Parents hope, pray after baby arrives too early and so tiny

Premature births are skyrocketing. Nearly a half-million babies in the U.S. were born prematurely in 2003 — a 33 percent increase since 1981, according to the March of Dimes.

In half of the cases, the cause is unknown. But often, there's a frightened family behind the cold statistics.

Lori and Brandon Dow were filled with hope as they prepared for the birth of their first child. Then came the fears — first for Lori's life and then for the future of their son — when the pregnancy went wrong and Aidan arrived weighing a little over a pound.

This is their story.

Lori and Brandon Dow gaze at their newborn son.

It's the week before Christmas, and the first-time parents decorate their Redmond home with flickering lights and velvet stockings. Brandon jokes about 4 a.m. feedings, while Lori cradles Aidan in her arms.

She smiles at her baby, as if they inhabit a private universe.

She holds him carefully, so as not to press against the thin, white tubes taped to Aidan's cheeks, tubes that run from his nose to an oxygen tank in the corner.

"Mommy's got you"

Lori does everything right to prepare for this baby.

Before she gets pregnant in February, the 34-year-old works out six times a week, takes prenatal vitamins and boasts the resting heart rate of a top athlete.

She sails through the first half of her pregnancy. But Aug. 19, at 26 weeks along, Lori's blood pressure spikes. Doctors at Evergreen Hospital Medical Center in Kirkland run a panel of tests.

They discover she suffers from a severe form of preeclampsia, a pregnancy-induced condition that causes hypertension and restricts blood and nutrients to the fetus.

In the United States, preeclampsia occurs in about 5 percent to 8 percent of pregnancies, according to the Preeclampsia Foundation. There's no single explanation for its cause. Research indicates that genetics or the way some women's immune systems react to pregnancy may play a role.

Lori's particular condition — known as HELLP syndrome — is rare and dire. Women with her disorder form blood clots in the placenta. Her liver is at risk for rupturing. Ultrasounds reveal that Aidan's growth is weeks behind what it should be.

"He's being robbed in there," Lori says.

A normal pregnancy lasts about 40 weeks. Lori is 14 weeks from her due date. If she delivers now, the baby's chances for making it are about half, doctors tell her. Every day she keeps him in utero adds 2 to 3 percent to his survival prospects.

Doctors order strict bed rest at the hospital. Lori, a part-time fitness instructor, swallows pills to control her hypertension. Shots of blood thinners are injected into her stomach. A fetal monitor is strapped to her belly. She forces down three high-protein meals and a gallon of water every day to pass more nourishment through her damaged placenta.

She feels the baby flutter inside.

"No worries, Biscuit," she tells him. "Mommy's got you."

Tiny Aidan arrives

The pain comes unexpectedly.

It's Aug. 30, and Lori's liver begins to enlarge. A sharp ache knifes at her side and grows worse by the hour.

Dr. Dan Gavrila, her perinatologist, sees signs that Lori's liver enzymes are elevating at a rapid rate. If he waits for lab tests to confirm his suspicions, her liver could burst, and mother and baby could die. Delivery is the only option.

He enters Lori's room in scrubs.

"Tonight's the night," he says.

Her heart falls. The baby is just 28 weeks along.

She's wheeled into the operating room at 3 a.m. and put under general anesthesia. Brandon waits outside.

At 3:24 a.m., Gavrila pulls the crying baby from Lori's womb.

They measure him: 12 inches.

They weigh him: one pound, five ounces. He is the size of a baby born at 24 weeks.

Lori moves into recovery, and Brandon follows the doctors and nurses as they wheel Aidan in to the neonatal intensive-care unit (NICU).

They scramble to get oxygen to him. They poke his skin looking for vessels to start an IV. Finally, a line is snaked through a vein in the stump of his umbilical cord.

Brandon hangs back in the darkened room as the team works. He has read the statistics for babies born this size. He understands how underdeveloped their organs are, how their tiny lungs labor for each breath. The next 24 hours will be telling. Doctors will monitor Aidan closely for signs of brain hemorrhaging and any drop in his heart rate.

Brandon watches Aidan, pink as a slice of salmon, thrash around his feathery limbs. The pride of a new father swells inside him.

This is my son, he thinks.

Another thought looms: Is he going to make it?

Mom's first embrace

Lori awakens from surgery groggy and sore.

Doctors have put her on a drip of magnesium sulfate to prevent seizures after the delivery — a possibility with preeclampsia.

Pain shoots through her torso like fire, but nurses gently insist she get up so her muscles don't atrophy and her blood doesn't clot. Plus, they say, she needs to pump breast milk for the baby.

Fifteen hours after delivery, Lori lays eyes on her son.

The Isolette where Aidan sleeps is enclosed by plexiglass. Wires pop out of him at all angles. A knitted cap keeps his head warm, and a preemie diaper hangs off his frame.

"I can't believe something that tiny was kicking me so hard," she says. She reaches through a hole in the covering and touches her index finger to his foot.

Four days later, Lori is discharged from the hospital; she and Brandon will go home without their son.

Before they leave, Kathi Kinsella, one of Aidan's primary nurses, has a surprise.

She tells Lori to undress from the waist up and sit in an armchair. Kinsella picks up Aidan from the Isolette, secures his ventilator tube and hands him to Lori.

Slowly, hesitatingly, the new mother holds her baby against her chest for the first time. She feels his skin melt into hers. She inhales the sweet puff of his blond hair.

She closes her eyes, listening to his breaths.

Caring for preemies

Aidan is the third-smallest patient admitted to Evergreen's NICU.

The 26-bed nursery opened in 2002 and is classified Level 3 — a place where sick and premature infants spend days to weeks gaining strength before they're healthy enough to go home.

The increase in premature births is an alarming trend. Some risk factors include multiple births, advanced maternal age, smoking and diabetes. But in half of all cases, the causes are unknown. The March of Dimes, a nonprofit focused on preventing birth defects, has launched a $75 million campaign to research the phenomenon.

Infants born early are vulnerable to a host of lifelong disabilities, such as cerebral palsy, mental retardation, blindness and deafness.

Prematurity also takes a financial toll. An average hospital stay for infants born too soon or too small costs $77,000, compared to $1,700 for a birth without complications. Lori and Brandon estimate that their four-month hospital stay — covered by insurance — cost upward of $400,000.

Doctors say strides in drugs and technology — such as incubators, respirators and artificial substances to help inflate lungs — have dramatically boosted the survival rate for babies like Aidan and others born even smaller.

"It still blows my mind," said Dr. Stephen Chentow, neonatologist and director of Evergreen's NICU, who has delivered preemies since the 1970s.

He has tended to babies weighing hardly a pound. Some develop learning disabilities or chronic lung disease, he said. Others escape unscathed.

The fragility of these patients hovers in all corners of Evergreen's NICU. Visitors must pass through locked double doors and answer questions at the front desk about recent colds or flus.

A medley of alarms and beeps comprise the music on this floor. Babies are hooked to a wall of high-tech life-support machines, oxygen tanks and ventilators in private rooms. Some wear sunshades to shield their eyes from heat lamps. The dark, cocoonlike atmosphere of each room protects the preemies from overstimulation.

Nurses hustle from room to room, insert needles in microscopic veins, adjust feeding tubes and check blood oxygen levels. They lay their palms on tiny backs to feel for fluid in the lungs. They watch the babies' body language for signs of distress.

Most babies here eventually make it home; some don't.

"You hope and pray"

It has been one month since Aidan entered the NICU.

He has gained weight; a sign congratulates him for reaching 2 pounds. Doctors assure Brandon and Lori he's making progress.

Still, the couple struggle to be parents. How do you comfort an infant attached to a web of tubes? How do you care for a baby living behind a shield of plastic?

"It seems like you're slowly climbing uphill," Brandon says. "It's almost like you're climbing Mount Everest, and the higher you get, the more difficult it is, and the less oxygen there is.

"You thank God that everything has turned out the way it did. But you also realize that you're only really halfway up the mountain. You hope your wife isn't going to have any permanent liver damage. You hope your son isn't going to have any long-term issues."

"You hope and pray. You hope and pray."

Kinsella can spot the fear a mile away. It's that look in the eyes of parents facing the mortality of their child. She has been an NICU nurse for almost 32 years but also sees her job as empowering parents to care for their babies. She teaches them how to change a diaper 2 ½ inches long. She helps them bathe their infants in tubs no wider than a phone book. She demonstrates how to caress babies ultra-sensitive to touch.

"Inside, you think, this can be a family. This has possibilities. This is meant to be."

She has seen her share of infants struggle and die. But sometimes a newborn will stir something inside her, and she volunteers to be that preemie's primary nurse. It was that way with Aidan.

"There was a sparkle to him," she says. "He communicated that he was going to be a survivor."

Ready to go home

It's the day before Thanksgiving.

Lori and Brandon sit in Aidan's room at the NICU.

Room 132 has become their second home. Pictures of the couple's trip to Italy hang on the bulletin board, and Lori keeps a laptop and a collection of preemie books next to the bed.

She and Brandon have taken leaves of absence from their jobs and spend 10 to 12 hours a day at Evergreen. Part of that time is devoted to "kangaroo care": snuggling with Aidan, dressed only in a diaper, against their bare chests. The contact promotes bonding, and Aidan instinctively curls up against them.

At 6.2 pounds, their son has become a champ at eating. His next goal is to take 16 ounces of breastmilk in one day, and he's already halfway there.

Aidan will be ready to leave in two to three weeks. Lori is surprised that she feels sad.

"These nurses have become like part of our family," she says.

Postscript

The new year has passed, and a quiet afternoon rain falls against Lori and Brandon's home. A baby's cry rings inside.

Three weeks after leaving the hospital, mother and father are settling into a routine of feedings and doctors' appointments. There are no more monitors, no more nurses to rely on. Aidan sees a physical therapist and a pediatric pulmonologist who watches the recovery of his lungs, damaged from months on a ventilator.

It's unclear at this point what long-term scars Aidan might bear, but doctors are encouraged by his progress. He's up to 9 pounds and should be off the oxygen tank by February, though he'll need to remain somewhat isolated from people because he's so susceptible to colds and other viruses.

Brandon will go back to work at Microsoft next month. Lori plans to stay home with Aidan for at least a year.

"I can't leave him now," she says. "Everything is just beginning."

Sonia Krishnan: 206-515-5546 or skrishnan@seattletimes.com

Preemie units
The boom in premature births has given rise to high-tech, neonatal intensive-care units (NICUs) in hospitals around the country — including eight in the Puget Sound region. These units have helped dramatically boost the survival rate for these babies. Here are the area hospitals with high-level NICUs:
City	Hospital
Bellevue	Overlake Hospital Medical Center
Everett	Providence Everett Medical Center
Kirkland	Evergreen Hospital Medical Center
Renton	Valley Medical Center
Seattle	Children's Hospital & Regional Medical Center Swedish Medical Center/First Hill campus University of Washington
Tacoma	Tacoma General Hospital
Source: Washington State Department of Health, certificate of need program