By Steven Clark
At first, Jocelyn Colon tried not to grow too attached to her newborn son, who “had tubes coming out of every part of his body.” After all, as she had been told, the one-pound baby she had delivered after a 25-week pregnancy “wasn’t supposed to make it past two weeks.”
Thanks, however, to doctors and staff at the Neonatal Intensive Care Unit (NICU) at SBH, and, quite possibly, to an assist from above, the preemie she named Javis beat the odds. Today, her son is a happy, social, and active nine-year-old in the fourth grade who, as his mother will attest to, “eats like a big boy and is not scared of anything.”
This was very different from when Colon, 29 years old at the time, gave birth at St. Barnabas Hospital on May 25, 2010, nearly four months prematurely. Weeks earlier her doctor had recommended an abortion because it had become evident that her pregnancy would not go full term because of a short cervix. “And they told me that if he did live, he would need a lot of surgery and wouldn’t be a regular kid,” she says.
Although he never did require surgery, Javis needed a blood transfusion during those early days in the NICU. His white blood cells dropped precipitously. He suffered from frequent infections that forced doctors to isolate him from the other babies. And he nearly died when he stopped breathing. But every time there was a crisis, the NICU staff pulled him through.
During the 15 weeks he stayed in the NICU, his anxious mother took up residence in the unit, sleeping several days a week outside her son’s incubator.
“Everyone was amazing. Someone was always there, playing with him, feeding him. The dedication, the love. They cried with me and gave me support,” remembers Colon. “The nurses worked overtime to just sit next to me and make sure I did the right thing. They took time and care of my son as if he were one of their kids. My son would not be here if not for them.”
Dr. Lazaro Lezcano, director of Neonatology at SBH, who started the program 21 years ago, has memories of many children like Javis, preemies who barely weighed as much as a small bottle of water and faced multiple hurdles for survival. (In fact, three years ago, during the hospital’s 150th anniversary, about 75 parents and children came to SBH for an emotional NICU reunion with their doctors and nurses. More recently, he and his team treated for months the newborn of a young man who himself had been a preemie under Dr. Lezcano’s care in the NICU many years before.)
The hospital’s level 3 NICU – level 4 is a regional perinatal center – treats about 15 percent of all babies delivered at the hospital. These infants may stay anywhere from 15 weeks (for a preemie like Javis) to a couple of days for those who may be in need of antibiotics or suffer from jaundice.
The more acute preemies typically stay through what would be the 40-week gestation period (for example, a child born at 32 weeks would likely stay eight weeks). As these babies tend to have respiratory issues, many are placed on mechanical ventilation. In addition, the medical team places many preemies on Total Parenteral Nutrition (or TBN), an intravenous solution of protein, fat, and carbohydrates. This solution provides such nutrients as calcium, phosphorus, and iron to replace what the mother’s
body is unable to pass to her baby.
The NICU staff routinely screens the premature newborns for intracranial hemorrhages and eye problems, both of which are common within this population. A sonogram of the head determines the grade of hemorrhage. “While it is obviously better if you don’t have any bleed at all, with grades one and two the prognosis is usually good,” says Dr. Lezcano. “Grade 3 is 50/50 and grade 4 is usually a bad prognosis.”
Depending on the gestational age, infants are usually screened for visual issues at four to eight weeks by a retinal specialist. Laser surgery, in some cases, may be recommended. Retinopathy of prematurity (ROP) causes abnormal blood vessels to grow in the retina. When blood vessels grow abnormally and randomly, they become fragile and tend to leak or bleed. This causes scarring of the retina. When the scars shrink, they pull on the retina, causing it to detach from the back of the eye, a major cause of blindness.
The goal of ROP surgery is to stop the growth of abnormal blood vessels by focusing treatment on the peripheral retina (the sides of the retina) to preserve the central retina (the most important part of the retina). ROP surgery involves scarring areas on the peripheral retina to stop the abnormal growth and eliminate pulling on the retina.
Many preemies during their early months of life are susceptible to Respiratory Syncytial Virus (or RSV), a severe infection which can cause pneumonia or bronchiolitis during certain times of the year (October to March) and lead to serious complications and re-hospitalization. They receive a monthly injection of the drug palivizumab for six months to prevent the chances of wheezing and asthma.
To help premature babies recover from Respiratory Distress Syndrome (RDS), neonatologists place a tube in the infant’s trachea as a means to surfactant replacement therapy. This keeps the alveoli from sticking together, and is supplemented with oxygen or ventilation to help the baby breathe. The majority of preemies recover from RDS without major complications.
Dr. Lezcano never intended to dedicate his life to a specialty that keeps him on call every third or fourth night (as one of four neonatologists at SBH who provide the NICU with 24/7 coverage).
“The first time I ever rotated through the NICU as a pediatric resident, I said I would never do this because of all the alarms going off and the fact that you had to wear gowns back then and it was hot in there,” he says. “And then after the first month of rotation, I knew this is what I wanted to do because of the acuity of the babies and how they often get better. Most of them are very sick and yet do well. It’s been very rewarding.”
This includes children like Javis who, according to his mother, loves his rice, beans and chicken, as well as soccer, karate and dancing. Colon and Javis return regularly to the NICU to treat the staff to pizza and express their thanks.
“He comes in as if he knows me his whole life and he hugs me,” says Dr. Lezcano, who produces a photo of Javis, dressed in raptor costume from a recent Halloween. “We stay in touch. It’s a reminder that he beat everything and today is a normal kid.”