She has delicate fingers, a tuft of dark hair, bright brown eyes and her mother's addiction to drugs.
Mother and child remain anonymous at the insistence of child welfare officials, who plan to place the baby in a foster home -- though that won't happen until she is weaned from methamphetamine and other narcotics, and overcomes a rash of ailments that requires breathing tubes in her nose, monitor wires taped to her feet and 24-hour care.
Her first four months of life in Sacred Heart Medical Center's neonatal intensive care unit (NICU) have been made even more difficult by the consequences of being born two to three months too soon.
Nurses and other hospital caregivers marvel at the fragile tenacity of this tiny fighter, who's dressed in a hospital-issue pink polka-dotted onesie.
"She has had just terrible, miserable respiratory problems," says occupational therapist Margaret Miller, recounting how the infant tries to draw 100 breaths a minute rather than the 40 to 60 that is normal. "This makes it hard for her to ever get a deep sleep or even eat."
Premature babies have higher childhood death rates and are less likely to have children of their own. That makes national reports of more babies born early during the past two years a discouraging trend.
There's this, too: These most vulnerable children are in greater danger of being beaten, shaken and neglected by parents or others entrusted with their care.
A 2006 study published in the Journal of Epidemiology and Community Health determined that the more premature the infant, the more likely he or she would be abused. The findings were based on an eight-year study of 119,771 infants. Researchers entered birth data including names and weight, and then began comparing it against the roster of children on a child protection register. The matches revealed a trend.
"There's a widely accepted connection between special needs children and abuse," said March of Dimes program coordinator Kris Christensen of Spokane. "And that includes premature babies."
Sometimes that's because preemies cry more and are difficult to soothe. Sometimes they lag behind other babies and frustrate parents desperate for simple early signs such as smiles. Also, many premature babies are born to parents coping with poverty or drug addictions and may receive little follow-up care with pediatricians.
Premature babies account for one in every eight births, leading the March of Dimes to declare a national crisis.
Overflowing NICUs at Sacred Heart and Deaconess medical centers provide the anecdotal evidence: More than 110 babies requiring critical care were being treated at the two hospitals during one day earlier this month.
It's a scenario that costs businesses, insurers and parents millions of dollars in medical expenses and lost productivity, and further strains an overburdened social services system.
Most of the 540,000 preemies born in the United States in 2006 will survive and grow up to have good health. Yet studies show babies born earlier than 37 weeks are 15 times more likely to die within the first year of life than infants born full term at 40 weeks. And evidence continues to mount that the 3,100 preemies born in Spokane County from 2002 to 2006 are at greater risk of suffering lifelong consequences, such as mental retardation, cerebral palsy, chronic lung disease and blindness.
"Everyone wants to know why any of this happens," said longtime Deaconess nurse educator Maureen Shogan. "Sometimes we have answers and sometimes we don't."
Abuse is a heartbreaking truth acknowledged by nurses, dietitians, therapists and others in hospital NICUs. While they're nurturing premature babies until they are ready to go home, sometimes they're also protecting infants from unfit parents.
Registered nurse Juanita Parker has been caring for babies at Sacred Heart's NICU for 30 years.
She speaks with pride of many mothers and fathers who are models of exemplary parenting, pointing to a collage of pictures and notes expressing thanks and sharing milestones such as first steps and birthdays.
And she tells dark stories of watching helplessly as babies leave the NICU, "praying with all my heart that when these precious little ones return to us beaten and bruised, that it's not too late."
Nurses watch mothers and fathers interacting with their babies, encouraging good parenting skills and offering gentle yet firm guidance about keeping babies safe and healthy.
They are diligent about documentation, keeping notes on progress and parental interactions and needs. Sometimes, they firmly believe they avert an impending tragedy.
"If parents know they are being watched, they will rise temporarily to meet normal expectations," Parker said. She remembers one couple who gave the impression they would be good parents. They listened, asked thoughtful questions, arrived on time for bottle feedings.
One day their baby was upset, fussy. After cooing about how cute baby was as its crying slowed, the couple pulled the privacy curtains.
Parker was jotting notes nearby and overhead the mother whisper to her baby: "If you act like this at home, I'm going to beat the shit out of you."
That baby didn't go home with the parents.
The alarm of premature births in Spokane doubling from 1994 to 2007 spurred the creation in February of a birth outcomes task force. The membership includes Planned Parenthood, Catholic Charities of Spokane, Deaconess, Sacred Heart, the Spokane Regional Health District, March of Dimes and others. The group hopes to address issues that lead to premature births, such as education about the dangers of using drugs and smoking during pregnancy and the importance of prenatal care.
While Spokane's rate of premature births remains lower than the national average, it is rising more quickly.
Researchers know the causes of prematurity -- smoking, multiple births from fertility drugs, mothers older than 37, mothers in their teens, illegal drugs, poor nutrition, infections, illness and inadequate access to prenatal checkups.
These scenarios, however, account for just half of premature births. Researchers are investigating the other 50 percent and suspect genetics, the environment, pollutants and the effects of poverty.
"It's unknown," said the March of Dimes' Christensen, "but there is data to suggest that ethnicity and socio-economics may play a role."
A four-year-old report from the National Center for Health Statistics found that 18 percent of babies born to black mothers were premature compared with 11 percent of babies born to white mothers, 12 percent to Hispanic mothers and nearly 14 percent to American Indian mothers.
However the rates are rising regardless of ethnicity, despite a national goal of reducing the U.S. premature birth rate to 7.6 percent within two years.
"What we're focusing on now is getting women to think about their whole reproductive lives," Christensen said. "Whether they intend to be mothers or not, pregnancy can happen. It's a reality of where we need to get as a culture."
Nurses, doctors and sociologists worry about stereotyping mothers of premature babies as people who somehow made bad choices.
"That's one of the things that is so hard about this issue. There are moms who did everything right and it still happened," Christensen said. "And sadly, these are the moms who feel so guilty."
Oftentimes women and their doctors make the best out of difficult circumstances.
Teresa Anderson takes prescription painkillers to cope with back injuries. When she became pregnant, she worked with her doctor to strike a balance that cut her dosage yet allowed her some relief from the pain.
Her baby boy, Caleb, was born early and mildly addicted to painkillers. He was weaned from his mother's medications within days and showed all the signs of being healthy, normal and ready to go home in early April.
His father, Stacy Sessions, is proud of Teresa's courage, witnessing daily her pain from injuries that required multiple back surgeries.
"She's amazing," he said from the baby's hospital room earlier this month. "For her to even be able to walk in such pain for the good of my beautiful little boy ... I'm just blown away."
Babies born between 34 weeks and 38 weeks -- a group known as late preterm -- account for the biggest increase in premature births.
These are not the doll-size miracles that capture hearts and seem to defy science.
Most of them develop as expected, leading to a false sense among some parents that being born a few weeks early and few pounds light is OK, said Shogan, the Deaconess nurse educator. "That's just not true," she said.
Babies arriving even a few weeks early often are not ready for the sensory blast of life outside the womb. It may take weeks in the NICU before the babies are sent home.
The final few weeks of a full-term pregnancy are important -- a period of rapid brain and lung development. It's why preterm babies may need breathing assistance and help moderating their body temperature, and may have developmental delays.
Babies born in that 34-38 week window are twice as likely to die of sudden infant death syndrome, or SIDS; have an 80 percent increased risk of attention deficit hyperactivity disorder; and have a 20 percent risk of serious behavioral problems at 8 years old.
A common problem that continues to add to Spokane's higher premature birth rates is the continued high rate of pregnant women lighting up. Dr. Deb Harper, a pediatrician with Group Health Cooperative, said 19 percent of pregnant women in Spokane continue to smoke -- almost twice the national average -- despite years of tobacco cessation campaigns.
It is drug use, however, that is most worrisome, say medical professionals.
A study in the mid-1990s revealed that eight of every 100 babies born in the county's four big hospitals had been exposed to opiates, cocaine or marijuana. The babies were not tested for methamphetamine.
Health officials at the time were especially alarmed as most of the pregnant women in the study had insurance and received routine prenatal care.
A decade later, Spokane continues to struggle with drug use and pregnancy.
While there remains uncertainty about the prevalence of meth use during pregnancy, Shogan, the Deaconess nurse educator, estimates three in 10 babies sent to the 46-bed neonatal intensive care unit have been exposed to the drug.
Screening for drugs has been done using a baby's first stool, called meconium. Many traces of drugs or substances that a mother digests and passes to her baby through the placenta can be found there.
But evidence of meth use disappears within about four weeks, said Bob Demaree, an executive with U.S. Drug Testing Laboratories.
The company is encouraging testing of umbilical cord blood, a more complete library of the drugs a mother passes to the fetus.
"I just wish, with all my strength, that young people just wouldn't take that first hit of meth," Shogan said. "I wish we could break this cycle. Take a hammer to it and say, 'No more.' "
But Shogan knows nothing is simple and she warns against the urge to judge mothers and fathers. "We don't know their lives," she said.
Indeed, some say the blame game that has helped drive intervention programs may be causing more harm than good.
"As often as not, when you have children that are in crisis, you have parents in crisis, too," said Roy Harrington, associate director of Washington State University-Spokane's Area Health Education Center.
Family violence afflicts one-third of Spokane families, Harrington said, and children who are beaten or witness family abuse are four times as likely to repeat the behavior.
Such traumas also lead to drugs and alcohol as a coping device, said Mary Ann Murphy, executive director of Partners with Families and Children: Spokane.
It all feeds into poverty and Harper's belief that more and more NICU babies are coming from mothers who either didn't have access to prenatal care or avoided it.
"When you look at the fault lines of poverty, insurance coverage and people in chaotic lives, it begins to fit," she said.
Christensen added that even though some statistics say the standard of living seems to be rising in Spokane, factoring inflation into the data reveals that for many people economic progress has stagnated or retreated.
Addressing the problems, including poverty, is not a new idea, Harper said. She is quick to credit Deaconess' efforts more than a decade ago to establish the women's health clinic in the West Central neighborhood after nurses noticed a disproportionate number of unprepared women -- those who hadn't received prenatal care or birthing education -- had addresses in that area.
"Spokane has innovative programs that can address these problems," Harper said, ticking off examples including Partners with Families and Children, and the public health nurse program run by the Spokane Regional Health District. "There are ways of fixing this."
As debates continue over the funding and focus of social programs, problems mount.
Quietly, so quietly, Sacred Heart occupational therapist Miller slips into a pastel hospital gown. She ties a mask over her mouth and nose, and pulls on a pair of latex gloves. She enters the anonymous baby girl's softly lit room filled with a jumble of machines, tubes, paperwork and the whimsy of toys.
"Isn't she beautiful," says Miller, holding the infant as a nurse brings a bottle of formula. There's no breast milk provided for this baby, whose drug-addicted mom calls at times but likely won't be a factor in her life.
"I do think people want to be good parents," Miller says, "and this can be a real wake-up call for some.
"But wanting to is not good enough, and that means (the baby girl) will know the system."
To see more of The Spokesman-Review, or to subscribe to the newspaper, go to http://www.spokesmanreview.com. Copyright (c) 2008, The Spokesman-Review, Spokane, Wash. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
More News:
Market Updates |
Stock Alerts |
All Trading News |
Stock Index
|
|
