06 August 2007

Amazing Babies

Most do not realize it, but being a baby is tough. The odds against surviving are always high. Especially if you are born prematurely in a poorly-equipped hospital, which more often than not, is the case in Philippine provinces. The baby in the picture, born in a primary care hospital somewhere in Bulacan a month ago, is an example. Let's call her Baby girl A (for amazing). Baby girl A was born prematurely at 30 weeks (normal is 37-40 weeks) and weighed 900 grams only (about 1.98 pounds). Her young mother is 18 years old, and delivered prematurely because of severe emotional stress. Her attending pediatrician (my best friend) described her as "so small, her diaper practically covered all of her body." Considering that the hospital where she was born in was poorly equipped, it is a miracle she survived.

My friend doctor said he has adapted to the "law of unavailability," when caring for premature babies like Baby Girl A. The law of unavailability pertains to facilities and medical equipment that should be used, but are unavailable: [1] no incubators, or even if there is one, it is usually a very old model, [2] no pulse oximeters, [3] inavailability of lab tests like arterial blood gases (ABGs) monitoring, and [4] unpredictable x-ray availability, which my friend said depends if the x-ray technician is sick or not. 'Sounds amusing and depressing at the same time, right? But that is the harsh reality for these premature babies. You need not wonder anymore why many premature infants die here.

It goes without saying then that a pediatrician's competency may be one of the most crucial factors for premature infant survival. My friend doctor and I both agree that not all the things we learned in medical books work under these harsh circumstances. The things they teach in medical school applies only when hospital conditions are optimal or more than optimal. Faced with lack of necessary facilities to help premature babies survive, my friend has managed to see an opportunity in the middle of this crisis.

How does he do it? He tries his best to mimic the womb environment as much as possible. The key is less stress for the baby. He orders minimum handling of the baby during this observation period. This is easily achieved of course, because there is practically nothing that can be done anyway (lack of facilities, remember?). So, the management setting is usually very simple: plenty of warmth, either by a lamp or an old-model incubator, and less touch or handling of the baby. He sees this approach as beneficial because the baby is less exposed to stress. Any form of stress can easily kill premature babies. In his clinical management style, he lets the premature babies' bodies develop and function on their own as they should, while keeping chances of infection down by limiting exposure to foreign sources like frequent touching of the baby.

Does it work? Oh, yes! Baby girl A is one of the many premature babies my friend has taken care of. He calls them ELBW babies, for extremely-low birth weight babies --- babies born prematurely weighing less than 1 kilogram. One of his most challenging is another baby born prematurely weighing only 800 grams (about 1.76 pounds only!), who also survived, and like Baby Girl A, is a healthy baby right now.

5 reactions:

rolly said...

Amazing nga.

"The things they teach in medical school applies only when hospital conditions are optimal or more than optimal."

I think this is also true in most colleges. Even in law practice, laywers will tell you they have not really been prepared for what its like in the outside world. Of course, training doctors should be as close as possible to what the real world is. Buti na lang, your friend has that much logic and initelligence in him.

Ebb Tide said...

What an interesting article.! It's good to know that simple method warmth can help a preemie survive. Our first grandson was a preemie (1 lb. 10 oz.). He was born here in the U.S. Of course he survived with the advanced neo-natal care. He's a miracle baby. Today, he's a normal and very active. This Sept., he will be 10 yrs. old.

cathy said...

no one can beat Filipino doctors and nurses when it comes to resourcefulness.

Dr. Emer said...

T.ROLLY - magaling talaga friend ko, and he also has the willingness to stay here and serve instead of going abroad.

EBB TIDE - advanced birthday greetings to your miracle grandson. thanks also for visiting!

CATHY - oh yes! we are also known abroad for localizing neurological pathologies without the benefit of CT/MRI scans. just pure clinical observation.

iya.camaya said...

Hi! It is truly wonderful to see ELBW babies surviving even with minimal resources. We were also blessed with a miracle ourselves. Our baby was born 841g at 26 weeks two years ago. She's now a funny and smart little girl and thankfully, no signs of any of the risk factors as a result of her prematurity. I hope there are more doctors like your friend to help especially the underpriveleged parents care for their preemies. Thanks!

Emer Camaya
Proud parent of Iya (http://onlittlefeet.blogspot.com)