Brave Little Dominic

By Jessica Wall

Pittsburgh, Pennsylvania residents Tyler and Jocelyn Santo traveled to their family’s vacation home in Myrtle Beach in August 2023 for a birthday celebration. Planning to spend only a week in South Carolina, the couple had no idea how much their plans were about to change. 

The night before their drive back to Pittsburgh, Jocelyn, who was 24 weeks and five days pregnant, began feeling discomfort around 10 p.m. A short time later, she noticed some unexpected bleeding, so she and Tyler went to the nearest Emergency Department. The source of the discomfort had been identified – Jocelyn was in labor. The care team attempted to stop the labor, but all efforts were unsuccessful. 

Jocelyn needed to be transported to McLeod Regional Medical Center (MRMC), the only hospital in the region equipped to care for extremely premature infants. She arrived in Florence in the early morning hours of August 12.

McLeod OB/GYN Dr. Edward Kowal explained to Jocelyn that she was fully dilated, and they prepared for delivery. McLeod Neonatologist Dr. Karli McCoy and the Neonatal Intensive Care Unit (NICU) team was also present in the delivery room and gave Jocelyn and Tyler a very quick overview of what to expect.

At 7:23 a.m., their baby boy, Dominic, was born at 24 weeks and six days. He weighed one pound, six ounces. 

The NICU team immediately stepped into action to save his life. The first step was to secure Dominic’s airway. He was intubated and given artificial surfactant, which allowed the ventilator to support his breathing while his lungs transitioned. 

“When a baby is born this early, all parts of his body are premature,” explains Dr. McCoy. “Everything is formed but still in the process of developing. The most urgent issue was the development of his lungs.”

Thermoregulation is another critical step in stabilizing a premature baby. To keep Dominic warm, the NICU team immediately placed him under an overhead warmer, on a warming mattress and in an evaporative proof case to help him hold on to body heat.

Once the team transported Dominic to the NICU, they worked quickly to regulate his blood sugar. 

“We immediately put in umbilical lines, or catheters. These catheters helped us monitor Dominic’s blood pressure continuously and give him fluids containing both glucose and protein,” explains Dr. McCoy.

All of these measures - ventilation, thermoregulation and fluid/glucose - took place within Dominic’s first hour of life, known as The Golden Hour.

“This is truly the most important hour of a baby’s life,” says Dr. Doug Moeckel, McLeod Neonatologist and Medical Director of the McLeod NICU. “Our team here at MRMC has a very detailed and regimented Golden Hour protocol. Dominic successfully reached every one of our checkpoints and was tucked in and resting by the time he was one hour old.” 

On Monday, Dominic’s care transitioned to Dr. Moeckel. This happened to be the same day Jocelyn was discharged from the hospital.

“From the beginning, we discussed how quickly we could get Dominic closer to home, but it was too risky, and his health was too fragile,” recalls Dr. Moeckel. “I knew what was stacked against Dominic and the importance of Jocelyn being here to give him breast milk.”

Dominic was facing many serious complications of premature birth, including an eye disease known as Retinopathy of Prematurity; an Intraventricular Hemorrhage (IVH), or brain bleed; and Patent Ductus Arteriosus (PDA), among others. 

PDA is a congenital heart finding common in premature infants where the blood vessel connecting the heart’s two major arteries does not close after birth and allows blood to flow into the lungs. 

Dr. Moeckel consulted with McLeod Pediatric Cardiologist Dr. David Steflik, who performed an echocardiogram on August 15, three days after Dominic was born. The results showed a large PDA, so the two physicians decided to treat him early with medication, which made the vessel smaller. Dominic would eventually undergo a procedure to fully close the vessel.

With Dominic facing such a critical road to recovery, Dr. Moeckel explained how providing breast milk was the single most important thing Jocelyn could do for her son. Premature infants are given human milk, and the only alternative to mom’s milk is donor milk. While a good option, donor milk lacks the immune cells and mother-baby specific components that a mom’s milk provides.

Jocelyn and Tyler drove from Myrtle Beach to Florence every day. When Tyler had to eventually return to work, he frequently flew from Pennsylvania to be with his family.

“It was truly inspiring to witness how hard Jocelyn and Tyler worked to be at Dominic’s bedside and do what was right for him,” explains Dr. Moeckel. “I truly believe he is alive today because Jocelyn was there providing her milk.”

This encouragement from the NICU team is exactly what the Santo family needed.

“The staff helped us anticipate all the ups and downs of an extended NICU stay,” recalls Jocelyn. “They told us for every step forward, there would be one hundred steps back, but it is still going to be progress.” 

Early in their stay, the family received a book from the NICU entitled Be Brave Little One. Given what they were facing, Jocelyn says she and Tyler both cried and decided to embrace this as their motto.

For every step forward, they would be brave. For every step backward, they would be brave.

On October 31, 2023, after three and a half months in the McLeod NICU, Dominic was finally healthy enough to be transported to a children’s hospital in Pittsburgh. Jocelyn and Tyler were ecstatic to have their baby close to home. 

Dominic endured another three-month stay in the children’s hospital followed by two weeks at a transition hospital, where Jocelyn and Tyler learned how to care for Dominic at home. 

Then the moment finally arrived. After spending 206 days in three different hospitals, Dominic came home in March 2024. 

He continues to undergo extensive therapies but has already made great progress. He only needs oxygen at night and no longer requires a feeding tube, so his parents like to say he is “cordless.”

Dominic is now sitting unassisted and going to day care, where he is making friends. Having been isolated for most of his first year, he genuinely enjoys being with other babies. He also loves for his parents to take him for walks in the park or on nature trails. He is fascinated by his two dogs and loves to visit the zoo and see all the animals. 

In honor of Dominic’s first birthday, the Santo family donated a copy of Be Brave Little One to every NICU family at McLeod in hopes that other families could be encouraged to keep hope and courage alive during their NICU journey.