Wednesday, March 16, 2011
My world, a nursery tour by phone photos
This is the Special Care Nursery, a.k.a. the NICU. 15 to 18 beds, or rather cots and incubators, mostly full of babies, about 9 monitors, two or three nurses, a handful of nursing students, an intern, a paeds resident, moms, and me. This is our tiniest baby at the moment, 790 grams. She's being assisted in her breathing with "nasal bubble CPAP", a flow of air mixed with oxygen under pressure. She's up to a whopping 3 cc of feedings every two hours. The smallest baby to survive here, so far, is about to go home. She was born at 620 grams and is now close to 2 kg. This baby came from another hospital on Monday, and almost died in the first hour. He has severe congenital heart defects. I spent a good part of today negotiating a way to get him to the national referral hospital, Kenyatta. Jaundice is very common here. This baby came with dangerously high bilirubin levels, being treated by phototherapy. The blue light emits a wavelength that isomerizes the bilirubin in the blood into an excretable form. I always think the babies under lights look like sunbathers on the beach. This little pumpkin was born today two months early, because his mom was very ill with pre-ecclampsia . Due to a lapse in communication we were not called to the c-section until the baby was out, and arrived to find the infant blue, cold, wrapped with a small scrap of cloth, with a faltering heart rate and no breathing. I made a split second decision to grab the baby and run to the nursery for a functional heating bed and oxygen . . . no one stopped me, so off I went. Once we had bagged some life into the baby he looked great, and I went back to find out who he belonged to . . Baby Pauline's mom is 23 years old, and after she delivered her preemie she did not recover normally, but lost weight and was weak. It turned out that she has extensive, incurable stomach cancer. This young woman can barely get out of her bed, but shuffles to the NICU to visit Pauline. And manages to encourage our faith on the way, reminding us that God is in control. This is the cutest baby in the nursery, born to an HIV-positive mom. In Kenya the national policy is to treat all babies as long as they are breast-feeding, so this child is on an anti-retroviral medication and has a good chance of escaping infection. Precious is aplty named. She was admitted severely dehydrated with a sodium of 200 (! really!) and in kidney failure (Cr of 9). That was several weeks ago, note her thoughtful pose as she contemplates her first day off of oxygen. This baby has a rare cleft in the sternum, meaning his heart is covered only by a thin layer of skin and jumps ominously out of his chest as it beats. He has a constellation of heart defects that is probably not survivable, but we're trying to get him to a place where he can be helped as well. Paediatric resident Dr. Allison speaks with the parents of a newly admitted baby today. I am very thankful for her, and Dr. Sheila our hard-working intern! And the nurses who are very skilled in the care of sick and tiny newborns. I'm learning a lot from all of them. The moms come to feed their babies every two hours. For most this means squeezing out their breast milk and filling a syringe to feed the baby through a nasal-gastric tube. These women don't ever get more than an hour or so of sleep. They "board" in a section of the maternity ward next door. The same place I stayed when Caleb was born. That's a brief tour. Every day we listen to these babies breathe, feel their abdomens, calculate their fluids in cc/kg/day, order labs and xrays and ponder the results, titrate antibiotics and vitamins and oxygen. Several times a day we're called to attend the birth of a high-risk new baby, which is often just a happy moment of drying off a crying newborn. . . but occasionally becomes an all-out struggle to give life a foothold.