.....And Two Become Four

'You have a real NICU again all of a suuden', a friend exclaimed last week, when Baby Boy arrived. Suddenly, I had three medically fragile neonates in my care.

Well, Baby Boy lived less than a day and a half, and then, regretfully, three were two again. Applying the 'rule of three's' my friend and I surmised that no more premature babies were likely to be admitted for a while.

Last night brought news. In Cite Soleil, an 800g baby, almost three weeks old, was clinging on to life at home. She had been discharged from St Catherine's Hospital with an NG tube that her mother was struggling to manage. My heart sank. The baby weighed less than 2lb. Since she had survived this long, I assumed that she wasn't extremely premature, but she had to be severely malnourished and severely malnourished newborns tend not to survive.

As I finnished preparing the NICU for Louna, we admitted a 6 month old baby boy. Mario's Mother died 2 months ago. It was immediately obvious to us, looking at his puffy cheeks and peeling skin, that he had been in the care of a father without any real social support network, since his mother had passed away. Mario's father didn't have the knowledge or the means to nourish this fast growing baby, with high energy and protein requirements.

Mario is swollen due to Protein-Energy-Malnutrition, also know as Kwashiorkor. Low levels of protein in Mario's blood have caused fluid to leak out under his skin. 'No, he is not puffy,' the father insisted, 'that's just his shape, he's got a big round face!'

Hearing this I gave thanks inwardly, that his Father had decided to bring Mario here when he did. Like many people, Mario's fahter does not understand that his son is malnourished and in a critical condition. Over the next two weeks, we will attempt to re-nourish this child. We pray that Mario will stabalize. We need to see his weight go down as fluid moves out of his tissues and leaves his body. This will be a very fragile period. We pray that the electrolyte shifts will not be too dramatic and that Mario's organs will be able to process nutrients. Unfortunately, his protein deficiency has compromised his immune system and he will be very vulnerable to infection.

Louna arrived with her Mother early this afternoon. We learned that her mother had spent the last three and a half weeks going from hospital to hospital, seeking care for her tiny daughter. Louna was one of a twin, her brother did not survive, and Louna's mother doesn't have any other children. She has been very devoted to her tiny daughter, and has managed to keep her warm all this time. Last night though, the baby was bitten by a rat, and her mother knows that rat bites could make her fragile infant extremely ill.

I soon learned that Louna had been overhydrated. She has fluid on her lungs, which, is making it difficult for her to breath, so I am giving her compressed air through a nasal cannula to make this easier for her. She is also reciving antibitics, because she spiked a fever this morning.

I have estimated her gestational age at 34 weeks, but I am not sure how accurate these assessment will be in a baby who is almost a month old. Usually they are performed soon after birth. A visiting Neonatal Nurse Practitioner is going to do some more in-depth assessments tomorrow. If Louna really was born at 30 weeks, it is trully a miracle that she survived.

So now, two have become four.............