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Connected, coordinated care helped baby Emmeline beat a lung tumor

Our maternal-fetal medicine and neonatology teams forge close partnerships to care for mothers and their babies.
When an ultrasound found a suspicious mass on Tricia Paulson’s unborn child, she placed her life and the life of her baby Emmeline in the hands of a multi-disciplinary team of experts.
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Expecting her second child earlier this year, Tricia Paulson had no reason to believe this pregnancy was going to go any less smoothly than her first go-around. But an ultrasound at 17 weeks showed a concerning shadow on one of her baby’s lungs, and her obstetrician suggested she receive a level II ultrasound at Fairview Ridges Hospital in Burnsville.

That screening at 20 weeks uncovered a mass on the baby’s lung. Though doctors suspected that the tumor was benign, it still put the baby at risk. Masses like these often continue to grow with the baby, impeding their developing lungs and causing heart failure, according to University of Minnesota Health Maternal-Fetal Medicine Physician Tracy Prosen, MD, who took on Tricia’s medical care.

That was the case with baby Emmeline, whose constantly growing tumor crowded her chest and pushed on her heart. And so began Tricia’s long journey throughout the remaining months of her pregnancy.

Large tumor, tiny body
During a 10-week period, Tricia had seven procedures during which Prosen placed shunts in Emmeline’s chest to drain fluid from the mass. Then, when Tricia’s water broke at 30 weeks, she spent nearly seven weeks on bed rest at The Birthplace at University of Minnesota Masonic Children’s Hospital.

After Emmeline was born in late May, she was intubated for respiratory failure, then admitted to the neonatal intensive care unit (NICU) at University of Minnesota Masonic Children’s Hospital—just steps away from the newly renovated Birthplace. Because of her cardiorespiratory instability, Neonatologist Kari Roberts, MD, and Pediatric Surgeon Donavon Hess, MD, put Emmeline on heart-lung bypass. Two days later, surgeons removed one lobe of her lung and the tumor, which had grown to the size of a computer mouse—huge in a 7-pound, 1.5-ounce baby.

“Our worry was that this mass was still very large and taking up space in her chest where the lungs would normally grow,” said Prosen, who directs the M Health Fetal Diagnosis and Treatment Center. “This was a baby whose life was in danger at multiple times during the pregnancy and in the hours, days, and weeks after birth.”

Well-orchestrated care
It’s been a stressful time for the Paulson family, to say the least, but some of that stress was eased by the medical care Tricia and Emmeline received through University of Minnesota Health.

“I’m just glad that we had the University of Minnesota and people who had the expertise to deal with this,” says Paulson, who lives with her husband, Ryan, and 3-year-old daughter, Joey, in Rosemount, Minn. “It made it a little easier knowing that we were in good hands.”

It also helped knowing that Prosen was orchestrating their care among a large team of health care professionals.

This coordination of care is the norm at Masonic Children’s Hospital. When maternal-fetal medicine physicians treat women who have complicated pregnancies or babies who have abnormalities, they partner closely with all of the people who will take care of the newborns once they arrive.

Strong physical and professional links among specialists help teams offer seamless care to their patients. The M Health Maternal-Fetal Medicine Center is physically connected to the children’s hospital as well. And when high-risk babies are born, the hospital’s neonatology team is at the ready.

“When we call for a NICU team during a delivery, they are there in under a minute,” Prosen said.

“To have everyone in one place was really great,” Tricia added. “Knowing that they have worked together before and trust each other and were all on the same page going into this was a relief. They all knew the plan, and they were all going to take care of us.”

Strong links
This inter-professional communication was tremendously valuable for Tricia Paulson and her family, Prosen says. Their team worked through a multitude of issues, such as how long Tricia should keep Emmeline in utero, the best timing for the baby’s surgeries and how much respiratory support Emmeline might need after birth.

University of Minnesota Health Neonatologist Thomas George, MD, the medical director of the Masonic Children’s Hospital’s NICU, helped plan for Emmeline’s birth. Providing such coordinated, comprehensive care is a big part of his job. It’s something the M Health has been doing for years because it puts parents at ease and helps the medical team provide the best outcomes.

“It really leads parents to have a sense of confidence that we’re ready to take care of their baby as a team. It truly is a village,” George said. “We want to ensure them that we’ve thought of everything to prepare for their babies.”

As for baby Emmeline, her prognosis is excellent. After recovering from a third surgery in August 2015 to place a gastric tube, she went home at nearly 12 weeks old. She will continue to be seen at the M Health NICU Follow-Up Clinic, one of the first of its kind in the nation, to make sure her growth and development stay on track through childhood.

The Paulsons couldn’t be more excited and grateful for the care they all received through M Health.

“It’s just been amazing,” Tricia said. “I’m completely overwhelmed by it.”

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