Tele-NICU program guides Grand Rapids team through complex birth – in a snowstorm
A high-risk pregnancy, an unexpected early birth, and a snowstorm in northern Minnesota.
Jessica Johnson was scheduled to deliver her son, Teddy, via cesarean section in late January. The family lives in Hill City, Minnesota, and Jessica planned to give birth 90 minutes away at a Duluth hospital with advanced care for complex pregnancies.
When she unexpectedly went into labor six weeks early, the family drove through a snowstorm to the closest hospital, which was Grand Itasca in Grand Rapids. Normally, the team at Grand Itasca would have arranged transport with the goal of having delivery at a hospital with a dedicated maternal intensive care unit and neonatal intensive care unit (NICU), which provides specialized care for premature babies.
The storm made this impossible: air transport teams were grounded, it would take the Duluth NICU team more than two hours to drive to Grand Itasca, and Teddy was on his way.
“The baby was coming one way or another,” said Timothy Pehl, MD, family medicine physician, chief of staff, and clinic medical director at Grand Itasca. “We needed to make sure we had the best possible outcome for mother and baby.”
Caring for mother and baby during a snowstorm
Jessica’s pregnancy was considered high-risk in large part because of pre-existing medical conditions. As a young adult, she had undergone three surgeries and radiation to remove a large pituitary tumor. For this reason, her doctor had recommended giving birth via C-section to prevent the risk of increased head pressure that can occur during vaginal delivery.
The team at Grand Itasca brought her to the operating room for a C-section and, during surgery, discovered a serious pregnancy-related complication. Johnson had a rare condition called placenta increta, in which the placenta attaches too deeply into the lining of the uterus. This can lead to serious bleeding during delivery. OB/GYN Katy Johnson, MD, led the team in stopping the bleeding and ultimately removing Jessica’s uterus in order to save her life.
“Although we’re a rural facility, we need to be ready for whatever happens to come through our doors,” said Johnson. “We have the training, and everyone stepped up and did what they needed to do in an emergency setting.”
Neonatologist helps stabilize Teddy virtually
While Jessica was finishing delivery, Pehl engaged our new Tele-NICU program, which launched in 2021 and expanded to Grand Itasca last fall. It allows care teams from across the state to instantly connect virtually with one of our neonatologists (physicians who specialize in premature and high-risk births) at M Health Fairview Masonic Children’s Hospital.
Tele-NICU technology allows care teams to share a newborn’s vital signs and close-up, high-quality video of the delivery room in real time, which the remote neonatologist can access and control from their office, home computer, or smartphone.
Ellen Diego, MD, a neonatologist at Masonic Children’s Hospital and assistant professor in the Department of Pediatrics at University of Minnesota Medical School, was on-call that night. She helped guide Pehl and his team through resuscitating Teddy – a common need for premature babies, which means ensuring they’re able to breathe – placing an IV for fluids and keeping him warm until the NICU team from Duluth arrived.
“I stayed online with the team for three hours while they established breathing and placed an IV to make sure Teddy had access to fluids,” said Diego, who guided the team through the IV placement. “After a couple of minutes of us breathing for Teddy, he had enough spontaneous effort where he did not have to have a breathing tube placed immediately.”
The team at Grand Itasca stabilized Teddy until the NICU team arrived, placed a breathing tube, and took him to a specialized facility in Duluth for ongoing care. The Tele-NICU program not only offered specialized guidance for the team on the ground, it also gave Jessica peace of mind as she came out of delivery and began treatment for her own pregnancy-related complications.
“I knew they could call somebody, but to have the computer screen and camera there — they were fantastic,” said Jessica. “They were right on top of it, walking through the entire process of getting him warmed, getting the IV started.”
Jessica stayed at Grand Itasca while recovering from surgery, then visited Teddy often in the NICU in Duluth. Both were able to return home before the new year, healthy and happy.
‘Future of rural care’ for rare, complex cases
Grand Itasca averages a little over one birth per day and sees few premature deliveries, said Pehl. If possible, in those situations, the team works with families to facilitate delivery at a larger hospital with a NICU and maternal ICU. But, as with Teddy’s unexpected birth during a snowstorm, there are rare occasions where the community hospital needs to provide advanced specialty care.
“One of the ways we’re able to provide quality care is through leveraging the technology that’s available. That’s part of the future of rural care — we need to have specialists available when we need them,” said Pehl. “It’s been great to build out this infrastructure to manage these things that we might only see every few years.”
