Strong Kids

Miracle Kids 2024: Isabel Vazquez-Mercado

May. 17, 2024
A Collective Effort from Caregivers and Family Help an Extremely Pre-term Infant Overcome Long Odds

Bringing a child into the world is a momentous occasion, a culmination of months of anticipation, preparation, and hope.

For parents of premature babies, this period of life can feel much like an emotional rollercoaster, especially when pregnancy complications can cause birth to take an unexpected turn and defy the conventional experience.

For first-time parents Claritza Mercado Rosa and John Michael Vazquez Vargas, the birth of their daughter, Isabel Ruby Vazquez Mercado, was filled with unpredictable complexities and challenges.

It started when Claritza began to experience some pain and discomfort during the second trimester of her pregnancy. While attending an appointment for a routine anatomy scan at around 20 weeks, physicians sent Claritza to labor and delivery for additional testing and observation. Initially, they wanted to be sure that everything was okay, given the symptoms she had been experiencing at home; however, upon examination they realized that she was already dilating, and things took an abrupt turn.

An Unexpected Arrival


Claritza’s care team sprang into immediate action.

Physicians had hoped to perform a cervical cerclage to keep her from dilating further and delay labor to better Isabel’s chances of survival, but quickly realized that she had dilated to 5 cm and that she no longer qualified for the procedure.

At this point, John and Claritza were given their odds: Babies born before 22 weeks typically have a 5 percent or less chance of survival and are not currently eligible for resuscitation in New York State; however, those chances improve each week until delivery. Claritza was kept in the hospital on full bed rest to delay labor.

 At about 21 1/2 weeks, after Claritza had been in the hospital almost two weeks, physicians decided to transfer the Mercado-Vazquez family to Strong Memorial Hospital. Shortly after their arrival, Claritza delivered Isabel—on the very night she made the 22-week mark.

Due to Isabel’s extreme prematurity, Claritza was administered a host of medications aimed at bolstering Isabel’s chances of survival, including a steroid shot to help with her lung development.

As the night progressed, Isabel gradually descended into the birth canal, signaling her readiness to enter the world. On March 25, Isabel was born via an emergency C-section, weighing one pound; she was a fighter from the very beginning—displaying a strength and resilience that belied her tiny size.

The reality of Isabel’s premature birth shattered Claritza’s and John’s expectations, leaving them grappling with the overwhelming emotions of shock and worry. It was the beginning of a journey filled with unexpected twists and turns as the new parents learned to navigate the unfamiliar terrain of the GCH Neonatal Intensive Care Unit (NICU).

“I call it a rollercoaster; we got off one ride and went to the next. There were a lot of small goals—feedings, weight gain, breathing on her own, hoping,“ said Claritza. ”It is something that you cannot prepare for. I don’t imagine what it would be like losing her—I don’t even think about it.”

Defying the Odds

Isabel was vulnerable to a host of severe health complications affecting her body’s major systems. Because of her extreme prematurity, she was included in the small-baby program in the NICU, where she had an additional team rounding on her to evaluate and monitor her progress closely and to also make sure John’s and Claritza’s needs were being met.

Colby Day Richardson, MD, neonatologist and medical director of the NICU, describes the small-baby program as “an incredible addition to our clinical care made possible by the dedication of a multidisciplinary team, with the goals of improving outcomes in some of our most vulnerable patients and focusing on supporting and empowering our families at the same time.”

Isabel’s lungs were underdeveloped when she was born, leading to Bronchopulmonary dysplasia (BPD), a form of chronic lung disease that affects premature babies. From the time she was born, Isabel required the support of high-frequency and conventional ventilators to breathe.

“She was up and down on the ventilators; she would move to another one but then need higher support again later that night. It was a true balancing act between the ventilator supports and medications.” said Claritza. “I was numb but I didn’t want to show her my weakness; she was showing us she was strong, and so I wanted her to know that we were strong, too. “

Due to the severity of her breathing complications and an esophageal perforation, Isabel was unable to work on feeding by mouth for several weeks. Once she was able to reduce the level of ventilator and oxygen support, she started trialing feeds with milk on cotton swabs and received most of her nutrition through a nasogastric tube (NG tube) that ran down her throat and into her abdomen.

It was not long, however, before Isabel’s care team noticed that she was struggling with feeding. Her abdomen would turn black, and she was unable to suckle and swallow effectively, leading to feeding difficulties and failure to thrive. Additional testing and imaging revealed that Isabel was suffering from Necrotizing Enterocolitis (NEC). NEC is a serious gastrointestinal infection in which the infant’s intestinal tissue becomes inflamed and could become perforated, causing it not to function appropriately and affecting their bowel movements.

“Isabel’s weight gain was up and down a lot. Getting the right balance was tough, and she was not pooping like she should, so we did not want to ramp up feeding, but she wasn’t gaining good weight,” said Claritza.

On April 5, Isabel’s care team performed an emergency bowel resection surgery to remove the dead tissue from her intestines and placed an ostomy bag to help with bowel movements. These procedures would help her better tolerate feeding and digestion and support her ability to gain weight in the NICU.

“I remember speaking with someone who had gone through a comparable situation and the baby didn’t make it,” said Claritza. “I remembered how blessed we were that we took the 10% chance of survival and that she was still here with us. We wanted to grab her and hold her, and we couldn’t most of the time—but we didn’t give up, and neither did she.”

John and Claritza remained steadfast advocates for Isabel. They alternated their disability time between them so that they could be sure that someone was always available to be with her and quietly bond once her respiratory support allowed them to hold her and engage in skin-to-skin care.

“We are a small local family. Our parents live in Puerto Rico, so it was important for us to be present for Isabel,” said Claritza. “In the beginning I would go during the day, and John would go at night; once I went back to work, we switched, and John would go during the day.”

Skin-to-skin care, also known as kangaroo care, can be one of the most important aspects of an infant’s wellbeing in the NICU. Studies have shown that skin-to-skin care improves outcomes for premature babies: It supports temperature regulation, growth and neurodevelopment, sleep quality and feeding, and decreases infant stress, length of stay, and mortality.

“We know, based on evidence, that skin-to-skin care provides a large number of medical benefits both to families and to the infants in our unit,” said Richardson. “In the NICU, we are committed to promoting skin-to-skin care as part of our mission to provide optimal health care to our infants and their families.”

Persistence was a key factor in Isabel’s journey. Claritza and John would attend small-baby rounds, ask questions, and serve as active members of their infant’s care team.

“We were fortunate enough to have a wonderful team that supported us along the way; every little step she would take meant a lot. It made us feel that she was going down the right path. We celebrated any small moments,” said Claritza.

The Greatest Gift

As the months went on, Isabel continued to grow and improve. She was making strides with feeding, and her lungs continued to get stronger. In July, she was extubated, and physicians decided that it would be okay for her to trial off oxygen support; by August Isabel no longer required any respiratory or IV support.

Finally, Isabel was close to going home with her family and had just two tasks left to accomplish before she could be discharged: surgery to reconnect her intestines, and she needed to be able to drink from the bottle without relying completely on her NG tube.

John and Claritza were offered the option of doing NG tube feeds at home, but they preferred to give her some extra time to grow and learn to feed by mouth. Ultimately, Isabel did just that and was discharged to home—taking all of her feeds on her own—on September 5, in time for John’s birthday.

“Isabel’s parents were amazing at being at bedside. They integrated themselves into her care from the very beginning, which is hugely beneficial to a premature baby’s development as well as the transition home,” said Richardson. “It’s nice to see a baby born so early doing so well.”

Though Isabel continues to manage some minor conditions associated with her extreme prematurity, she does not require any major supports at home. She has had follow-up appointments with pediatric specialists in pulmonology, gastroenterology, hepatology, and nutrition and has undergone multiple procedures with ophthalmology to address retinopathy. Additionally, she receives care from Developmental and Behavioral Pediatrics to address some developmental delays. Despite the hurdles in her journey, she is making strides and preparing to embrace the world ahead.