The pregnancy seemed to be going well – until the ninth week, when Jennifer started bleeding. The parents-to-be prepared for bad news, but their baby was still hanging on. Though frightening enough the first time, it was a fearful situation that incredibly would be repeated four more times; each time, they would prepare to hear the worst, and each time, they would be pleasantly surprised to find out that their baby still was hanging on to life. “I think I knew at that point that this kid was a fighter and wasn’t going to give up easily,” Jennifer says. Still, those close calls would be only the beginning of the struggles Nolan would face. With doctors concerned about the difficulties Jennifer already was having not even three months into her pregnancy, she was put on bed rest for the remainder of the gestation. The difficulties would continue at 21 weeks, when Jennifer felt some leaking and returned to her doctor, who ordered an ultrasound. The test showed low levels of amniotic fluid, the liquid that cushions and protects the baby in the womb. Again, Jennifer and Christopher thought the baby would be lost. “We really thought it was over,” Jennifer says. “You think that once you get past 12 weeks, you’ll be okay,” but with low levels of amniotic fluid, Nolan would face another difficult battle. The good news was that, 72 hours after her water broke, she still had not gone into labor. The bad news was that no one was certain that the baby could survive with an almost immeasurable amount of amniotic fluid. While terminating the pregnancy was an option, it was clear that that was not the option for Jennifer and Christopher. The parents were thrilled when the Geisinger Maternal Fetal Medicine physician offered another option: Jennifer would be put on antibiotics to prevent infection and would get as far along in the pregnancy as possible. If the baby could make it to 24 weeks, he might have viability. Jennifer made it to 27 weeks and five days. Nolan was born weighing 2 pounds and 3.5 ounces – a virtual giant by many preemie standards. Another hurdle had been cleared with the viability threshold passed, but Nolan still faced a number of complications from his premature birth. Jennifer and Christopher had been warned about some of the possibilities, especially that Nolan’s lungs may not have developed. If that were the case, he would not survive. “Dr. (Lauren) Johnson-Robbins told us, ‘if we don’t have enough lung tissue to get him going, we’ll just bring him in and let you hold him, but if he’s got enough, we’ll do everything we can,’” Jennifer says. “I just kept thinking, ‘don’t let them bring him back too soon’ because that would mean they couldn’t do anything for him.” She says she remembers hearing footsteps in the hallway and growing more anxious as they approached – and feeling relieved when they would pass by. Nolan did seem to have enough lung tissue, but doctors still had a very difficult time getting air into his lungs, and his outlook was once again becoming grim. There was one possibility, however: a risky undertaking that would require the use of a gas that only had been approved for babies who had been born at 34 weeks or later. “The regular therapy was failing, and that’s when we approached the family about nitric oxide,” says Lauren Johnson-Robbins, MD, a Janet Weis Children’s Hospital neonatologist. “The gas hadn’t been approved for preemies, but he wasn’t going to make it if we didn’t try something. … And it worked wonderfully.” It was yet another obstacle that Nolan had conquered, but there still were other complications he would face in the NICU: urinary tract infections, gastroesophageal reflux and infections, among other problems. There also was the possibility that Nolan had biliary atresia, a condition that could require a liver transplant. Nolan would undergo surgery for hernia repair, then the surgeon would have a more definite answer on the biliary atresia. “I probably never cried that much in that short amount of time. There was always something,” Christopher says. There was some good news at times, they remember, but Nolan’s health would go downhill again after that. “After a while, you learned not to be high-spirited for too long because there’s something else just around the corner,” Jennifer says. “You never felt like you could sleep because you were afraid of the phone ringing in the middle of the night." They also were concerned about Emily, then 9 years old. Not only did she have concerns for her baby brother’s health, but she also had to cope with her parents’ absence when they visited Nolan in the NICU. “I always tell the parents that they need to be wherever they need to be,” Dr. Johnson-Robbins says. “When you have a child in the NICU, you feel a total lack of control, and it’s an incredibly difficult balancing act. Sometimes they just need to hear that they have permission to take care of their life outside of the NICU.” During the months of specialized care, Nolan was making slow but steady improvements. Roughly 75 days after he was born, he was strong enough to undergo the hernia repair surgery, during which doctors discovered that he did not have biliary atresia – more great news for his family. He was brought back to the NICU for further recovery and, after clearing the final hurdles, was able to go home less than a week later. “Everyone at Geisinger did a phenomenal job,” Jennifer says. “When we left, there was almost a sadness because you missed them. These were the doctors and nurses who were taking care of the most important thing in your life. They become part of your family.” Once home, Nolan continued to grow stronger, both physically and mentally. Today, with no further effects of the prematurity, this toddler has grown tremendously, and he loves to play outside and to sing the alphabet. “Throughout it all, he never gave up,” Jennifer smiles. “He still doesn’t." | 
