She gave birth intubated: ​my son had sepsis, necrosis, ​and cardiac arrest

The risk was high, but physiotherapist Michelle Inácio Malzoni, 37, managed to conceive and carry her pregnancy to 33 weeks. Her son, now 7 years old, overcame severe health issues during the four months he spent in the neonatal ICU.​

"The doctors said there was nothing to be done, that Isaac could die, and that I had to accept it. But I had so much faith that I couldn't understand," she says. Michelle gave birth in November 2016. To VivaBem, she shares her story.​

"I was diagnosed with adenomyosis at 26. Since I was 15, I had hemorrhages, an intense flow that required blood transfusions, and I would even faint."​

At that time, I was doing a postgraduate course at Santa Casa de São Paulo. The doctor treating me said it was time to get pregnant because my uterus wouldn't hold up for much longer. I started the IVF (in vitro fertilization) process, but I began experiencing a lot of pain and stopped. The doctor then told me to slow down. I was working at two hospitals and reduced my workload to just one, with shorter hours. I started eating better and focused on physical exercise.​

In six months, I felt I was pregnant. A day before my birthday, I bought a test and confirmed it. I went to the gynecologist, had an ultrasound, and was diagnosed with a placental abruption. He told me not to get my hopes up too much because it might not progress. I took medication to sustain the pregnancy, but a week later, I experienced bleeding.​

"I had to stop working because it was a high-risk pregnancy. I felt anxious, and it affected my mental health a lot."​

In the fifth month, everything seemed to be going well, and I was cleared to do some activities, but I started having high blood pressure. I took all the prescribed medications at home, but nothing worked. So, I was admitted to Santa Casa for monitoring ultrasounds.​

"I already suspected that Isaac would be born prematurely, but imagining it and experiencing it are two different things. I was terrified."​

'I DIDN'T SEE MY SON BEING BORN'

I went to the delivery room very nervous, my blood pressure spiked, and I was intubated. I only felt immense despair. Before, while talking to God, I said that if He was going to take away the son He had promised me, I would accept it, but I asked Him to let me know. My brother had told me that the promise was not canceled, so I clung to that word.

"I didn't see Isaac being born. My husband, at first, wasn't going to attend the delivery, but since my condition was very critical, he had to go. The doctors said he might have to choose: 'either her or the baby.'"

I only saw Isaac two and a half days after his birth. It was wonderful to see his little face, which looked a lot like my mother-in-law, who had passed away shortly before. But at the same time, it was very distressing. I was in a lot of pain, very hurt, and suffered greatly. But at no point could I give up because he was waiting for me.

TACHYCARDIA, NECROSIS, AND DIALYSIS

He was extubated within the first 24 hours and placed on CPAP [a device that maintains continuous positive airway pressure]. Everything was going well; he came to my arms, and it felt so good to hold him. It was very frightening, but it was a familiar place for me. I was afraid of the future, but I felt calm because the team was excellent.​

In the first week, he showed signs of infection: fever, tachycardia, late-onset sepsis, and was intubated again for treatment. At 26 days old, he developed abdominal distension, but the exams couldn't reveal what was happening.​

"The doctor said they had to open his abdomen to take a look. It was a shock."​

At 7 a.m. on December 25, he was taken to surgery. It felt like my husband and I were alone in the world. After the procedure, he improved, was extubated, and was learning to breastfeed, but 15 days after the surgery, he developed tachycardia and signs of a new infection.​ He had a cardiac arrest, and the team resuscitated him. They had to intubate him again to treat the infection, which turned out to be meningitis. The next day, when I arrived at the hospital, the physiotherapist was wrapping his foot with cotton. When I looked, it was necrosis. They told me that he would likely not only lose his foot but also his hands and fingers.​

He was in critical condition, with kidney failure, low platelet levels, and intracranial hemorrhage. During the third infection, he had a seizure, and they started brain monitoring. I saw Dr. Gabriel Variane on several occasions; he spent the entire day observing the device, analyzing the curves, showing an extraordinary level of dedication. Isaac underwent dialysis, and it was another desperate moment. But, as always, God spoke to me.​

"When people asked me how he was, I would say he was doing great. But if Isaac were to leave, I wouldn't be able to bear the pain."​

I ACCEPT MY STORY

He spent about three days in critical condition, unresponsive to anything. At one point, the doctors said there was nothing more to be done, that Isaac could die, and that I had to accept it.

"But I had so much faith that I couldn't understand that they had 'given up.' Medicine did everything it could for him."

One night, he improved, and his kidneys started functioning again. As his functions began to recover, there was concern about the hemorrhage in his head, which had progressed from grade 1 at birth to grade 3. But despite the imaging results, he showed clinical improvement and went home with hydrocephalus and a bleeding issue that later resolved itself.

"It was all very difficult, but I had the support of my family and the medical team. Everything that happened, no matter how painful, led me to be with Isaac today. I accept my story and the things that happened to me because everything turned out well."

Isaac is a very happy and strong child. He goes to school and lives a life like other children, without excessive protection. He enjoys jiu-jitsu, going to the movies, and dining out at restaurants.

TECHNOLOGY FOR NEONATAL HEALTHCARE

Isaac was monitored using PBSF (Protecting Brains & Saving Futures) technology, which had just been developed. The digital neurological ICU includes brain monitoring and therapeutic hypothermia to prevent sequelae in babies born with issues like his, particularly oxygen deprivation in the brain.

The device detects seizures in newborns, which often lack visible manifestations such as tremors or stiffness. By combining multiple data points (brain waves, oxygenation, blood pressure, heart rate, imaging exams), it provides a comprehensive view of physiology and enables early diagnoses.

Artificial intelligence helps identify correlations automatically to assess the baby's risk level. According to Gabriel Variane, the company's founder, it is possible to analyze hundreds of physiological data points in real time, something impossible for the human eye.

Due to the digital nature of the concept, the technology can be implemented anywhere in Brazil: 50 hospitals have adopted the digital neurological ICU, including 21 public and 29 private facilities. With support from PBSF's central hub, patient cases can be discussed remotely when necessary. "There are no physical barriers, which promotes the reach of specific methodologies and reduces structural costs."— Gabriel Variane, founder of PBSF. The protocol also enables uniformity of care in health centers, even with varying resources.​

ACCESS ACROSS THE COUNTRY​

At Santa Casa de Misericórdia do Pará, the technology was implemented in 2019. Since then, nearly 20,000 hours of monitoring have been conducted for over 200 newborns. "Before the technology, almost 100% of the babies developed sequelae because the treatment focused solely on sustaining life," says Salma Saraty, head of neonatology at the hospital, which has three beds equipped with this modality.​

The center had mechanical ventilation, electroencephalograms, sedatives, and anticonvulsants, but sometimes the young patients were either undertreated or overtreated. "In the end, they would develop hydrocephalus, cerebral palsy, and motor and cognitive sequelae." Brain protection is also achieved through therapeutic hypothermia, which involves reducing body temperature in a monitored way to protect the brain and prevent neuron death.​

In the Unimed Goiânia network, five hospitals have neonatal neurological ICUs. Since 2021, more than 25,000 hours of monitoring have been conducted for over 500 babies. In 90% of cases, seizures were not recognized by doctors but were detected by the device—and thus treated in time. According to Marcela Regina Araújo, a hematologist and board member of the network, specialized neonatology neuropediatricians are scarce, making accurate clinical diagnoses challenging.​

With the technology and remote team support, the advantage today is delivering more precise treatment. This, she says, protects the baby from alterations caused by unintentional medical errors.​

CHALLENGES AND SOLUTIONS​

The implementation of the protocol in the hospitals of the Goiânia network arose from a demand from the professionals themselves, who conveyed to Araújo the need for a neurological ICU.​

"In my ignorance, I thought it was unfeasible within the model we have," she says. But when she understood the concept, she saw that it was worth the investment. Among the barriers to adopting a new technology, especially one so specific, the doctor highlights:​

• Resistance from the hospital owner: the idea of having another team monitoring the work of professionals, even remotely, creates an obstacle, as if there were an inspection.​
• Medical pride: it is a challenge for the professional leading the ICU to accept the technology or external monitoring as a partnership in their work, not as competition. ​
• Management: the always-discussed economic barrier, but not only in terms of service coverage. ​

“There needs to be a strategic investment vision in the benefit, which improves their care for a positive outcome.”— Marcela Regina Araújo, board member of Unimed Goiânia.​

Contrary to what one might imagine, Variane says that the barrier to adopting technologies is not the cost, since, in the long term, preventing sequelae today reduces expenses with medical care in the future.​

The problem lies in clinical education. "Changing clinical practice requires initial and longitudinal training and showing results." The challenge is also competing with other priorities of the healthcare system, in addition to the traditional public sector rituals for evaluations and hiring.​

Saraty comments that, even though the technology exists in Pará, access is restricted to Santa Casa. Therefore, he envisions at least one specialized care unit in each region of the state.​