THE VIRGINIAN-PILOT
Copyright (c) 1997, Landmark Communications, Inc.
DATE: Sunday, January 5, 1997 TAG: 9701050072
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: 367 lines
They named her April, because she was supposed to be born in the fragile warmth of an early spring day.
But she came into the world during the January freeze, 16 weeks early.
She wasn't the youngest preemie ever in the neonatal intensive care unit - the NICU - at Children's Hospital of The King's Daughters.
But she was the smallest.
Weighing less than a pound, she fit easily into the palm of her father's hand. Her body was covered with fine hair, her eyes fused shut, and her skin translucent and gelatinous.
Seconds after the obstetrician pulled her from her mother's womb, a neonatologist threaded a tube smaller than a coffee stirrer down her throat and started her breathing with a miniature respirator.
She kicked fiercely, a good sign.
But everyone knew the odds.
Most babies born so early and so tiny die within 48 hours. Of the remainder, more than half leave the hospital with severe disabilities ranging from mental retardation to cerebral palsy to blindness.
April's mother, Lucy Catbagan, knew the statistics and wouldn't pump breast milk to feed her baby. ``What's the point?'' she asked. ``She's just going to die.''
But April held on. Past the critical first 48 hours. Through the infections, collapsed lung, broken bones, blood transfusions.
For six months, April lived in the NICU, a hushed, dim room whose only purpose is to save babies born too early or too sick.
It is a room of cutting-edge technology tempered by old-fashioned comfort. Where mobiles and stuffed animals share isolettes with ventilators and tubes. Where the unexpected beep of a machine interrupts a lullaby.
And where the very technology used to rescue babies can damage them.
Ventilators that help them breathe scar their lungs. Feeding tubes that bring vital nutrition provide pathways for fatal infections. Laser surgery to help their immature eyes see may cause cataracts.
The nurses and doctors who cared for April doubted she'd ever leave the hospital alive.
But April managed to avoid the two worst complications a NICU baby faces: severe brain bleeds and an intestine-destroying infection called necrotizing enterocolitis, or NEC.
On July 2, dressed in a frothy pink dress, April was bundled into a too-big infant car seat. Still on oxygen and attached to a heart monitor, she was going home.
Now it was up to her parents, Lucy Catbagan and Horace Lawrence Jr. The around-the-clock expertise and technology of the NICU were gone.
Horace and Lucy were on their own.
Luciana Catbagan, 46, and Horace Lawrence, 42, met at the computer disk manufacturer in Chesapeake where they worked.
Despite the differences in their backgrounds - Lucy, a tiny slip of a woman who had come to this country 11 years ago from the Philippines, and Horace, a bear-like African American born and raised in South Norfolk - they began dating.
The pregnancy, while unexpected, was a blessing. Horace had no children; Lucy had a grown daughter and thought she was finished forever with babies.
On New Year's Eve 1995, the couple celebrated with their family, eating platters of heavy, spicy food, staying up late to see in the New Year.
So when Lucy began sweating profusely on New Years' Day, she thought it was from all the salt she'd consumed the night before.
But it was a sign of toxemia, a potentially fatal condition of pregnancy marked by severely high blood pressure. Delivering the baby would cure it.
April was born by emergency Caesarean section three days later.
The travail of the NICU brought the couple closer. They spent every day there, alternating shifts when they weren't working. They learned to bathe their daughter around the wires and tubes that tethered her to the isolette, to give her the injections needed to cleanse her body of excess calcium.
And to treat her like a baby, not some medical freak.
Their devotion and commitment convinced the NICU staff to discharge April, weighing only 4 pounds, as early as they did.
Still, Lucy and Horace were terrified when they took the baby home. April still turned purple when she cried. She needed six different medicines.
That first night home the couple dozed on the narrow daybed in April's nursery. They tensed with every sigh or sneeze, anticipating the shrill alarm of her heart monitor each time they closed their eyes.
It was a level of vigilance they would maintain for the next six months.
Lucy met another April in the waiting room of the pulmonary clinic at Children's Hospital of The King's Daughters. Born two months early at 3 pounds, 2 ounces, she had grown to a chubby little girl of more than 12 pounds with a head full of thick, curly hair who sat on her mother's lap, chewing her hands.
Lucy's April, at 8 months, was still barely visible in her infant carrier.
Lucy envied that other April, born less than two months after her April. When, she wondered, would her daughter get that big? Was there something wrong with her April because she wasn't growing as fast?
Today she hoped to take a major step towards normalcy. She wanted the doctor to remove April's oxygen.
Since leaving the NICU six weeks ago, April was never without the slim, clear plastic tube that snaked from her nose. Her cheeks were chapped from the circles of adhesive needed to keep the tube attached to her nose. Lucy wanted to have April's portrait taken, but not until the oxygen tube was gone.
April needed the oxygen because her lungs were damaged from months spent on the ventilator. The air sacs that deliver oxygen to the blood and release carbon dioxide were enlarged, thicker and more fibrous than normal. So they weren't very efficient at getting oxygen into her blood.
It was important to keep the amount of oxygen circulating in her blood at about 95 percent - the medical term is ``saturation.'' Any less, and April would have to work too hard to breathe, stealing valuable nutritional energy that would otherwise go into the all-important job of growing. The extra work would also strain her heart and could damage her brain.
But at 5 pounds, 4 ounces, April was still too small to lose the oxygen, said pediatric pulmonologist Gerald L. Strope after examining her.
``She's still a peanut, aren't you?'' Strope said as he pulled April's diaper up.
Lucy ducked her head to hide her disappointment and concentrated on dressing April. She felt like she had just taken a step backward, instead of the forward leap she expected.
Six weeks out of the NICU and April still needed oxygen. Still needed to be woken every three hours to eat, to get her medicine. Still had to stay cooped up in the apartment, lest her immature immune system fail to protect her. Couldn't start on solid food, like other 8-month-olds.
Life with April had lost much of the drama of the NICU, where every 1-ounce weight gain was celebrated, every milestone heralded.
Change came slowly, in nearly invisible, often mundane, increments.
It never seemed fast enough for Lucy. On leave from her job, she spent every minute with the baby, talking to her, singing to her, exercising her stick-thin arms and legs.
She traveled with a paper plate in her diaper bag, pulling it out during the long waits in doctor's offices and urging April to ``push, push'' her feet against it.
It looked like play. But with a baby like April - born too soon and way too small - it was serious work. To reach important developmental milestones that seem automatic for other babies - rolling over, reaching for a toy, sitting up, crawling and then walking - required hours of painful exertion.
A baby couldn't hold a toy if she couldn't bring her hands together in the middle of her chest. Couldn't roll over if she couldn't bring her hand down to her foot. Couldn't crawl if she couldn't roll over.
It was up to Lucy and Horace, together with the physical therapist who came each week, to help April reach those landmarks.
Often, parents of NICU babies are too young or too stressed - living in poverty, sick, unmarried with other children to care for - to provide the kind of intensive follow-up a premature baby needs.
But Lucy and Horace knew the odds and never stopped pushing April. In two months, they'd spent only one day away from her - when Horace's mother forced them to go to Busch Gardens while she babysat.
With her daughter, the normally shy and introverted Lucy became playful, almost childlike. With others, she spoke in a barely audible voice. But with April, she chattered incessantly in a loud, clear voice.
Lucy's life was April. She spent her nights on the daybed in the baby's nursery, her days trekking to doctor appointments, oxygen tank slung over her shoulder like a golf bag.
It was exhausting. The doctors always ran late, leaving Lucy trying to entertain an infant in a cold examining room for hours. Often, by the time the doctor came, April was tired and fussy, sometimes asleep.
And it was difficult for the reticent Lucy to ask the kind of hard questions she needed to know of the medical professionals around her. When will she lose the oxygen? Why can't she start on food yet? When will you know if she'll be normal?
For April's medical problems didn't end when she left the NICU.
She needed surgery to repair an inguinal hernia, a loop of intestine poking through her abdominal wall.
An operation to remove the cloudy lens that blinded her left eye, the result of laser surgery in the NICU.
Monthly appointments with the endocrinologist to track her growth and monitor the abnormally high levels of calcium in her blood.
Coordinating it all was the NICU follow-up clinic.
The Children's Hospital clinic involved nurses, doctors, social workers and therapists to track the progress of NICU babies. Officials hooked preemie parents up with early intervention programs, nutritionists, occupational, speech and physical therapists, home health - the people necessary to ensure these infants had the best possible start.
Studies showed that this kind of early intervention minimizes the learning and physical disabilities many premature babies develop.
April's first visit began, as all clinic visits did, with a Polaroid picture of baby and mom. Clinic director Martha Jones posts the pictures in the NICU employee lounge so unit nurses and doctors can track the progress of ``their'' babies.
To the nurses in the follow-up clinic, many of whom had seen April in the NICU, the 5-pound, dark-haired baby was enormous. But clinic nurse Tracy Duke had never seen April before today.
``She's so tiny!'' she exclaimed, aiming the camera. ``How much did she weigh at birth?''
``13 ounces,'' Lucy said.
``Really? She's a miracle baby.''
The ``miracle baby'' lunged at the air with her arms and legs as she was weighed and measured, sucking furiously on the pink pacifier that covered half her face.
Then nurse practitioner Lisa McGonagal pulled out her blue bag of tricks to test April's development. She rang a silver bell on the left side of the baby's head and April startled, turning toward the sound.
``She hears it. She doesn't like it, but she hears it. That's good,'' McGonagal said.
When she tried to capture April's attention with a red plastic hoop on a string, however, the baby closed her eyes and dozed.
``She's not going to perform for me. She's saying, `I've had it.' '' McGonagal said.
But the nurse had seen enough to know April was doing well. Although 8 months chronologically, her gestational age - the age she'd be if she'd spent the full nine months in Lucy's womb - was just 4 months. And because of her size, she was expected to function at an even lower level.
``In general,'' said the clinic's medical director, Dr. Jamil Khan, after his examination, ``she's coming along OK. You guys are doing a great job with her at home.''
It was the first cold night of fall, windy and chilly outside. It was also Lucy's first night back at work since April left the NICU. Three months of family leave was over.
The immaculate apartment she shared with Horace in Great Bridge was hushed.
``I hate to go to work. I hate to leave her,'' she said, peeking into the nursery where April slept on her back in the crib.
The room was a curious mix of hospital and nursery. The cheerfulness of the Disney characters on the walls, crib bumpers and comforter was muted by the CPR chart on the door, the bulletin board filled with doctor appointment cards, the syringes piled on the dresser.
The soft ``whoosh, whoosh'' of the oxygen tank provided a steady background rhythm while the cord from the heart monitor snaked across the floor.
Lucy cradled her sleeping baby.
``I hate to leave you,'' she crooned, ``but Mommy has to go to work. Stay with Daddy. Be a good girl now.''
She covered April's face with kisses and lay her back in the crib.
She stepped through the apartment, moving the baby monitor into the bedroom with Horace, turning off the lights and TV, and grabbing the plastic bag with her uniform.
For the next six hours, Lucy, dressed in white overalls and a face mask, loaded and unloaded computer disks onto 90 toaster-sized machines in this sterile factory.
There was no room here for baby pictures. No time for hourly calls home to coo to April. But dozens of co-workers stopped by to hug and kiss Lucy, to ogle wallet-sized pictures of the ``miracle'' baby.
As Lucy moved among the machines, sorting discs, punching computer keys, she tried not to count the hours. Five hours. Four hours. Three hours more until she could hold April.
On an oddly warm day for December, April, dressed in a frilly red-and-white dress, had her second visit at the NICU follow-up clinic.
This time, she weighed 8 pounds, 4 ounces and was 21 inches long. At nearly 1 year, she was finally the size of the average newborn.
She was off the oxygen, had outgrown her preemie-sized clothes, and was eating baby food - a major milestone.
She'd had her cataract removed, and was being fitted for a miniature contact lens. Otherwise, her vision seemed fine.
She was the size of a day-old infant, but she had the personality and mannerisms - smiling, rolling over, playing with toys - of a 6-month-old.
This visit, April made it through nearly half an hour of developmental testing, easily following toys with her eyes, reaching for them, putting them in her mouth.
``Does she say ma-ma?'' asked the neonatal nurse practitioner, Therese Cooper.
``Not yet,'' Lucy said.
``You ungrateful girl,'' Cooper scolded.
Developmental pediatrician Dr. Frank Aiello had another question.
``Does she blow raspberries?''
Lucy shook her head.
``Do you blow them to her?''
Lucy looked alarmed. ``No one told me to do that,'' she said, concerned that she'd missed something crucial.
``It's OK,'' Aiello said quickly. ``You haven't done any serious developmental damage. Just start blowing raspberries.''
Lucy shyly asked about April's development.
The news was good. Although April was 11 1/2 months old, her adjusted age was 7 months and she was functioning at the level of an 8- or 9-month-old physically, Aiello said.
Her language skills, however, were at about the 4-month level.
He warned Lucy that April may not walk for another six months or more. ``But if she didn't walk at 15 or 16 months, I still wouldn't be too worried. Because we just don't have much experience in seeing how 300-plus-gram babies do.''
Then came the really good news: There were no signs of cerebral palsy.
The room erupted with whoops. For once, Lucy's reserve shattered and she grinned broadly, even as she wiped the wetness from her eyes.
You guys did it, Aiello told Lucy.
It came as no surprise to Thelma Lawrence, Horace's mother, April's grandmother. She'd spent nearly every day the past year watching her son and Lucy with April.
``If love was a drug to see her through, she'll be here a long, long time.''
There were pink balloons floating up to the ceiling. A pink-iced cake, pink-and-white party hats and cherry-flavored punch. On the presents table, a 4-foot stuffed bear - bigger than the birthday girl - stared blankly at the gathering.
Saturday, April Marie Lawrence turned 1 year old.
The Lawrence and Catbagan clans, two families who barely knew each other a year ago, came together in the South Norfolk recreation center's all-purpose room to celebrate this miraculous anniversary.
Dressed in red-velvet trimmed in lace, a white satin headband framing her black hair, April was passed from relative to relative. She scanned each person's face, granting most a smile, sometimes cooing in her hoarse voice.
There were platters of food, the Philippine pancit and egg rolls sharing the table with greens, hot dogs, baked beans and deviled eggs. A blending of cuisine, even as these two families had blended over April.
Horace's aunt, Lillie M. Gray of Chesapeake, voiced the thoughts of many on Saturday when she led the blessing before they ate.
``Bless little April. That she may have many more birthdays.''
For Lucy, flitting around the room, her high-pitched giggle trailing behind her, it was a day of blessings. That morning, she and Horace had sung a quiet ``Happy Birthday'' to their daughter.
``I couldn't believe she is 1 year old today,'' Lucy said, squeezing April close to her. ``Yesss, you are 1 year old.''
Horace just tried not to think about the terrible day a year ago. ``I want to forget what she's been through this year,'' he said.
As her uncle, Carlito Catbagan of Norfolk, held April high on his shoulder, the crowd of about 50 sang ``Happy Birthday,'' and Lucy, giggling excitedly, tilted the cake with its one candle toward her daughter.
``Blow, April,'' she said, huffing. ``Blow.''
Then she took her daughter's tiny hand and pressed it down into the pink-and-white icing, covering it with the sweet stuff.
And, like any other 1-year-old baby on her birthday, April put her hand up to her mouth, smearing the icing over her face and grinning broadly. ILLUSTRATION: Color photo
BETH BERGMAN/The Virginian-Pilot
Lucy Catbagan helps her daughter April get a taste of frosting from
the girl's birthday cake while April's uncle, Carlito Catbagan,
holds her. April was born 16 weeks early on Jan. 4, 1996.
BETH BERGMAN photos/The Virginian-Pilot
Coming along nicely
Dr. Jamil Khan, medical director of the neonatal intensive care
unit's follow-up clinic, tests April's reflexes in August. Nurses,
doctors, social workers and therapists at the Children's Hospital
clinic track the progress of NICU babies. Early intervention like
this can prevent a lot of the problems many premature babies
develop.
A big difference
Two Aprils meet in the waiting room of Dr. Gerald L. Strope. April
Lawrence, so small she cannot be seen in her carrier at left, and
April Parker, right, were both born premature within two months of
each other. But April Parker spent a month longer in utero. Every
baby develops differently, but that time has a lot to do with how
much faster April Parker has grown.
Special shower
Friends and family throw Lucy - and April - a baby shower, above.
Complications with her pregnancy delayed Lucy's shower until after
the baby was born.
Be brave
Horace Lawrence kisses his daughter in the doctor's office before
yet another examination.
Small victory
It took April several months before she could eat solid foods, such
as these mashed peas. And her mother was eager to begin filling
April's small body with solids.
Extra effort
April, reflected in the mirror, responds to the visual and verbal
stimulation from her mother, top, during a physical therapy session.
Since leaving the NICU, April has struggled to develop as a normal
child. Doctors attribute much of her successful development to the
active involvement of her parents in the process.
Mother and child
Lucy snuggles with April during one of her seemingly unending
doctor's appointments - this one with pediatrician Buu Lien.
Christmas gift
Horace helps April learn to stand. Because preemies are pricked so
often on the bottoms of their feet, their feet are sensitive and
they are reluctant to stand on them.
KEYWORDS: PREMATURE BABIES TREATMENT