When my wife, Diana, went into labor 12 weeks early, I was out of town. On the stunned, early-morning ride to the airport in Baltimore, I was certain our child would either not survive or that the complications would be too severe to imagine. Fending off the grimmest thoughts, I rehearsed writing to loved ones to explain what had happened.
But while I was still in the car I received a call from my father-in-law at Cambridge Hospital, first congratulating me on the birth of my son and then informing me of a “best-case scenario.’’ The baby had received a high Apgar score - a rating of overall infant health - and weighed 3 pounds, 2 ounces, in the 90th percentile for his gestational age. Diana’s father also mentioned the figure 80 percent, which I would later learn referred generally to survival for babies born at 24-32 weeks.
My response to the upbeat call was disbelief. How could an event so out-of-order, so unforeseen, end well?
FRAGILE BEGINNINGS: Discoveries and Triumphs in the Newborn ICU
But, as Dr. Adam Wolfberg explains in his book, “Fragile Beginnings: Discoveries and Triumphs in the Newborn ICU’’ - a page-turner for any parent of a premature infant - today’s enhanced prospects for preemies are grounded in an array of scientific advances. And the successes are well documented. According to one study, the mortality rate for infants born at 28 weeks fell from 70 percent in 1958-1968, to 10 percent by 1988.
Wolfberg’s book begins with the deeply personal story of his daughter, Larissa, who was born at 26 weeks in January 2002, weighing just shy of 2 pounds, and alternates with a broader discussion of recent innovations in care for premature infants. A medical resident at the time of Larissa’s birth, Wolfberg is now a physician specializing in high-risk obstetrics at Tufts Medical Center.
Wolfberg writes that a pivotal case in the modern quest to improve outcomes for premature babies was that of Patrick Bouvier Kennedy, the son of President Kennedy who was born at 34 weeks in August 1963 and survived only two days after developing respiratory distress syndrome, a condition routinely treatable today.
Since then, advances have included the creation of separate hospital units for preemies, along with improved methods of feeding intravenously, more sensitive regulation of oxygen - a cause of blindness when given too liberally - and the discovery of surfactant, a naturally occurring product whose absence in preemies can lead to lung collapse.
Premature infants have also benefited from renewed attention to neuroplasticity, a concept first proposed by the psychologist William James in 1890 and according to which neurons have the “remarkable ability to reassign tasks from an injured area of the brain to a healthy one.’’ On this count, Wolfberg pays homage to researcher Jason Carmel, whose twin brother was paralyzed below the chest after a swimming accident and whose work now focuses on ways to restore spinal function and sensation to injury patients.
Having suffered a serious brain bleed at birth - common in early preemies - Larissa was assessed to be at risk for “universal movement impairment and a very high likelihood of diminished intelligence and cognitive function.’’ But her impressive development would defy the bleak prognosis. By age 8, aided by intensive therapy and her family’s medical knowledge and access, she faced only one hindrance - limited movement in “Righty’’ (her right hand) - for which she traveled to Birmingham to participate in “a seriously intense and uniquely effective therapy program’’ at the University of Alabama.
To look at our own son now, you would never know he’d spent two months in the Tufts Neonatal Intensive Care Unit before we drove him home on a snowy Wednesday morning a little more than a year ago. The science, as accessibly outlined in Wolfberg’s book, validates this outcome. But when Diana and I look toward Eli’s future development, and then back at the rupture of his sudden arrival, we cannot help feeling the chill of the unknown.