“Such a little baby!”
The words ricocheted through Jannette Ortega’s mind like a forbidding mantra, her eyes locked on the wizened body of her newborn, a latticework of tubes and wires sustaining life.
“How will she ever live? So tiny, so very tiny.”
If only she knew. Janet Alexis Rivera-Ortega came into the world Jan. 19, tipping the scales at 955 grams, a shade over 2 pounds. Amid the whirs and bleats of medical machinery in the neonatal intensive care unit at the University of Miami/Jackson Children’s Hospital, Janet falls into the welterweight category.
The real lightweights are half her size at birth.
In the last two decades, in an unprecedented triumph of medicine and moxie, babies routinely expected to die are now routinely expected to live. Better gadgets help them breathe, and better drugs make their lungs work.
Sometimes, it has been as simple as understanding that doctors and nurses were poking and probing the smallest of the small too much, changing their diapers too often. Better to leave them alone.
But progress always exacts a steep price, in more ways than one.
The bill for babies born four months early and weighing 1 to 2 pounds can easily top $250,000, catapulting as high as $500,000, even $1 million.
Concerns persist about the risk of cerebral palsy and retardation and, more commonly, learning and behavioral problems.
After 20 years of improvements at a breakneck pace, doctors who specialize in rescuing the smallest and youngest have confronted this reality:
They believe they have reached the outer edge of viability, keeping infants alive who weigh less than a pound and have spent as little as 22 weeks in the womb. To go lower would be to assault physical and ethical barriers. Fetuses younger than 22 weeks simply don’t have sufficiently mature organs to survive outside the nourishing realm of the womb.
“Getting much lower gets you into the Robin Cook novels, forming the artificial wombs and having the baby suspended in liquid, and having fluid infused through their umbilical cords,” said Dr. Steve Haskins, medical director of the neonatal unit at Broward General Medical Center in Ft. Lauderdale.
Everybody loves a baby story.
Witness the attention lavished on the McCaughey septuplets, born last November in Iowa. The four boys and three girls were born 31 weeks into pregnancy, weights ranging from 2 pounds, 5 ounces to 3 pounds, 4 ounces.
They all survived.
In a way, Thomas Terlecky’s tale is just as impressive. He was born 2 1/2 months ago in Miami weighing scarcely more than a pound, so small his whole body could snuggle in an adult’s palm with room to spare.
“I couldn’t believe this was really happening to me,” said Thomas’ mother, Michelle O’Brien, herself a slight infant when she was born 17 years ago weighing 2 pounds, 13 ounces. “I touched his hand–not that there was much to touch, really–and as soon as I did we bonded.
“I always believed he would make it, but inside me I was scared something would happen because there was always that chance, especially with a baby that small.”
In fact, back when Eduardo Bancalari first trod the shiny floors of Jackson’s neonatal intensive care unit a quarter century ago, this was the cold reality for babies of Thomas’ size:
“When I started, there were five neonatal intensive care beds. That tells you part of the story,” said Bancalari, whose domain as neonatal chief spans 126 beds, meaning one of every 10 beds at Jackson is devoted to small, ailing babies.
“There was pretty much a rule here: The residents were not to use mechanical means of respiration if the baby was under 1,000 grams.”
Thomas Terlecky weighed 487 grams at birth. For days, that was a high point. Like most newborns who shed fluid reserves accumulated while in the womb, Thomas lost weight.
In the days, weeks and months after his birth, he would benefit from all that doctors such as Bancalari had learned:
Experts widely hail a substance called surfactant as the most important addition to the neonatology medicine chest.
We’re all born with it, and it’s crucial to our respiratory system, prying open the small air sacs in the lungs that act like thousands of pulmonary conductors, guiding oxygen into the bloodstream.
Underdeveloped lungs are the biggest threat to the life of tiny babies, who are born with an insufficient reserve of the critical lung lubricant. So surfactant, in synthetic forms and in varieties harvested from animals, is delivered into the lungs through a tube snaking into the trachea.
