Angles In the NICU

 Do you believe in Angels?

“How can you believe in God in a place like this?” Asked Dr. Juan. He was referring to the number of deaths particularly prevalent in the NICU that month.

I immediately replied, “How can you not?” referring to the hope and miracles and love that never died. It was 07:30, time for morning rounds to begin. Dr. Juan flashed me a smile - what a philosophical way to start the day.

The US preterm birth rate peaked in 2006 with 12.8% of babies born before 37 weeks. To meet the demand, many NICU’s in the 90’s and 2010’s were large, open spaces able to accommodate up to eighty (sometimes more) babies, and all the equipment and machinery that went with those babies. They were noisy, hectic, places. At best, they were controlled chaos. With staff rushing to emergent deliveries, or to resuscitate a critically ill infant, the NICU was an overwhelming environment to most people. There were cardiac and respiratory monitors, ventilators, IV pumps, blood transfusion pumps, tubes winding in and out and around an infant, and large banks of screens filled with numbers reflecting the physiologic status of each baby. IV lines, which were so thin they were nicknamed spaghetti lines because they resembled angel hair spaghetti, hung from IV bags and threaded into tiny preemie veins. The noise of alarms emanating from monitors was obtrusive. Some of the beeps signaled a healthy heart rate, other alarms screaming out that a baby’s heart rate was dangerously low and needed immediate attention. Only the experienced staff could accurately discern which alarm was a true emergency, and which was merely a benign warning. On rounds, the decibel level grew exponentially as nurses, doctors, pharmacists, respiratory therapists, nutritionists, and social workers all crowded around each baby’s incubator and discussed a plan of care. Add to that the secretaries on the phone, raising their voices to be heard over the din of the unit. If you were to stand anywhere in the NICU amidst all the cacophony, you would feel a full-on assault of your senses. And in the midst of this maelstrom, lay little babies trying to survive.

Life and death hang together in the air of the NICU with a razor-thin line between the two. As long as life is still in the race, there is hope. Hope is something every parent clings to and is impossible to steal away. Babies, so woefully close to death, are blessed with parents who hold out hope until their last breath.

But on the flip side, miracles happen. Miracles are born every day, born to fight and survive the unlikely odds of extreme prematurity. Countless times I’ve seen babies on the brink of death, turn around and make a heroic comeback. It’s enough to sound the music to Chariots of Fire.

Despite all the scientific knowledge, discoveries, technological advances, and ongoing research, still some babies live, and some babies die.

Thirty-five years ago, a groundbreaking drug became available that would forever change the lives of preterm babies. In 1990, Beractant, (trade name Survanta) came on the market. This miracle drug for preemies was as much a game changer as the polio vaccine was in 1955. Survanta provided premature lungs with all the phospholipids, triglycerides, fatty acids, and proteins that a preemie set of lungs was missing.

Before this, premature babies frequently died from Hyaline Membrane Disease, a disease of immature lungs. John and Jacqueline Kennedy had a child who died in infancy from Hyaline Membrane Disease. In 1991, our NICU was testing Survanta against a placebo in a double-blind randomized controlled trial which was the gold standard in scientific research.

Kyle, a baby born at 27 weeks, was entered into the study with the parents' consent. He was blindly randomized into one of the two study groups – there was a 50% chance that Kyle would receive the experimental drug and a 50% chance he would receive the placebo, and nobody would know which one he received.

Once a preemie survives the first week of life and then the first month, the focus of care becomes preventing morbidities such as blindness, deafness, cerebral palsy, and developmental delay. It takes a full team to guide an infant through the years of surviving prematurity – a team of parents, nurses, doctors, caretakers – and angels.

Kyle survived. Did his angels have a hand in helping him to receive the real drug and not the placebo? Not only did he survive, but he grew up to live a full life. He works as a computer programmer and is married with a child. He’s skinny and wears glasses, the only two indicators that he was a former preemie. How can you not believe in God?