Before River ever took his first breath, his life was already being fought for.
Now 7 months old, with expressive eyes that seem to tell their own story and a personality beginning to shine through, River is finally home — after 195 days in the Neonatal Intensive Care Unit (NICU) at Atrium Health Levine Children’s Hospital.
The moment everything changed
At 20 weeks pregnant, Alli scheduled a private ultrasound — a chance to get an early glimpse of her baby before her anatomy scan.
Instead, she got a moment she’ll never forget.
“There wasn’t much fluid around him,” she says. “I knew right away something wasn’t right.”
Follow-up appointments confirmed the unthinkable. River had bilateral renal agenesis — no kidneys had developed at all.
Without kidneys, a baby cannot make amniotic fluid. And without that fluid, the lungs don’t have what they need to grow.
Doctors were direct. They encouraged Alli to go home, prepare for comfort care and cherish the time she had left in pregnancy.
“I was heartbroken,” she says. “But I was also fighting for my baby. He had a strong heartbeat. He was kicking. I just couldn’t believe that was the end of his story.”
Refusing to say goodbye
Alli went home and started searching for any sign of hope.
She found a program out of state offering amniotic fluid infusions — a rare approach that could give River’s lungs a chance to develop.
She didn’t hesitate. And by the time she arrived, River had no fluid left.
At 24 weeks, she began weekly infusions, each one replacing what his body couldn’t produce and buying precious time.
“It was exhausting, but I knew I had to try,” Alli says.
A fragile beginning — and a team ready
On Thanksgiving night, Alli’s water broke.
River was born in the early hours of November 29, weighing just 3.1 pounds.
He wasn’t breathing. In those first moments, everything moved quickly — resuscitation, urgent care, difficult decisions. A physician began calling hospitals, searching for a team equipped to care for a baby as small and as medically complex as River.
Atrium Health Levine Children’s Hospital answered.
Just after he was born, River was on a flight to Charlotte. From the moment he arrived, his care required precision, coordination and constant attention.
“The immediate concern was how to replace what his kidneys would normally do,” says Dr. Aesha Maniar, pediatric nephrologist at Atrium Health Levine Children’s Hospital. “Without kidneys, his body couldn’t regulate fluid or electrolytes, which can quickly become life-threatening.”
Within his first days of life, River was started on dialysis.
Because of his size, his team used specialized approaches — transitioning between different forms of dialysis to safely support his body as it adjusted.
“It’s incredibly challenging in a baby this small,” Maniar says. “We’re balancing so many things at once: fluid, nutrition and blood pressure, while helping him grow.”
The quiet moments that mattered most
For months, River’s world was the NICU.
Machines hummed, lines and tubes supported every function his body couldn’t yet manage on its own. There were complications and setbacks — moments that required quick action and careful problem-solving from his care team.
But there were also quiet victories. A little more weight. A more stable rhythm. A step closer to something once unimaginable.
For Alli, not all of those moments showed up on a monitor. Some were felt.
“I hold him whenever I can,” she says. “Even when he’s hooked up to everything. He just knows.”
She sat beside him through dialysis. Learned his cues. Watched his personality slowly emerge.
“He’s got his own little attitude already,” she says with a smile.
A turning point
One of River’s most important milestones came when he was able to transition to peritoneal dialysis — a form that can be done at home.
“That was a huge win,” Maniar says. “It meant he was stable enough to move toward life outside the hospital.”
At the same time, River was growing — gaining strength, gaining weight, inching toward the milestones he’ll need for future surgeries and, one day, a transplant.
Finally home
On June 12, after 195 days in the NICU, River went home.
The transition didn’t happen overnight. Alli and her mother trained extensively to perform dialysis themselves — learning how to manage the machines, monitor his condition and provide the level of care he needs each day.
That preparation, his doctors say, has been essential.
“His mom is incredible,” Maniar says. “Her dedication is the reason he’s here. She’s been his fiercest advocate from the very beginning.”
A future still unfolding
River’s journey is far from over.
Because he was born without a bladder, he will need additional surgeries before he can receive a kidney transplant. As he grows — typically around 2 years old — he’ll be evaluated for transplant, a step that could come from a donor.
Alli already holds onto one hope. “I want to be his match,” she says.
For now, though, she’s focused on what once felt uncertain: simply being home.
Listening to the quiet. Watching him grow into the baby she always knew he could be.
River was born without kidneys — a diagnosis that once came with no path forward. But today, his story isn’t defined by what’s missing.
It’s defined by everything that made it possible for him to be here: a mother who refused to stop fighting, a care team that said yes and a baby who continues to prove just how much life can hold.
Learn more about pediatric nephrology and kidney care at Atrium Health Levine Children’s Hospital.
