A Brave Decision for Lifesaving Care Helps Baby Elias Thrive

In the Neonatal Intensive Care Unit (NICU) at Mass General for Children (MGfC), machines beeped and whirred in the background as Tarek Asry and Laura Bacallao, of Watertown, Mass., sat at their newborn son Elias’s bedside reading classic childhood books. Elias slept soundly, listening to his parents’ voices. This moment of calm, however, deeply contrasted the worry that infused the room just days before when Elias’s future was uncertain.

Shortly after he was born on February 10, 2017, Elias became fussy and feverish. Nurses at the local hospital could not calm him. At just over a day old, he was transferred to the NICU at MGfC. He had developed early onset septicemia from E. coli bacteria infecting his bloodstream. He was struggling to breathe and his body was not getting the oxygen it needed.

With their son in critical condition, Tarek, Laura and providers from Neonatology and Pediatric Surgery made the difficult decision to put Elias on extracorporeal membrane oxygenation, or ECMO. ECMO is a heart-lung bypass machine that oxygenates blood and brings it back into the body through a cannula in the neck. In Elias’s case, ECMO did the job of his lungs while his body fought the infection and began to heal.

“In medicine, we say that babies who are that sick are deep in the weeds,” said Daniel Ryan, MD, the pediatric surgeon who performed the ECMO surgery on Elias. “Naturally, parents feel overwhelmed when making the decision to put their child on ECMO, but Laura and Tarek knew their baby was sick and that he needed more medical care. They were brave in helping to make this decision even though there was a lot of uncertainty.”

Ten days later, Elias made amazing progress and was taken off ECMO. Tarek and Laura got to do what all new parents anxiously await: to hold their baby. “I had mixed feelings, mostly because I was nervous to unplug anything, but I was also so excited and so, so proud,” said Tarek. “He was still on morphine and had his eyes closed, but it was a sweet moment. It felt like he really made a lot of progress.”

With babies who are very sick, there often is not a definite point of knowing when they will be okay. “For Elias, being taken off ECMO was a big turning point,” said Kate Sparger, MD, a physician in the NICU who cared for Elias. “We only do a handful of ECMO cases per year for the most critically ill infants in the NICU, so there is always a sense of relief when patients are able to be taken off it.”

Day by day, doctors removed the machines and weaned Elias off his medications. “It was like watching a new baby emerge from all these tubes and his personality started to come out,” said Tarek. “Then you get to hold him and interact with him more and more.”

Four months later, Elias had near-permanent smile on his face and loved babbling with anyone who will listen. “With babies who were that sick, we want to know how they’ll do in the long-term. We want them to meet their best potential,” said Sara Bates, MD, a physician in the NICU who cared for Elias. “When Elias came off ECMO and his physical exam was normal, we knew he was on a good path. Now, he really is a miracle baby.”