College of Nursing Alumna's Second Look Leads to Miraculous Turnaround for NICU Baby

UK College of Nursing alumna Mary Smith witnessed her first miracle in the field when she trusted her intense gut feeling that ultimately saved a NICU baby's life.

Presley Collins spent the first 12 hours of her life like most newborns — swaddled in blankets and fawned over by family members in a hospital room.

On the outside, Presley appeared healthy and normal. But on the inside, Presley’s small intestines, the portion of the gastrointestinal system responsible for absorbing nutrition, were cut off from blood flow and oxygen. Only a couple inches of viable tissue remained in the small intestines of the 2-day-old baby.

After Presley was born in August 2014, a pediatrician at Baptist Health in Richmond suspected a serious problem with her gastrointestinal tract. She was sent to the neonatal intensive care unit at Kentucky Children’s Hospital where pediatric surgeon Dr. Sean Skinner received the family’s permission to perform emergency surgery to diagnose the condition. The operation revealed tissue death in most of Presley’s small intestines, with only 1-centimeter sections at opposite ends of the intestinal tract viable.

Skinner diagnosed Presley with ischemic bowel, a condition in which diminished blood flow prevents oxygen from getting to the cells in the digestive system. During development in the womb, a blockage in the vessels prevented blood flow to the intestines, and the damage to the baby’s vital organ was irreversible.

“We got a call from (Dr. Skinner) pretty much saying we needed to get to UK as soon as we could because chances were slim our daughter would live,” Derrick Collins, Presley’s dad, said. “He explained what he found and told us she had a 10 percent chance of living.”

Presley would likely need a bowel transplant, but even as a full-term newborn, she was too small and vulnerable for the procedure. Skinner obtained second opinions from colleagues at Cincinnati Children’s Hospital, who confirmed his conclusion that Presley was not yet a candidate for bowel transplant. He held a teleconference with the family, the KCH medical team and specialists at Cincinnati Children’s Hospital. The medical teams offered two possible courses of action for Presley: take her off her breathing ventilator and go home or put her through an additional surgery to remove the dead bowel and begin the long and risky wait for a transplant. 

Neither action seemed desirable for the parents. The parents didn’t want the memory of their daughter dying at home. And removing the dead bowel was a temporary intervention to protect Presley from infection while awaiting a transplant. To receive the transplant, she needed to survive without small intestine until she gained 20 pounds and turned 1-year old.

NICU nurse Mary Smith, who was Presley’s primary nurse, gained the family’s trust and empathized with their struggle. While caring for Presley, she talked to the parents about their options. Even after receiving consultation from the pediatric palliative care team, Jessie Roney, Presley’s mom, believed her daughter was going to survive. During casual conversation in their NICU room, Collins and Raney asked Smith what she would do in their position.

“I had this gut feeling, and as a nurse you always follow your gut,” Smith said. “I just wondered if it would be different if Dr. Skinner went back in? I couldn’t live with myself wondering, ‘What if?’”

Smith’s advice encouraged the parents to allow Skinner to perform the second procedure and remove the dead bowel in preparation for transplant. The next day, Skinner took Presley into a second surgery to remove the dead bowel. When he opened Presley’s abdomen, he found only two-thirds of the original portion of dead bowel measured during the first procedure. He couldn’t explain why, but Presley’s body rejuvenated a portion of the intestines enough, Skinner determined, to salvage the entire organ.

“That was letting the body sort out what it could,” Skinner said. “Kids’ bodies are more resilient that adults.”

Skinner extracted 75 centimeters of dead bowel and left 50 centimeters of viable bowel. After two hours of surgery, Skinner reported the news of a medical  “miracle” to the family.

“I fell down and started crying like a baby,” Collins said of hearing the outcome of the surgery. “But her mom didn’t even budge — she knew the whole time her baby was going to be fine.”

The surgery signified a turnaround in Presley’s treatment. Skinner’s ability to keep several centimeters of Presley’s bowel negated a transplant, and subsequent procedures performed by Skinner enabled the baby to eventually go home with a feeding tube. Presley transitioned from breast feeding to formula within a year of her treatment at KCH, and now eats regular food. Collins said he wouldn’t have trusted anyone but Skinner to work on his daughter.

“Even though he gave us all the bad news, there was just this trust there that I felt like she was in good hands every time she went into surgery with him,” Collins said of Skinner.

The family also praised Smith for the support she provided during an uncertain time. They felt Smith was the best person to parse down complex and overwhelming medical information when they were facing decisions concerning their daughter’s fate. Smith became an advocate for their daughter’s care.

“We owe everything to Mary and the support that she gave us,” Collins said. “She treated us like we’d known each other our whole lives.”

Smith has heard of dramatic recoveries and unexplained phenomena in the NICU, but Presley was the first miracle baby under her care. She won’t ever forget the resilience of Presley, who is now a toddler and recently visited Mary in the NICU.

“She is why I love my job,” Smith said. “I’ve never felt this way about a patient — I’ve never seen a miracle like this.”