Daniela wasn’t very optimistic after hearing a report from her obstetrician about her baby.

An ultrasound showed absent end-diastolic flow (AEDF), a condition that indicates the placenta is resisting flow of oxygen and nutrients through the umbilical cord, which can lead to low birth weight, compromised neurologic development and other conditions that may imperil the baby’s survival. Daniela was experiencing a difficult pregnancy, including two hemorrhages during the first trimester, gallstones and severe nausea and vomiting.

She told her fiancé, Federico, to hide all the baby-related items at their Sarasota, Florida, home.

“We were very depressed and hopeless,” Daniela says. “We really had no hope given about our situation, and we had a lot of questions.”

Then they met Preceous Jensen, D.O., M.P.H., a neonatologist at Johns Hopkins All Children’s Hospital in St. Petersburg.

“Meeting with Dr. Jensen for a neonatal consult was the first time we had hope that there was a chance he would survive and then potentially be OK,” Daniela says.

Premature Birth

Daniela was hospitalized for two weeks before the baby’s heart rate kept dipping, causing him to be delivered by cesarian section.

Lukas arrived on May 9 at 30-weeks gestation, weighing about 1.57 pounds (710 grams). Daniela describes his skin as super thin and his thighs as the thickness of a pencil. Lukas was too small for even the smallest pacifier at first. He was transferred to the neonatal intensive care unit (NICU) at Johns Hopkins All Children’s, which carries a Level IV designation, indicating the most advanced care.

Like most significantly premature babies, Lukas had a variety of challenges, including fetal growth restriction (FGR), necrotizing enterocolitis (NEC), acid reflux, anemia that led to blood transfusions, trouble with his glucose, urinary tract infection and more.

The Johns Hopkins All Children’s neonatology team — ranked by U.S. News & World Report #24 in the country for 2024-2025, the highest ranking in Florida — helped Lukas and the family navigate those challenges.

As Lukas improved, one persistent issue kept him in the NICU — eating.

“Lukas overcame a lot of medical challenges without having to undergo a single surgery during his NICU stay,” Daniela says. “It seemed toward the end, while we were so close to the finish line, that he might need to get a G-Tube. He was struggling to keep up with the feeding volume required as it kept increasing. We felt like he just needed more time.”

Jensen had rotated in as Lukas’ primary neonatologist. She had an idea.

Introducing the FEED Clinic

Infants — particularly premature ones — commonly have challenges with oral feeding. Many remain in the NICU only to develop their feeding skills. Sometimes they need a surgically inserted gastronomy tube (G-tube) that delivers nutrition directly to the stomach.

But Jensen leads an effort to let babies go home sooner and avoid the invasive G-tube as they continue to develop their feeding skills. Often, these babies have a less-invasive nasogastric tube (NG-tube), which is inserted through the nose down to the stomach without surgery.

The Feeding Enhancement and Development (FEED) Clinic at Johns Hopkins All Children’s provides outpatient support to reduce reliance on the NG-tube and help develop oral feeding skills in the home environment. The team consists of Jensen along with a nurse coordinator, a speech-language pathologist and a dietitian.

“These babies who go home with NG tubes have less ER visits and less admission into the hospital for feeding or tube-related issues compared to babies who get surgically placed G-tubes,” Jensen says. “Research has also shown that these babies grow at the same rate as babies who stay in the NICU with a feeding tube or babies who go home with a gastrostomy tube.”

Lukas was discharged from the NICU on Aug. 23.

How the FEED Clinic Works

Initially, Lukas came to the FEED Clinic each Wednesday.

The FEED team measured his length and head circumference and checked his weight. Daniela and Federico met with the speech-language pathologist and the dietitian, who observed feeding sessions and offered suggestions on feeding techniques and recommendations for formula amounts, nipple sizes and feeding times. Jensen reviewed the plan and gave Lukas a checkup.

“She makes sure she answers any of our questions and that we are all on board with what needs to happen for the following week,” Daniela says. “We go over any medication adjustments. We also let her know of anything else that we were concerned about outside of the feeding, like stool issues, etc.”

After a few weekly sessions, the schedule moved to every other week. Hurricanes disrupted the schedule.

“There were some moments where we felt discouraged about his progress,” Daniela says. “But all of a sudden, three-quarters of the way through, he started having less stomach issues and started eating enough to gain weight without the NG tube. Yet another thing he managed to conquer!”

On Nov. 6, Lukas experienced a FEED Clinic “graduation.”

“This was really an all-star family that did everything they needed to do,” says Jensen, medical director of the FEED Clinic.

Daniela and Federico are grateful to the doctors, nurses and other specialists who cared for Lukas during nearly four months in the NICU.

“Our time in NICU was an exhausting and sobering experience as first-time parents, but the outcome is more than what we could've ever hoped for,” Daniela says.

Jensen and the FEED Clinic helped them get Lukas home and continue his development while avoiding surgery.

“She was a lifesaver,” Daniela says. “Although he is still relatively small for his corrected age, he seems perfectly healthy and normal!”