The Race To Save the High-Risk Baby

How Baylor Hospital helps the most helpless get a start in life.

Seven-fifteen on a hot Friday evening in Dallas. Inside a small operating room at Baylor Hospital, 33-year-old Bonny Brown waits for the Caesarian section that will bring her third child into the world. Three doctors and two nurses talk quietly to each other and to Mrs Brown as they get ready. She is lying under two large spotlights, draped with large green sheets, only her head and protruding abdomen visible.

“Can you feel what I’m doing?” obstetrician Jim Boyd asks.

“No.”

“Well, good. I just pinched the daylights out of your tummy, so you’re good and numb.” He looks at his masked colleagues. “Is everybody ready?” With a pair of scissors he begins the incision.

Seven-twenty. A rush of blood and fluid and a savage little face emerges from the opening. The baby breathes, gurgles, cries. Dr. Boyd works first one shoulder out, then the other. Except for the rope of umbilicus, the pinkish-gray little body is soon free. Murmurs of approval greet its arrival. A girl.

The mother is anxious. “Is she all right?”

“She looks good! She’s beautiful.”

Six pound, fifteen ounce Carolyn Ann Brown does look good and she is beautiful, but had she been born just ten years ago, chances are she would not have lived. Because Mrs. Brown’s Rh-negative blood contained antibodies that were attacking the Rh-positive red blood cells of the fetus – necessitating the C-section thirteen days before term – Carolyn must spend a few days in Baylor’s Special Care Nursery, one of the most innovative high-risk infant treatment centers in the country.

“I was trained in the era when we had nothing to offer babies, really nothing,” says Dr. Dolores Carruth, Director of Nurseries at Baylor. “We lost probably 50 percent of the babies.”

A native of Tulia in West Texas, Dr. Carruth is a tall, commanding woman with a disarmingly direct way about her. She is a neonatologist – a specialist who cares for newborn infants. Her work overlaps with that of the fetologist, an obstetrical specialist. As what is known as a perinatal team, they apply the recent remarkable advances in both pediatrics and obstetrics to save high-risk infants.

“In 1970 and 1971,” Dr. Carruth recalls, “the only neonatal intensive care unit in Dallas was at Children’s Medical Center where I worked. Then it became obvious that one unit could not handle all the babies that sought its help. We also learned in the early 1970s that if the high risk mother was delivered at a center where her baby could be cared for, the baby had a 30 percent greater chance of living and doing well than it did if the baby was transferred to a high risk center from another hospital. It was obvious the woman should deliver in the place where she and her baby could get optimal care.

“We decided that we could deliver premature babies at a high-risk perinatal center and save the beds at Children’s Medical Center for those babies who needed heart surgery and other major surgery. We saw Baylor as a hospital that had the resources to deliver high-risk perinatal care.”

Since 1975, Baylor has been a high-risk pregnancy referral center, working with smaller hospitals in Sherman, Sulphur Springs, Corsicana, Longview, Greenville, Tyler, Grand Prairie, and Paris. These smaller hospitals, many of which deliver fewer than 500 babies a year, can’t afford the staff and equipment to save the life of the occasional premature or high-risk birth.

Most of the babies in Baylor’s Special Care Nursery are premature. Many complications result from premature birth, basically because the infant’s lungs, heart, cardiovascular system, and liver are not mature enough to sustain life. Sometimes the brain is so immature that the baby forgets to breathe.

Several breakthroughs have given premature babies a fighting chance. One of the most important is the treatment of hyaline membrane disease. The lungs of some premature babies have not developed the lining material that keeps some air trapped in little bubbles inside them; without this lining, the lungs collapse completely when the baby exhales, and the baby doesn’t have the strength to re-inflate them. A technique called Continuous Positive Airway Pressure, developed in 1970, keeps the air the baby breathes under pressure, so that the lungs cannot collapse. Another breakthrough technique, analysis of the amniotic fluid before birth, tells the doctor in advance whether the lungs of the baby are mature enough to prevent hyaline membrane disease.

In the Special Care Nursery, the babies lie under overhead heaters, connected by wires to various monitors and support devices. The most recent monitoring technique is the transcutaneous pO2 monitor, which measures the oxygen in the baby’s blood through the surface of the skin.

The room is filled with the steady beeps of the monitoring systems. At times a buzzer sounds and a nurse hurries over to a baby who has forgotten to breathe. “Breathe, April!” the nurse commands, rubbing the tiny back, and little April starts to breathe again.

Each child soon develops a distinctive personality, and it responds to the sound of its mother’s voice or to that of its favorite nurse. Nurses often grow attached to the babies, and watch to see that “bonding” has taken place between parents and child. “You have to understand that we become very emotionally involved,” Dr. Carruth says.

On the night little Carolyn Brown is brought to the nursery, she joins six other babies, all of them premature, all of them fighting to survive. Across the aisle is little Jim Barton, two pounds, eight ounces, nearly two weeks old. His twin sister Michelle died a few days earlier. “Five years ago, Jim would never have made it this far,” Dr. Carruth says, ’’nor would about three other babies in here.” Hooked up to a ventilating machine, a heart rate monitor, a transcutaneous oxygen monitor, and a thermostat, Jim is still a desperately ill baby, but he’s a fighter. “How can you give up on a baby who’s trying like that?” Dr. Carruth asks.

Jim’s parents are from Tatum, a small community south of Longview. Little Jim’s father, also Jim, is an ex-Marine. “I was in Viet Nam a long time,” he says, “and I guess I’m a little cynical about people, but this has been one of the most humbling things I’ve ever been through. I’ve had people I didn’t even know knew me try to give me ten or fifteen dollars on the street. That’s what’s shocking, when you have problems, they really care.”

Stephany Barton was six months pregnant when she woke Jim at four in the morning and told him her water had broken. They drove to the Longview hospital emergency room and checked Stephany into the hospital. Her doctor told her if she had any contractions at all he would send her to Dallas. She started labor late in the evening. As the contractions grew more frequent, an ambulance was secured for the 125-mile trip, and a nurse who had delivered babies got ready to go along.

“We were all ready,” Jim Barton says, “but everybody forgot to tell us it would take cash to get in the ambulance. I had to round up $120 at 10 p.m. so it was about 11:30 when we left. And then along about Terrell the ambulance had a blow-out. I helped them change the tire, and we got here about one.”

When the gestation period has been 35 weeks or shorter, complications are inevitable; 28 to 30 weeks is pretty much the minimum if an infant is to have any chance of surviving. Mrs. Barton’s Longview doctor estimated she was 23 weeks pregnant, but he told her he could be off a few weeks. Luckily, he was.

Contractions were two minutes apart when Stephany Barton got to Baylor. A doctor immediately started alcohol I.V.’s to stop labor, and the contractions stopped about four. “Dr. Factor told us that what we’re doing is buying time,” Mrs. Barton recalls. “He said that every hour is that much better for the baby.”

The contractions began again the next morning. At 10:20 that night Mrs. Barton was wheeled back into the labor room. She and her husband were told that if the babies were born, their chances for survival were about 10 percent. The babies came at 3:52 a.m.

Three hours later, the Bartons met Dr. Carruth. “She’ll tell you how a cow eats cabbage, I’ll tell you,” Stephany Barton says, laughing. “She told us the babies were very sick, that they had saved babies that young before, but they don’t save them all.”

Those first days were difficult. “I didn’t want to go down there because I didn’t know if I could stand it,” Stephany says, “because I had wanted children for a long, long time. But after I got the pictures the nurses took of them and saw them with the tubes in their little noses, it wasn’t so bad.

“We sat there and watched Michelle get worse, and we knew. Dr. Carruth told us she probably wouldn’t make it through the night, but she did. She passed away the next day. The chaplain was there with her, and they called and asked me if I wanted to come down and hold her. I realized that I had bathed her and touched her, but I’d never had a chance to hold her. I didn’t know, but we held her – Jim and I and my mother – and it really helped. We had a small graveside service for her at home, and then we came back Wednesday.

“Jim was doing real good on Wednesday, but on Saturday he got real sick. He had blood in his spinal fluid. 1 had stood down there in that nursery through lots of things, but Saturday I had to leave. He just looked awful. But they gave him antibiotics, and he just kicked off again like it was a new ballgame. Dr. Hirsch says that he may take three steps forward and one back, but we’re still making progress. Yesterday they took his tubes out, and he breathed on his own a while.

“Every day we just hope and pray. We go down there and visit and hold him and bathe him, but we still know we could lose him. And even if Jim dies, I would not have seen my babies, I would not have held them, if we had been anywhere else. I don’t think he will die because he’s doing pretty good, but even with Michelle, I had four days with that child I wouldn’t have had if I’d been somewhere else. If I ever have anything to give, it will be to this place.”

From a shelf in her office down the hall from the Special Care Nursery, Dolores Carruth retrieves a box crammed with photographs of healthy children, all of them alumni of the Special Care Nursery. She remembers them all, knows their parents, and sees most of them at a Nursery Christmas party every year.

She lingers over a picture of Jody Lively, one of the smallest babies ever treated at Baylor. Born in April of this year, three and a half months premature, weighing one pound, seven and one-half ounces, she endured heart surgery and weeks in the nursery before doctors knew she would live.

She holds up a picture of a smiling little boy named Benjy. “Benjy’s an inspiration to all of us,” she says, “especially to me because he proved my intuition wrong. He weighed less than a thousand grams, he had every possible complication, and he lived. He was on a ventilator for three months. I never thought he would live, but the nurses never thought he would die.” She shakes her head and looks of.’ for a moment. “After Benjy Stovall,” she says, “I’ll try on anybody.”

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