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.

Lana Part 2 - 28 weeks & 5 days

The nurse practitioner informed us that the hospital visit will only be a one-hour observation. They want to make sure that Kelly’s BP would not stay elevated, and also to see if Lana is being affected. Our prior ultrasound showed that Lana is a tad smaller than expected. However, they also said the same thing about our first daughter, Hailey. In fact, Hailey weighed barely over 5 pounds when she was delivered at full term.

One hour, turned into two hours. Kelly’s BP was still pretty high and they decided to administer a beta blocker (Labetalol) to see if it would respond. Another 30 minutes went by, and by then, her BP has started to trend downwards. We were all smiles, and thought we would soon be ushered out of the hospital.

It was at this point when our nurse, Sherita, noticed something on the monitors that would change any hopes of leaving the hospital that day. “I don’t like how that looks like”, she said to herself. She explained to us how Lana’s heart rate would decelerate randomly.

These decelerations are usually seen when the mother is having uterine contractions - except we’re only 28 weeks & days into our pregnancy. Another possible reason for the decelerations is that Lana isn’t getting enough blood flow via placental exchange. Which means she isn’t getting the oxygen she needs (intrauterine growth restriction).

Our doctor said that the plan is to keep Lana in the womb for as long as possible assuming that she is getting enough oxygen and nutrition. At the time, her decelerations didn’t occur too often and he advised us that Lana staying inside for a few more weeks is a good (and also probable) scenario. He said to stay put in our room for a little longer to make sure it doesn’t occur more frequently, and so we did.

Less than 30 minutes after last speaking with our physician, he comes barreling through our hospital room. We thought we had at least a few more days to at least give her time to grow and mature. However, that clearly wasn’t going to happen based solely on our doctor’s concerned facial expression. He stated that Lana’s heart rate has been decelerating more frequently in the last half-hour than it ever did the whole time we were there. Essentially, if we waited any longer, Lana probably wouldn’t have made it through the weekend. “It’s time to have this baby!”, he declared.

And with that, Kelly was whisked away to another room, and I was wrapped with a surgical gown by 2 nurses working almost in unison. One of them asked me what my name and date of birth was. I was only able to answer one of her questions, and that was because I had my work badge on.

Lana Part 1 - Just a Follow-Up Visit

Like numerous other pregnancies, sometimes a lab result or an ultrasound comes back outside of the expected normal limits. What typically happens next is to repeat the test a few days later to rule out other confounding factors. This was just a follow-up visit… or so we thought.

Friday - August 14 2015
Earlier in the week, Kelly made her routine monthly visit to her Ob-Gyn (we were approximately 28 weeks pregnant). They wanted her to return a 24-hour urine sample since they found a small amount of protein in her urine, and also because her blood pressure had been slowly trending higher. I assumed they suspected pre-eclampsia, which occurs in roughly 3-4% of pregnancies in the United States. Pre-eclampsia not managed properly can lead to eclampsia and cause to strokes and seizures for the mother, and may cause distress to the baby due to reductions in blood flow.

Kelly dropped off the urine sample and started driving to work. I asked her if the doctor’s office mentioned anything about her blood pressure and she said no. I became concerned because I’ve always known that Kelly tends to be on the lower side of normal with regards to her blood pressure (more on that below). So when her blood pressure readings remained high (the American Heart Association states that a normal blood pressure should be less than 120/80 mmHg), I decided to call the office myself. The receptionist put me on the phone with their nurse practitioner and it went like this:

Me: “My wife just left your office. I was wondering if you were planning to give my wife any medications to manage her blood pressures?”

NP: “Well I see that her BP has been progressively getting higher, but no we didn’t give her anything.”

Me: “Well her BP was 150/105 this morning at your office…”

NP: “Oh yes. You’re right. I see that here. What is her baseline BP?”

Me: “105/78…”

NP: “Oh… I see… Can you tell her to turn back around and head to hospital for observation?”