THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Wednesday, July 3, 1996 TAG: 9607030464
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: 171 lines
She weighed about as much as three sticks of butter and wasn't even as long as a Barbie doll.
April Marie Lawrence arrived 16 weeks before she was supposed to. Her eyes were fused shut, her skin so translucent you could almost see through it.
``We're all used to working with tiny babies,'' said neonatologist Jamil Khan. ``But this was another level of tininess.''
On Tuesday, after six months in Children's Hospital of The King's Daughters' neonatal intensive care unit, April sat in her grandmother's lap. Now 4 1/2 pounds, she was ready to go home.
``She is the miracle baby,'' said her grandmother, Thelma Lawrence.
Most babies born weighing as little as April did - 13 ounces - never make it to the hospital's neonatal unit.
They are usually wrapped in a warm blanket and given to their parents to hold in the delivery room while they die. Sometimes, a pediatrician isn't even called to the birth.
But April had one crucial thing going for her - the 24 weeks she'd spent in her mother's womb. One week less, and doctors might not have even tried to save her.
At 45, Luciana Catbagan of Norfolk had no intention of getting pregnant. When she did, it seemed an unexpected blessing.
But she struggled with problems throughout her pregnancy. Catbagan had dangerously high blood pressure, and ultrasounds showed the baby wasn't growing properly.
When Catbagan's pressure began rising again on Jan. 4, doctors performed an emergency Caesarean section even though the baby wasn't due until April 20.
Seven years ago, doctors wouldn't have even tried to save a baby who had been in the womb only 24 weeks. In 1989, a drug called ``surfactant'' which lubricates a preemie's tiny, stiff lungs, was approved. That drug and other medical advances give these babies about a 25 percent chance of survival.
Last year, Children's Hospital treated 18 babies born at 24 weeks gestation. Ten survived. In 1994, the most recent year for which figures are available, about 5,000 babies nationwide were born at less than 28 weeks, according to the Center for Health Statistics.
Most babies born at 24 weeks, however, weigh about 23 ounces. April, the smallest baby ever treated in the hospital's neonatal intensive care unit, weighed about half that.
Initial prognosis: death.
But in the world of tiny babies, maturity sometimes counts more than weight. And April had that most important extra week. Seven more days for her lungs to grow. For her brain to develop. So the NICU team went to work.
In the delivery room at Sentara Norfolk General Hospital, doctors slipped a straw-sized tube down April's throat. It was attached to a miniature ventilator, which helped her lungs expand and contract.
Then they rushed her next door, to the neonatal unit at Children's Hospital. There, they hooked her to a heart monitor, inserted a tube into her bladder, put an intravenous line in the stem of her umbilical cord, wrapped a blood-pressure cuff no bigger than a band-aid around her arm, and slid a blue felt shade over her eyes.
A steady drip of high-calorie fluid into her intravenous line provided food. Surfactant and steroids kept her lungs pumping and growing.
When she tried to breathe on her own - even though her lungs weren't big enough - doctors gave her drugs to paralyze her. And more drugs for the pain.
They talked to the parents.
Your baby, they said, will probably die.
Horace Lawrence Jr., April's father, and Catbagan then made what Khan calls ``the most loving decision.'' They signed a ``do not resuscitate order'' for April. If her heart stopped, no heroic measures like chest compression, or heart-starting drugs like epinephrine, would be tried.
``They said she'd only last 48 hours,'' Catbagan said, explaining their decision to let April die peacefully. ``And she was so small.''
With death imminent, Catbagan asked the hospital social worker to arrange for a baptism and help her plan her daughter's funeral.
But they kept coming to the hospital. The two, who work nights at a computer company in Chesapeake, spent nearly every day by April's side. And their tiny daughter held on.
On March 8, the ventilator came out. Catbagan and Lawrence canceled the do not resuscitate order and held April for the first time, feeding her from a doll-sized bottle of formula. And the roller coaster of hope started up.
Only to zoom back down.
Sixteen days later, April stopped breathing and turned blue. She spent 15 more days on the ventilator.
Nurses in the neonatal unit aim to get babies home by their original due date. By April 20, April's due date, she weighed 2 pounds, 12 1/2 ounces. But she was still so sick no one even mentioned the word ``discharge.''
Her arm, leg and ribs had been broken because her bones, starved of the calcium they would have received in the womb, were so brittle. She had a yeast infection in her blood. Then on May 15, she stopped breathing again and went back on the ventilator.
Catbagan was in the hall when it happened. By the time she reached April's bassinet, the baby had turned black. ``April, April,'' she shouted. And then the medical team rushed in, pressing on the baby's tiny chest, inserting the ventilator, getting her to breathe again.
In late May, the ventilator came out for good.
And in mid-June, Catbagan and Lawrence, 41, started decorating April's nursery.
The potential for complications in babies born as early as April are profound. Nearly half of those who survive will have some serious handicap: blindness, deafness, cerebral palsy, mental retardation or chronic lung disease.
``There is a downside to babies this small,'' said pediatric resident Manny Cirenza, who worked very closely with April. ``A lot of children leave here neurologically devastated. They don't cry, eat, move. They break your heart.''
Even though April is smiling, eating and rolling over, it's still too early to say what her eventual problems will be, Khan said.
There's a chance she'll develop some form of cerebral palsy, a neurologic disorder that could cause symptoms ranging from stiff limbs to mental retardation.
She's already had laser surgery for the retinopathy - scarring in the back of her eyes - caused by her extreme prematurity. More eye surgery may be necessary. And the developmental pediatrician was a bit concerned at how ``floppy'' her limbs were during last week's exam.
Even at home, she'll need injections three times a day and will remain on the heart monitor and on oxygen for several months.
The expense of getting April this far is huge. Her care has already cost about a million dollars, hospital officials said. But her parents both have private health insurance, and she is also now eligible for Medicaid. So large, out-of-pocket costs are one thing Lawrence and Catbagan won't have to face.
``People out there talk about how much money we spend trying to save a preemie,'' Cirenza said. ``But when you're there at the bedside and see the children and their parents, you can't put a price on that.''
To someone who has never seen April before, the 4 1/2-pound infant still looks fragile, like a china doll that should be sitting on a shelf instead of strapped into a car seat.
Tuesday, Catbagan's father and stepmother saw their new grandchild for the first time.
``Hello, little baby!'' Juliana Catbagan squealed, as she and her husband, Macario, entered the neonatal unit.
She tentatively touched one miniscule foot, almost as if she were afraid of breaking it. ``Oh, my God. She's so little.'' Macario leaned over and gently kissed April's downy head.
In the neonatal unit, there was laughter and tears - not just among the family, but among the nurses and residents who have cared for April for six months.
By 10 a.m., April was bathed and dressed in a frilly pink dress that buttoned up the back, leaving room for the heart monitor and oxygen tube to which she's still attached. She'd had her picture taken a dozen times.
The stuffed animals and photographs that shared her bassinet were carefully packed and a paper sack filled with medications and syringes sat on the counter to be taken home. She'd been measured one final time and was 16 inches long - about three inches smaller than a typical newborn.
April's last minutes in this dimly lit, hushed room were filled with instructions. About medications, temperatures, heart rates.
Her parents listened impatiently. They scribbled their signatures on the discharge papers.
April was going home, to a room decorated with Mickey Mouse and Donald Duck. ``So what else are we waiting for?'' asked Luciana Catbagan. ``Let's go, let's go.'' ILLUSTRATION: Color photos
BILL TIERNAN/The Virginian-Pilot
Horace Lawrence Jr. bathes daughter April before he and Luciana
Catbagan took her home from Children's Hospital. April was born Jan.
4 when doctors performed an emergency Caesarean section, 3 1/2
months before she was due.
Luciana Catbagan provides a handy toy for her daughter, April Marie
Lawrence.
Graphic
[For complete graphic, please see microfilm]
Photo
BILL TIERNAN/The Virginian-Pilot
As Luciana Catbagan, right, holds daughter April, three relatives
look on: from left, grandmother Juliana Catbagan; Norma Galupe,
Luciana's sister and April's aunt; and grandfather Macario Catbagan.
KEYWORDS: PREMATURE BABIES by CNB