Aspen: Overcoming Fetal Pleural Effusion

When Fernanda went in early for her routine 30-week appointment, the doctor offered to do an extra ultrasound while she waited for her husband to arrive. She didn't expect to learn news that would change the rest of her pregnancy.

The doctor found excessive fluid buildup in her baby’s chest and when she returned to confirm one week later, they immediately referred her to the  Colorado Fetal Care Center. Just hours later, she met her new, specialized care team for the first time. After initial tests, they recommended fetal surgery for the best outcome for their baby.

Maternal fetal medicine specialist and fetal surgeon Michael Zaretsky, MD, advised Fernanda and her husband, Nathan, that he needed to perform thoracentesis, an in-utero procedure to drain the extra fluid in baby Aspen’s chest. This would prevent the fluid from putting pressure on her lungs and heart.

“Fernanda asked him, ‘What if the baby moves?’ because the baby had been moving so much,” Nathan recalls. “He told us he’ll be quick, and Fernanda warned, ‘She’s fast.’ But Dr. Zaretsky said, “I’m faster.’”

That confidence gave Nathan and Fernanda the peace they needed. “He was our first introduction to the medical staff at Children’s Hospital Colorado, and he was amazing,” Nathan says.

Fetal surgery to fight the fluid buildup

Fetal pleural effusion is when fluid collects in a baby’s chest while they’re in the womb, which can cause problems by pressing on the heart, lungs and other main blood vessels. The primary treatment is draining the fluid or placing a thoracoamniotic shunt, but the fluid can return anytime. Nathan and Fernanda opted for Aspen to receive a shunt at 32 weeks.

“They gave us a sample shunt that we could hold, and it gave us confidence of what it was,” Nathan says. “Even though we were so overwhelmed learning new stuff that we had never heard of before, they were telling us what all the different routes are — the benefits and the risks — to really help us make an informed decision.”

Aspen’s shunt didn’t hold, and the fluid came back. At 33 ½ weeks, Fernanda arrived to stay at the Colorado Fetal Care Center until delivery for more consistent monitoring.

Delivery and NICU journey

At 34 weeks, the fluid started to impact Aspen’s lungs and heart, so her care team decided it was time for Fernanda to deliver Aspen and for her family to meet her.

“Once they got Aspen to a stable place, they said I could go over and stand next to her and hold her hand,” Nathan recalls “That was really special.”

That was the start of the family’s 75-day neonatal intensive care unit (NICU) journey and a challenging road to recovery for baby Aspen. At first, she was improving quickly, and doctors were able to rapidly turn down her ventilator settings. But Aspen faced many complications throughout her recovery. Being in the NICU made it possible for Aspen to be close to the experts and equipment needed to address these complications as soon as possible.

When the team had to call for the emergency thoracentesis, all specialties responded alongside the doctors, including social workers, psychiatrists and spiritual leaders.

“That day I was there alone, so they stood by me,” Fernanda recalls. “That was super helpful to have a system there. Although it was not my family, it felt like family at the second that happened.”

After more than 2 months in the NICU, the extra fluid in Aspen’s chest cleared and she was able to go home. She still has regular check-ins with our team, but now she’s flourishing.

“She’s honestly thriving in every single aspect,” Fernanda says. “She’s just this fighter, and she’s doing everything to be OK. She’s the happiest baby on earth.”

Holding on to hope

One of the biggest lessons Fernanda and Nathan hope others can take away from their experience is to hold on to hope.

“There’s a big team there for your support,” Fernanda explains. “Open yourself up to all of them, because they are there to help you. Take advantage of all the resources they offer you instead of putting it all on you.”

Nathan adds, “We really felt empowered to care for our daughter — not just to go along, but to be a part of that discussion and conversation.”