Chelsea and Joshua Franco were overjoyed to learn they were having twins. At Chelsea’s 18 week anatomy scan and prenatal checkup, they were also thrilled to find out they would be welcoming both a son and daughter.

“But then we also found out that I was dilating,” Chelsea says. “I was 2 centimeters. We were worried.” 

Her cervix was stitched up, which bought them some time. But by 22 weeks, she was experiencing preterm labor contractions. A much different experience than the birth of their first son, who was happy and healthy — a full-term baby at 38 weeks. 

“It was definitely scary for both of us,” Chelsea says. “We were just wanting them to come out healthy and be able to live normal lives, but I definitely tried to stay strong the whole time.”

Despite medication to slow labor, on March 11, 2023, Charlotte and Jett were delivered at HCA Florida Brandon Hospital, weighing just over 1 pound each and measuring only 11 and 12 inches long respectively. The hospital’s neonatal intensive care unit (NICU) is staffed by Johns Hopkins All Children’s Hospital neonatalogists. Lilly Chang, M.D. and Tracey McKinney, NNP were both at the delivery to immediately assist with the babies.

“They performed an excellent and amazing job resuscitating these 23 weeks twins who had a very small chance of surviving the delivery,” says Angel A. Luciano M.D., MS.MEdL, FAAP, medical director of the NICU at Johns Hopkins All Children’s.

“In my head, I was like, ‘Oh my gosh, are they going to make it? What kind of problems are they going to have at this age?’” recalls Chelsea.

They quickly learned the complications that can come with premature births. At a tiny 3 days old, Jett’s lungs became very sick. The team advised he be airlifted to the neonatal intensive care unit (NICU) at Johns Hopkins All Children’s Hospital in St. Petersburg to have access to equipment he needed to survive. 

“We take care of multiple 23-week premature infants daily in our unit,” says Chang. “Only about 5 percent of preterm deliveries occur at less than 23 weeks gestation. About half of all infants born at 23 weeks survive — this figure has been steadily increasing in the last 10-15 years.” 

Ironically enough, Jett was put on a special machine called the Jet ventilator to help his lungs. 

“High-frequency ventilators (including the Jet) gently move small amounts of air into and out of the lungs at very high rates as opposed to using higher pressures and volumes at lower rates with conventional ventilators,” Chang says. “The tinier puffs of air help protect the lungs and give injured areas time to rest and heal.” 

The Jet was just what he needed.

“Which is just so funny to think of because there was just a running joke that, you know, Jett is on the Jet,” says Joshua, finding positivity in a stressful situation.

It wasn’t long before Charlotte’s lungs took a turn for the worse, requiring her to also be airlifted to the experts at Johns Hopkins All Children’s. 

“Neonatal chronic lung disease (CLD) or bronchopulmonary dysplasia (BPD) is a significant cause of respiratory illness in preterm newborns,” Chang says. “It is due to disruption of lung development due to preterm birth and lung injury from the respiratory support that is required.” 

Soon after arriving to Johns Hopkins All Children’s, Charlotte improved.

“She was like, ‘OK, I'm with my brother now. I'm good, I just needed to be with him,” Chelsea says. “So she was doing fine.” 

Joshua and Chelsea both took notice that although the twins can’t talk yet, they still know how to communicate and have a special connection.

“They have this twin thing going on, when one goes up in weight, the other tries to keep up,” says Chelsea. “Jett’s a go-with-the-flow kind of baby and Charlotte is a bit dramatic — she will tell you when she’s upset. We don’t hear her cry yet — she makes this face. They’re both so cute and so sweet.”

Both babies also had a heart condition, common in preemies, called patent ductus arteriosus (PDA). This happens when the artery (the ductus arteriosus) that allows a fetus to send blood directly back to the placenta to pick up oxygen from the mother before birth, fails to close after birth. Charlotte’s resolved with medicine, but Jett needed a procedure from experts in the Johns Hopkins All Children’s Heart Institute to insert a Piccolo device. 

“Transcatheter PDA closure in preterm babies is a delicate procedure involving the care of a large team, including nurses, respiratory therapy, specialized anesthesiologists, sonographers, imaging experts and the procedural staff,” says James Thompson, M.D., pediatric cardiologist specializing in interventional cardiology. “It involves snaking a thin catheter (tube) from the leg and through the heart to place a tiny plug to close the PDA. This minimally invasive technology has the potential to help our most fragile patients.” 

As the months have passed, the twins have improved as they continue to gain weight, now tipping the scales at over 9 pounds each. Soon, after five months in the hospital, the family of five, including their 1-year-old boy who can’t wait to enjoy his siblings, will be reunited at home.

“It was worth the drive,” Joshua says. “Everyone here has been very good at explaining everything, including the pros and the cons. They also explained how even though it was science, it's also an art and what works for one baby may not work for another. The level of detail and expertise to take care of the baby is exceptional.”

While it was a trying time, it comes with one of the sweetest memories Chelsea holds close to her heart: when she was able to hold both babies at the same time. 

“It was on Mother’s Day and that was amazing, because it was their first time together again, since being in the womb,” Chelsea says. “They were holding hands.” 

And it’s moments like that and seeing families be able to go home with their babies that inspires NICU doctors like Chang at work each day. 

“I adore the Franco family!” Chang says. “They are very involved and ask great questions. They do lots of skin-to-skin, called kangaroo care and provide breast milk. Those things are tremendously helpful to help get the best outcomes.”