Fighting to Survive: Inside the Neonatal Unit

Story By Jhoanna Peterson

Photos By Brian Martinez and Jhoanna Peterson

Stephanie Ramirez holds her 3-day-old daughter, Michelle, in her arms while the tiny newborn sleeps in the Neonatal Intensive Care Unit at Hillcrest Baptist Medical Center. Michelle was delivered five weeks early.

Ramirez knows she is fortunate to have her daughter in stable condition. Although she only weighs 5 pounds, 3 ounces, Michelle had no complications.

“The feeling you get when your child is in pain is like no other. I hurt when she hurts, so I’m glad she is OK now,” Ramirez said. “I can’t help but to be sad for those babies that have to remain in the NICU.”

Watching babies come in and out of NICU reminded her of earlier days when she didn’t know whether Michelle would pull through.

“Michelle gets to go home tomorrow,” a nurse sitting with Ramirez said as Ramirez smiled. Ramirez is still holding Michelle and rocking her to sleep. Michelle then grabs Ramirez’s finger with her tiny hand, the perfect picture of their bond as mother and daughter.

Dr. Darrell S. Wheeler said, “Anything less than 37 weeks gestation is a premature baby. Forty weeks is what we call a normal term baby.”

Moderately premature babies are born between 35 and 37 weeks gestation; extremely premature babies are born between 24 and 28 weeks.

For preterm babies born around the Waco community, Hillcrest Baptist Medical Center offers the only level-three neonatal intensive care unit in McLennan County. It is also home to the only board-certified neonatologist in Waco, Dr. Darrell S. Wheeler.

Since Hillcrest’s NICU opened its doors in 1990, more than 4,500 babies have been treated there; before that, premature infants had to find specialized care out of town, according to Hillcrest’s Web site.

“Our average census is about 15 [premature] babies a day, but we’ve had 24 here recently,” Wheeler said.

Premature babies are required to stay in NICU for treatment or observation. The length of time they stay depends on how early they’re born. Smaller babies born at 24 weeks stay in the hospital for months, whereas a baby born after 30 weeks stays just a few weeks.

“The earliest baby that Hillcrest can take care of is 23 weeks gestation,” nurse practitioner Andrea Dossey said. “They’re normally about 1 pound, and they’re in NICU for about four and a half months.”

Allyson Ray, a junior at Baylor, was just a few weeks older than that when she was born. At 26 weeks, Ray was in Scott & White Hospital in Temple four and a half months after birth. Ray had to be on a ventilator to assist her breathing. She was born early because doctors decided to induce labor on her mother.

“My mom was getting very sick, and so they had to take me out then or risk losing the both of us,” Ray said.

The doctors told her mother that Ray would be behind mentally and slow to develop, “but thankfully, they were wrong,” Ray said.

Preterm labor tends to cause several long-term and short-term complications for the newborn. Wheeler said babies who survive a preterm birth face the risk of serious lifelong health problems including cerebral palsy, blindness, learning disabilities, hearing loss and other chronic conditions.

Samir Alabsi, author of A Primer on Preemies, discussed some common problems caused by a preterm birth: low birth weight, underdeveloped organs, intraventricular hemorrhaging, apnea, infection, respiratory distress syndrome and even death.

Intraventricular hemorrhaging, or bleeding in the brain, is one of the most common problems caused by preterm birth. Arlene Eisenberg, author of What to Expect the First Year, wrote that intraventricular hemorrhaging strikes 15 to 20 percent of premature babies weighing less than 3 pounds, 5 ounces “most often within the first 72 hours of life.” There are four levels of intraventricular hemorrhaging, from really mild to very severe.

“The kids with grades three or four grow up to have significant cerebral palsy,” Wheeler said.

Infection in premature babies is a big threat because they’re less able than full-term infants to fight germs that can cause serious illness, Dossey said.

Wheeler said he advocates breastfeeding to help fight infection.

Premature babies who are 23 or 24 weeks old often have breathing complications that full-term babies don’t typically face.

“Their lungs aren’t developed, so we have to get them through that phase first. They have to survive that,” Wheeler said.

Underdeveloped lungs can lead to respiratory distress syndrome, or RDS.

Dr. Mia Moody, assistant professor of journalism at Baylor University, is familiar with RDS. Her daughter, Heidi, developed the syndrome after a premature birth.

Heidi was born two and a half months early and weighed 3 pounds, 5 ounces. After she was born, she remained at Hillcrest’s NICU for about five weeks because of complications. When she was 5 months old, she was hospitalized with the respiratory syndrome, Moody said. Like any loving mother, Moody was worried about her daughter’s health. Heidi, now 17, remembers her mother telling her the story.

“She said I was in there for a long time, and they had me hooked up to needles,” she said.

Doctors had predicted Heidi would have vision problems in the long term, but according to Moody, her vision is very good. Heidi is happy and healthy with little resemblance to the tiny baby born premature.

After Heidi’s preterm birth, Moody’s doctor was able to take better precautions during her other two pregnancies. Although her sons, Timothy and William, were also born premature, she was able to carry them longer.

There are many reasons women go into preterm labor, though they can vary greatly among women and are not easily predicted.

“Sometimes moms have medical conditions where it’s too dangerous to continue the pregnancy,” neonatologist Wheeler said. “At some point the obstetrician weighs the risk of delivering a little bit early versus the risk of continuing the pregnancy to term.”

“Sometimes, they’ll deliver a little early so mom isn’t in the risk of dying.”

Harvey Alvarez, a former Baylor student, was born five weeks early. Because he was tangled in the umbilical cord, doctors induced labor early. Although Alvarez had no complications, he was kept in the hospital three weeks for observation.

His mother, Janie Garcia, remembers being afraid for her child and said it is something she will never forget.

“I just felt so helpless. I couldn’t do anything but cry. I became so anxious about the situation that I couldn’t even think straight,” she said. “Unless someone experiences it, they can’t understand the pain and anguish a mother goes through when her son is fighting for his life, and she has no idea what the outcome will be.”

From the reasons that are known to cause preterm labor, the most common ones are infection and gestational diabetes.

Wheeler emphasized the importance of having good obstetrical visits. He said that if a woman develops signs of preterm labor, she should go to the hospital instead of waiting. If she shows up early, there are medicines that doctors can give her to slow down labor. But once she’s dilated, it can’t be reversed.

Robert Sandoval’s daughter, Emily, was born a month and a half premature. Sandoval believes his wife delivered early because she didn’t go to the hospital right after contractions began.

“She figured that it was nothing since it wasn’t her due date,” he said.

Emily was in the hospital for several weeks, her parents growing more and more eager to take her home.

“My heart was in pieces, and I was in pain because I wanted to bring her home and couldn’t,” Sandoval said.

He expressed his overwhelming feelings of anger, frustration and panic. He said a big part of his heart was in the hospital with his daughter.

“I was worried, and I kept trying to tell myself it would be OK. It’s hard to do that when your child is in such a fragile condition,” he said.

Sandoval said Emily, at 14 months, is growing up to be a healthy child.

“I feel so blessed that she is a healthy and happy baby, and I couldn’t ask for anything else,” he said.

For families who have had a premature baby, lost a premature baby or now have their premature baby in the hospital, support groups can help them cope. Currently, there are no support groups in Waco dedicated to premature babies, but there are online support groups and nonprofit organizations such as Parents of Premature Babies Inc. that provide information and encouragement to families.

Some babies survive the obstacle of being born premature and have their entire future ahead of them. Many premature babies, however, lose that battle. Healthcare professionals said that by raising awareness and informing people about ways to reduce the risk of having a premature baby, the number of preterm births may decrease.

For pregnant women, reducing the risk can be accomplished by following the doctor’s orders and knowing their own bodies. Doctors advise that expecting mothers go to all their scheduled doctor’s appointments and tell their doctors if they are having any symptoms that may concern them. These signs are sometimes early warnings. Doctors may be able to deal with problems if they’re caught early, increasing the chances of having a healthy full term baby.

“After all, children are our future,” Sandoval said.