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12/08/2004

How is Charlie?

Some of you have asked how Charlie is. The following is a jargony, preemies-for-dummies way of saying that Charlie is doing very well.

Our immediate concern was his breathing. At almost 30 weeks, without time for a course of steroids, without some condition of stress that might have hastened their maturation, and with the complication of gestational diabetes, his lungs were still nowhere near maturity.

Charlie had RDS, respiratory distress syndrome, the term for breathing difficulties caused by a lack of surfactant. A baby's body naturally produces this substance, which holds lung passages open, preventing them from collapsing upon exhalation, but not until the last few weeks of pregnancy. These days, most babies with RDS survive. Since the introduction of exogenous surfactant in the late '80s, survival rates for premature babies have increased dramatically. Natural forms of the substance are derived from cows and pigs; while a synthetic version is also available, Charlie was introduced to the many delights of pork in the very first days of his life.

While two doses of surfactant are the normal course of treatment, it just wasn't enough for Charlie, who needed another hit. And while he'd started out on room air, which is 21% oxygen, it quickly became apparent that he needed more assistance. His oxygen level was increased as high as 37% during his first two days.

He didn't need the full support offered by a ventilator, but he was started on CPAP immediately. CPAP stands for continuous positive airway pressure, and is a fairly benign form of respiratory assistance: a baby on CPAP initiates every breath himself, while the pressure of the machine keeps his airways open as he exhales. The pressure is delivered via a tiny snorkel-like affair with two prongs that fit into his nostrils.

(For the record, Charlie has somehow come to the fervent and unshakeable belief that the snorkel sucks ass.)

Charlie also had a heart murmur caused by PDA (patent ductus arteriosus), a condition common enough in premature babies that 40-50% in his age bracket will have it. While a baby is still in utero, a large blood vessel in the heart remains open; it's expected to close within the first few days after a full-term birth. For premature babies with distressed lungs, it's important to get the vessel closed to avoid extra strain on the heart. Treatment with a drug called indomethacin can generally close the vessel, and if that doesn't work, it can be surgically closed.

Evaluations and treatments were all taking place on Sunday, while I was only vaguely aware that it was happening. I've lost most of that day, except for memories of my mother's arrival and my visit, at last, to the NICU. I was to be moved out of labor and delivery late Sunday night, so on the way to the regular maternity ward, my bed was carefully steered into the NICU so I could see Charlie.

I didn't see much. My bed was too low and I was too busy crying. But I could see his tubes, his wires, and the bright glare of the phototherapy lights being used to combat jaundice. I could also see he was alive. I was scared that night, more scared than I've ever been in my life, but that fear has receded as the days have passed. The joy almost always eclipses it.

Charlie has steadily improved. After medication for PDA, his heart murmur seems to have vanished. He hasn't needed supplemental oxygen in days. He's still on CPAP most of the time, but he's being kept off it for longer and longer at a stretch — today he was off for almost five hours, his longest time yet. He's had his first bath, his first bowel movement, his first taste of milk. He's worn his first scaled-down onesie, and is kept company in his isolette by his first stuffed animal. Paul and I hold him. We pretend his involuntary grimaces are smiles.

He is small and thin but fast closing in on his birth weight. He is a well-oxygenated pink, furred here and there by a long, light down. His head is perfectly round and fuzzed with a brown lighter than Paul's or mine. His ears are the size of my thumbprint. His foot is shorter than my pinky. He has the smallest human reproductive organs I've ever seen.

We've started to think he's cute.

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