Four Years After Birth, Toddler Finally Breathing Easy

March 2020 was a scary time for Adam Cardello and Zohra Ahmadi Cardello. It was the start of the COVID-19 pandemic, and their first child, Safaa Cardello, had just been born more than three months prematurely.

Safaa, weighing just 1.1 pounds, was in the Neonatal Intensive Care Unit (NICU) at Cedars-Sinai Guerin Children's.

"Shortly after Safaa was born, pandemic lockdowns were implemented and only one visitor was allowed in the hospital at a time, so we had to take turns visiting her in the NICU," Cardello said. "We were not only scared of getting germs at the hospital, but we were scared of bringing germs into the hospital and harming Safaa."

Safaa experienced a number of health challenges in those early days, including bronchopulmonary dysplasia, or premature lung disease, because her lungs were not fully developed. Additionally, her physicians discovered Safaa had an extremely narrow upper airway, making it difficult for her to breathe without medical intervention.

"I would honestly say Safaa had the smallest windpipe I've ever seen," said Irina Dralyuk, MD, a pediatric pulmonologist at Cedars-Sinai Guerin Children's and one of Safaa's consistent care providers.

To bypass her narrow airway, Safaa's doctors performed a tracheostomy, a procedure to create an opening in the neck that extends to the trachea, allowing easier breathing and enabling oxygen to reach the lungs.

Safaa graduated from the Cedar-Sinai Guerin Children's NICU four months later, in July 2020, but her airway issues were not solved, so she went home with the tracheostomy tube in her neck.

Fixing Safaa's Airway

"When I first met Safaa, her airway opening was only a couple of millimeters wide," said Gene Liu, MD, director of Academic Otolaryngology for Cedars-Sinai Medical Center and a pediatric ear, nose and throat specialist for Cedars-Sinai Guerin Children's. "And even though she was growing, her windpipe needed help to expand."

Hoping to avoid a major surgical procedure on her neck that would come with additional risks, Safaa's family and their care team opted for a less invasive approach using a balloon dilation to gradually widen her airway over time.

"Every few months, we would look at Safaa's airway with a fiberoptic camera, and the balloon dilation procedure would gently push open the airway little by little until it became a very nice, normal-looking airway," Liu said.

In March 2024, shortly after Safaa's 4^th birthday, her tracheostomy tube was removed.

Becoming Like Family

Through four years of appointments and procedures, the Cardello family and Safaa's Cedar-Sinai care team became quite close.

"Safaa got to know us really well and I think that helped when she would come in for her balloon dilation," Dralyuk said. "I would always meet her and her family in pre-op and either Dr. Liu or I would carry her back to the procedure area. She's a tough cookie. She and her parents have done an amazing job."

Dralyuk said she especially loves to hear Safaa say her name. "Early on, we didn't know what Safaa's voice might sound like due to her narrow airway and whether there may be any residual damage to her vocal cords. Now when I see her, and I hear, 'Hi Dr. Dralyuk,' it is really special."

Ahmadi Cardello said she and her family are thankful for the care and attention they received.

"The advice Drs. Liu, Dralyuk and all of Safaa's other doctors gave us always felt like it was something they would recommend for their own child," Ahmadi Cardello said. "We didn't feel alone."

What's Next for Safaa

Now that her tracheostomy tube has been removed, Safaa and her parents are waiting patiently for the stoma, or the hole where the tube was previously located, to close. That typically happens on its own in a few months.

Prior to the removal, many things that would be normal for a toddler were risky for Safaa as they could cause infection of the stoma.

"I can't wait to teach her how to swim," Cardello said, "It'll be fun to finally take her to the park and let her play in the sand. We haven't been able to do that until now."

Ahmadi Cardello is relieved. "Now that Safaa's tracheostomy has been removed, I feel like we can all breathe a little easier," she said.

Read more from the Cedars-Sinai Blog: Common Breathing Problems in Kids and How to Treat Them

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