Expert Fetal Care Makes a Lifesaving Difference for Ulisse

By ACA | July 22, 2019

When an ultrasound revealed devastating news about the baby they were expecting, Sara and Ugo Colombo turned to Mayo Clinic. The family’s Mayo care team helped Ulisse Colombo beat long odds and go on to be the happy, active little boy he is today.

In
January 2017, Sara Colombo walked out of an ultrasound appointment with no hope
after a Miami-based doctor gave her a grim prognosis. In a few days, he said,
Sara’s fetus would be stillborn just shy of 20 weeks.

Two years later, Ulisse bounds across the Colombos’ house, chasing their cavalcade of dogs and impishly grinning when caught by his dad, Ugo. “If not for Mayo Clinic, we wouldn’t have had a baby,” Sara says.

The man at the center of their care at Mayo Clinic, Rodrigo Ruano, M.D., Ph.D., an obstetrician and fetal surgeon, describes it another way. “I call Ulisse a miracle baby,” Dr. Ruano says. “That’s the best definition.”

Determined to find
answers

Sara was in shock following her ultrasound that Friday in 2017. A decade after their first two children — Uberto and Stella — were born, Sara and Ugo had been excited and surprised when Sara discovered she was pregnant again. Up to that point, her pregnancy was normal, and the couple had been planning a trip to Paris. They were to depart the day after Sara’s checkup. But then their lives were thrown into tumult.

“Friday,
I had zero hope and zero focus,” Sara says. “Ugo’s very methodical.
In a crisis like that, he starts to research and ask questions.”

Sara
and Ugo tried to decide what to do next while still taking their older children
to their weekend activities. Ugo first called a friend at the University of
Miami’s Miller School of Medicine to discuss the situation and its urgency.
Then, the Colombos decided to turn to Mayo Clinic.

An Italian-born real estate developer, Ugo had a long relationship as a patient at Mayo Clinic with endocrinologist Ian Hay, M.D., Ph.D. He knew the organization was an international destination for complex and serious patient care. That knowledge led the Colombos to connect with Mayo Clinic to arrange an appointment.

No time to wait

As soon as they could, the Colombos flew to Rochester, Minnesota, where they met Dr. Ruano, the chair of the Division of Maternal and Fetal Medicine at Mayo Clinic’s Rochester campus. After an examination, Dr. Ruano acknowledged how serious the situation was. The fetus had hydrops, a condition where fluid accumulates in places it shouldn’t. The cause became apparent, too.

“I thought the baby would die,” Dr. Ruano says. “It was not moving a lot. It was hydropic. In the ultrasound, we discovered signs of fetal anemia. The baby wasn’t getting any blood. We did some lab tests. We determined the fetal red cells were being destroyed by Sara’s immune system. That’s very severe, very lethal.”

“We had gone from zero hope to OK, maybe we can save the baby. So obviously, we’re going to try to save the baby.”

Sara Colombo

Thanks to Mayo Clinic’s on-site laboratory services, the initial appointment and associated lab work took only about an hour. After that, Dr. Ruano and his team came up with a plan. They would start special blood transfusions directly to the fetus in utero through the umbilical cord, which was a risky proposition because the pregnancy was still in its early stages at 19½ weeks.

“Dr.
Ruano was very clear. He never said this is going to work 100%,” Sara
says. “But we had gone from zero hope to OK, maybe we can save the baby.
So obviously, we’re going to try to save the baby.”

Dr.
Ruano, who specializes in complex fetal conditions, transfused blood to the
umbilical cord. However, with the heart getting weaker, he had to inject
medication to help the fetus’ heart and resuscitate it through what’s known as
intrauterine cardiac compressions.

“He
saved the baby,” Ugo says.

By
the next day, the hydrops had resolved substantially. But Sara’s fetus
continued to need transfusions every two weeks. The second and third
transfusions were tolerated well, but Mayo Clinic’s multidisciplinary staff was
ready if things went awry.

A sudden arrival

In March, the day of the fourth transfusion, Mayo Clinic neonatologist Christopher Colby, M.D., was on call and stopped by to counsel the family.

“I
was paged to visit with the family by Dr. Ruano and his team,” Dr. Colby
says. “The reason the discussion was important was that the pregnancy had
progressed to a point that there was a meaningful chance of survival if the
baby didn’t tolerate the transfusion and needed to be delivered. The family
needed to understand the basics of newborn resuscitation at such an early
gestational age.”

Dr.
Colby discussed the case with the Colombos and took time to answer all their
questions. He told them that he anticipated the procedure would go smoothly and
that Dr. Ruano would continue taking care of them. Later that day, Dr. Colby
received another page.

“I
got called over to the delivery room because they were having trouble keeping
Ulisse’s heart rate in a normal range during the transfusion,” Dr. Colby
says. “Dr. Ruano was doing everything he could to bring the heart rate
back into a normal range, but it remained so dangerously low that they decided
they were going to have to deliver.”

Sara underwent an emergency Cesarean section. But at first, Ulisse didn’t fare well out of the womb either.

“It
took several minutes for his heart rate to recover into a normal range,”
Dr. Colby says. “By 15 minutes, he had a breathing tube in, and his heart
rate was normal. I remember thinking, ‘We have a good chance of this baby
surviving.'”

Surviving and thriving

Ulisse
Colombo was born March 20, 2017, 12 weeks early. The time extra time the blood
transfusions had given him in utero made a world of difference.

“Dr. Ruano took a 19-week fetus that was dying and stabilized him,” says neonatologist Douglas Derleth, M.D., Ulisse’s attending physician during his first weeks of life. “We went from previable at 19 weeks, and very sick, to still premature but viable at 28 weeks.”

“Any one of these newborn risk factors creates challenges — severe anemia, cardiac arrest at birth or significant prematurity. Ulisse had all three, and despite that combination of risk factors, he’s thriving.”

Christopher Colby, M.D.

After delivery, Ulisse went to the Newborn Intensive Care Unit (NICU) at Mayo Clinic Hospital — Rochester, Saint Marys Campus, where he received care for six weeks. When he reached 34 weeks old, the Colombos elected to have Ulisse transported by the Mayo Clinic neonatal transport team to Miami to be closer to his family and finish his time in the hospital. Then, finally, Ulisse went home for good on June 28, 2017.

“Any one of these newborn risk factors creates challenges — severe anemia, cardiac arrest at birth or significant prematurity,” Dr. Colby says. “Ulisse had all three, and despite that combination of risk factors, he’s thriving.”

A culture of caring

Sara
says subsequent visits to health care providers determined that Ulisse has no
long-term cardiac issues. As Ulisse grew, the Colombos decided to help advance
Mayo Clinic’s mission and the work of maternal fetal medicine.

“What
Dr. Ruano wants to do with his research and his focus at Mayo Clinic is
something that we believe should be supported,” Sara says. “We walked
out of that NICU with a result that I know a lot of families I saw every day in
there didn’t leave with. I know they didn’t. If maybe we could make a
difference for some of those families and the families that pass through Mayo,
it would mean so much. Mayo is serving the entire world really.”

Mayo Clinic honors the Colombos by recognizing them as Distinguished Benefactors.

And
now, for Ulisse, every day is a new experience. “There’s absolutely no
question in my mind that without Mayo Clinic there would be no Ulisse,”
Sara says. “He just would not be here.”

Note: A version of this story previously was published in Mayo Clinic Magazine.

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