Mother had survived COVID-19, heart failure, with baby delivered at 27 weeks’ gestation
Abu Dhabi: A Filipino baby has been named Cleveland in honour of an Abu Dhabi hospital following the lifesaving care he and his mother received at the Cleveland Clinic Abu Dhabi.
Caleb Angelo Cleveland Baldemor was born on March 8 after his mother – Michelle Baldemor, a 30-year-old Filipina – survived COVID-19 and heart failure following treatment at the hospital. He is also the first baby to be delivered at the health facility, which does not have a maternity unit.
Baldemor had been experiencing an otherwise routine pregnancy when she developed a dry cough and breathing difficulties that progressed into a high fever. Concerned that she might experience complications at 26 weeks of pregnancy with her second child, her doctor referred Baldemor to a local maternity hospital.
When her condition continued to worsen, Baldemor was placed on a mechanical ventilator to support her lungs. Physicians found that she had already developed COVID-19 pneumonia, and was suffering from an enlarged heart. At this point, Baldmor was transferred to a second hospital for further management, where it was found that she had developed heart failure due to significant tightening of her mitral valve. Blood and fluid were collecting in her lungs, and the right side of her heart was failing, preventing her lungs from getting enough oxygen to her blood.
Baldemor was then transferred to the Cleveland Clinic Abu Dhabi, Abu Dhabi’s official chest pain centre.
Vivek Kakar, director of the hospital’s cardiac critical care and ECMO programme, said: “When Baldemor arrived at Cleveland Clinic Abu Dhabi that evening, she was in a critical condition. Our team worked on her all night to stabilise her and remove as much fluid build-up as possible, and to stabilise her blood pressure and oxygen levels. We had a surgical team from a nearby maternity hospital on standby in case we had to deliver her baby urgently. Happily, we got her stable enough that it wasn’t needed at that stage.”
The following day, the case was discussed at length in a large multidisciplinary meeting that included representation from critical care, cardiology, cardiac surgery, anaesthesiology, and the local maternity hospital.
As traditional surgery was not an option, the team decided to attempt to open her heart valve using a balloon. It was hoped that this would stabilise her condition, and allow her to carry her baby to full term before undergoing surgery to fully repair or replace the valve.
“If Baldemor hadn’t been pregnant, she would have been scheduled for heart surgery right away. It wasn’t possible to do surgery without jeopardising the baby, and we know that operating on COVID-19 patients within the first four to six weeks leads to much worse outcomes. As a result, we looked at other options to open the valve, and decided that using a balloon placed percutaneously was the only one available to us if we were to protect both her and the baby,” Dr Kakar said.
During the high-risk procedure, Baldemor’s care team was joined by a surgical team from a local maternity hospital that was ready to perform an emergency Caesarean section delivery if required.
Surgeons advanced the balloon through a vein in the patient’s leg, and used the balloon to open the tight mitral valve. However, when the balloon was in place, doctors found that Baldemor was now experiencing mitral valve regurgitation, causing some blood to flow backwards through her valve. It was then decided that an emergency delivery was the only way to protect mother and baby.
Baby Caleb Angelo Cleveland Baldemor was delivered at just 27 weeks’ gestation, and became the first baby to be born at Celveland Clinic Abu Dhabi since it opened in 2015. He was immediately placed on a ventilator to support his breathing, and transferred to the Neonatal Intensive Care Unit at a local maternity hospital.
Baldemor still had severe COVID-19 pneumonia, but with continued efforts, her condition improved significantly, and she was able to continue her recovery at Cleveland Clinic Abu Dhabi.
“The problem with heart failure and pregnancy is that pregnancy exacerbates the heart failure by causing even more water retention. Delivering the baby definitely helped the mother’s condition. After the birth, we were able to focus the treatment on the COVID-19 pneumonia, and as her condition improved, we were able to take her off the ventilator,” Dr Kakar said.
‘Truly a miracle’
When Baldemor awoke after the procedure, she found herself recovering at Cleveland Clinic Abu Dhabi where her nurse informed her that she had given birth and that her son was doing well.
“I remember waking up and the with a nurse congratulating me. She told me my son had been born and was doing well, and handed me a photo of the baby. I was shocked because I had been unconscious for the last couple of weeks, and I didn’t know what had been happening. That we are both here and doing well is truly a miracle. I am so grateful to all the doctors who looked after us both so well,” Baldemor said.
After recovering from her COVID-19, Baldemor focussed on rebuilding her strength and caring for her newborn son. In September, nearly six months after the delivery of her second baby, Baldemor underwent a successful surgery to replace her mitral valve at Cleveland Clinic Abu Dhabi. She was discharged within two weeks of her surgery.