Lana Part 3 - She's Smaller Than We Thought

The C-section all happened pretty quickly, and aside from the unsettling sounds of metal tools clanging, the procedure went well. We knew that Lana was going to be small since she is being delivered over 2 months ahead of schedule. The neonatologist who was taking care of Lana gave me a gentle nudge and said, “We knew she was going to be small, but she’s smaller than we thought”.

So at 5:13pm that afternoon, Lana Jane was born, weighing in at 1-lb 7 ounces. I honestly didn’t know much about premature babies at the time, but I soon learned that she is actually categorized as a “micro preemie”, because she weighed less than 800 grams (1-lb 12 ounces). The neonatologist also sat me down and went over the long list of possible complications to expect, survival rates, and all the other things that you don’t want to hear about your newborn baby.

  • Respiratory distress syndrome (RDS): Most micro preemies (about 85%) have difficulty breathing after birth. RDS is treated with respiratory support and medication.

  • Patent ductus arteriosus (PDA): Just over half of micro preemies have a PDA. A PDA is a persistent connection between the large vessels near the heart. The connection is normal for a fetus, but should close when a baby is born and begins to breathe. PDAs are treated with medication or surgery.

  • Sepsis: Premature babies are prone to infection for several reasons. Micro preemies have immature immune systems and face many invasive procedures in the NICU, each of which can allow bacteria into body. About 40% of micro preemies need antibiotics to treat bacterial infections.

  • Intraventricular hemorrhage (IVH): IVH is bleeding into parts of the brain. Micro preemies have fragile blood vessels in their brains, and these vessels can rupture easily. About a quarter of micro preemies have serious IVH. Most cases of IVH resolve on their own, but some babies may need surgery to help drain the extra fluid.

  • Retinopathy of Prematurity (ROP): The blood vessels in a micro preemie's eyes are not fully formed at birth. When the vessels develop, they may grow so rapidly that they damage the retina. Just under 15% of micro preemies develop ROP, which usually resolves on its own. Surgery may be required in severe cases.

  • Necrotizing Enterocolitis (NEC): Because micro preemies have immature digestive systems, their intestines are susceptible to infection. In NEC, the linings of the bowels become infected and begin to die. About 7% of micro preemies develop NEC, which can be extremely serious. NEC is treated with IV fluids and medication. Surgery may be required.

  • Cognitive problems: Developmental delay, trouble in school, and other cognitive problems are common effects of prematurity. About 20% of micro preemies have severe cognitive disabilities by age 8, and another 20% have mild to moderate cognitive problems.

  • Cerebral palsy: About 10% of micro preemies have moderate to severe cerebral palsy.

  • Chronic lung disease: About half of micro preemies need oxygen at NICU discharge. Micro preemies may also have asthma or other respiratory problems, including bronchopulmonary dysplasia, or BPD.

  • Digestive problems: Micro preemies are prone to digestive problems such as GERD, food refusal, or poor feeding.

  • Vision or hearing loss: Between 2% and 3% of micro preemies have permanent vision or hearing problems due to complications of prematurity.

On top of that, he told us that Lana will likely be in the NICU for at least a few months. If things go well, then she might be able to go home on her expected due date. If not, it may take even more months. He was also careful to reiterate that ups and downs are to be expected. She will have her good days and she will have some bad ones. “It will feel like you take one step forward, and then two steps back”, he continued. We knew we were in for a long ride.