Reena’s specialist team, which included a geneticist, a cardiothoracic surgeon, a pediatric surgeon, a cardiologist and a neonatologist, among others, wanted to give her unborn child as much time to develop in the womb as possible so that she would be better positioned for the inevitable surgeries.

Learn more about our specialty services at the University of Minnesota Health Maternal-Fetal Medicine Center.

Fortunately, Reena’s baby was able to digest fluids, and her care team determined a planned induction was the best course of action. The Monday morning of her planned hospital admission, Reena underwent an emergency root canal, went into work, ate dinner and then checked in at the hospital. Doctors planned to have Reena check into the hospital Monday evening for prep work, and to induce labor the following morning. Her care team anticipated a normal, vaginal delivery.

But Reena’s baby had other ideas. At 11:30 p.m. on Tuesday night, Aliza’s heart rate began plunging after each contraction and Reena—acting on the recommendation of her care team—opted for an emergency cesarean section. Early the next morning, Aliza was born weighing five pounds, two ounces. Two days later, she was whisked from the NICU into her stomach surgery, led by Pediatric Surgeon Robert Acton, MD, and assisted by Pediatric Surgeon Daniel Saltzman, MD.

“It was hard to see my baby hooked up to all that equipment, and see her go through surgery on the second day of her life,” Reena said. “Because she was in the NICU, I was not able to have many of the normal experiences new moms get to have, like holding my baby right after birth and breastfeeding.”

Expert care
Aliza’s stomach and heart surgeries were both successful; she quickly rebounded from the procedures.

There was a time when Reena wondered whether her child would ever lead a normal life. But those worries are now safely behind Reena and her young family—thanks in large part to the expert care Reena and Aliza received.

“Because of Aliza’s conditions, we received health care across so many specialties,” Reena said. “It’s given me a true understanding of and appreciation for multidisciplinary care, and the communication that went back and forth between our many care providers.”

“My care team was on top of all the monitoring, and made sure my baby and I got everything we needed,” Reena said. “I’m very appreciative of all the providers that have taken care of Aliza.”