Caleb’s Story: Tiniest Preemie Goes Home

When Caleb Alvarez Maldonado was born prematurely at Community Memorial Hospital Ventura on March 17, 2018, he weighed less than a pound and the odds were stacked against him.  At Caleb’s birthweight and stage of gestation (22 – 23 weeks), the likelihood he would survive to leave the Neonatal Intensive Care Unit (NICU) was just 15-20%. But Caleb has beaten the odds and finally gets to spend all of his time at home with his family.

Caleb’s parents, Ventura residents Fernando Castillo and his wife Raquel Alvarez Maldonado, were grateful — and a little nervous too — to take their now 12-pound son home in October following a 7-month stay in the NICU. It was a big day for Caleb and his family, but also an emotional day as his physicians, nurses, and therapists bid him a joyful farewell.

“With a birth weight of just 450 grams or 11.8 ounces, Caleb is the smallest baby born at Community Memorial Hospital to be discharged,” said Dr. John van Houten, a neonatologist and Medical Director of the Community Memorial Hospital NICU.

“Just from what we heard from the doctors, there was a minimum possibility of him making it to the NICU,” recalls Fernando Castillo. “But when I saw him moving it was unbelievable. It was so great.  It was like a miracle.  I thought for sure he wasn’t going to be able to survive, but the doctors did a great job.”

Caleb’s parents visited the NICU every day for seven months, juggling caring for their seven-year-old at home and Castillo’s job in the Ventura oil industry. “We tried to spend time with him,” said Castillo. “We held him, did exercises with him, and tried to learn the best we can to clean the G tube and feeding part.” Caleb is not yet strong enough to get adequate nutrition from a bottle, so the G-tube will stay in for now.

“It’s hard, but there’s nothing else for us to do but give him support and love and be there every day,” Caleb’s dad continued.

Castillo said the entire NICU staff has done a great job helping his tiny baby grow.  Castillo was impressed by how the nurses cared for the babies, played with them, and held them a lot. In the Community Memorial Hospital NICU, a large team of physicians, nurses, respiratory therapists, occupational therapists, dietitians, cuddlers, and other specially trained clinical team members work around-the-clock to care for their tiny patients and help them grow, while also encouraging parents to visit as much as they can and participate as much as possible in their baby’s care.

“They’re doing excellent work,” said Caleb’s dad. “Every nurse in there and all the doctors kept us informed of everything that’s going on, everything he’s taking, every medicine, all the things they’re giving him. It’s an A-plus right there.”

Dr. van Houten said Caleb did well. He was treated for some of the common preemie ailments including hernias that required surgery to close. He was on a ventilator for a long time and has a feeding tube that a surgeon will remove once Caleb is able to eat on his own.

“It will take some years for him to catch up in his development, but during those times we will follow him, and he’ll get whatever kind of therapy is necessary to help him,” said Dr. van Houten.

Advances in neonatology and the care for super-small preemies continue to improve, Dr. van Houten said. The very smallest – those born at less than 27 weeks or weighing 2 pounds, 2 ounces or under, are treated under the “Small Baby Protocol,” which the Community Memorial Hospital NICU adopted last year. Many NICUs do not have a Small Baby Protocol as it is a relatively recent change in the way of caring for this population of babies.  “It’s designed to give them the best standardized care from the moment the mother enters the hospital to after the birth,” Dr. van Houten said. “There is a new awareness for the babies born at the edge of viability,” he said.

One key change is that these preemies are fed only breast milk, either from the mother who is pumping or from a donor, as some preemies can’t handle formula well. The very tiny preemies at CMH are not given formula until they reach 34-35 weeks. The NICU physicians and staff also increase the calories of the breast milk using fortifiers made from human milk. “We think that makes a big difference,” Dr. van Houten said.

The Community Memorial NICU opened 22 years ago. As a Level 3 NICU, it offers an extremely high level of care. When the new Community Memorial Hospital Ocean Tower opens this winter, the NICU will expand from 16 beds to 23 beds and will include three private suites for babies needing one-on-one care, as well as a dedicated procedure room.

Caleb’s parents say they will do their best to continue giving their son the best care possible. Fernando Castillo would like parents of other NICU babies to know that whatever happens, their babies are in good hands at Community Memorial Hospital. “They will do anything to help the babies get well,” he said.