Charlotte Marie Harding

The culmination of months of worry, concern, stress, and anticipation peaked this morning: Charlotte Marie Harding was born this morning at 7:52, weighing 6lbs 6oz and 20 inches long. To our immense relief, before we could even see our baby girl, we could hear her crying. And crying and crying. For so long we've been concerned about her lungs and her breathing, so hearing her cry was such a weight lifted off our shoulders. Little did we know, she wasn't just crying, but breathing well enough on her own that she did not require a ventilator.

She was put on CPAP to provide a little extra pressure to help fill her lungs with each breath, but Charlotte was breathing each and every time on her own. She did well enough that before she left the OR, I was able to take some pictures of our little girl and Brittany was able to hold her hand. Then she was whisked away to the NICU for tests, PIC line insertion, and evaluation.

While Brittany was moved to her recovery room, I was able to go find Charlotte's new room. Her omphalocele was already dressed and bandaged, and all of her monitors and sensors installed. She has the longest little fingers and toes, and she does not like her feet touched - she kicks and wiggles every time her feet are touched.

Charlotte had more tests to undergo and to get her PIC line installed, so I returned to Brittany's recovery room. The neonatologist came to Brittany's room and gave us our first post-birth update: Charlotte's omphalocele was smaller than expected. The omphalocele was by no means small, but it wasn't as giant as some scans and indications suggested. The neonatologist hinted that the pediatric surgeon may recommend Charlotte's repair surgery earlier than expected. While we were hopeful, we were not prepared for the concerns or risks of an earlier surgery - all along we had been prepared for immediate ventilation with a focus on lung/heart function before addressing the omphalocele itself, likely in 6 months to a year.

The PIC line insertion was not successful, as the line kept turning the wrong direction. The neonatologist did not like the PIC line placement, so it was removed in favor of a central line. The echocardiogram showed no heart issues that would complicate surgery or concern the anastethesiologist.

The pediatric surgeon met with us just before noon and laid out the pros, cons, benefits, and risks of doing the repair surgery today, and waiting to do the repair surgery in 6 months to a year. The surgeon believed that there was enough skin to close the omphalocele, but wasn't sure if there was sufficient muscle tissue to close the opening. The only way to make that determination is to begin the surgery and discover the muscle lining location. He felt like performing the surgery today was the better option. The omphalocele was good sized, but not too big to correct immediately. There was a risk that if enough muscle and/or skin tissue wasn't available to close the opening, that a dissolvable patch or mesh may be used to bridge the gap. Worst case scenarios would entail an opening too large to bridge or gap with a patch, which would require a silo bag (emulating the protective covering of the omphalocele) or closing the opening too tightly creating too much abdominal pressure causing other issues. Best case scenario would be a repaired omphalocele and looking towards breastfeeding by NG or OG tube in the next few days. Post surgery, she would likely be on a ventilator for a few days to assist with breathing as she becomes accustomed with her new belly arrangement.

Brittany and I decided to perform the corrective surgery today, and little Charlotte entered the OR around 3:30 pm for her omphalocele repair and central line insertion. The insertion went well, and after an hour the OR nurse called to give us an update. The surgeon began the repair and if things went well, he'd call with the next update in an hour or so. At 5:00, the pediatric surgeon called us with good news: the repair was complete. There was just enough muscle and skin tissue to close the opening, but the layers were pulled pretty taught. He was a bit concerned that the sutures may tear under the strain, so he added some patch material on top of the muscle sutures to bolster the stitches. Then the skin closed on top of the patch material with another set of sutures.

Brittany and I are waiting for Charlotte to transfer back to her NICU room, and get settled back into her crib. She'll be sedated after the surgery and her very busy day, and will likely be intibated and on a ventilator. But we are incredibly relieved and ready for our little girl to tackle her next obstacles and steps.

~ Christopher and Brittany