Deliverance: 'There's mama's baby boy'
The twins are born within four minutes of each other on April Fool's Day.
They take their first breaths surrounded by a dozen hospital workers, in an operating room where Diane has been taken as a precaution. The room is brightly lit and no bigger than a two-car garage. Hulking monitors and anesthesia machines line the walls, and white surgical lights hang from the ceiling.
Diane delivers naturally, after nearly six hours in labor but barely a handful of pushes. Katelyn Diane comes out first; she weighs two pounds. Jacob Deane arrives next, with an extra half-ounce to sustain him.
“They look terrific,” Dr. David Logan, a youthful obstetrician with bloodstained gloves, says to no one in particular.
Their parents don't get to hold them. Like a quarterback making a lateral pass, Logan hands each wriggling baby to a nurse practitioner standing two feet behind him. The nurse lays them naked on a table with an overhead warmer.
The babies don't cry.
Dave, who has been sitting on a metal stool next to Diane's gurney, stands up to peek at his son and daughter.
Jacob is as long as a piece of office paper. Katelyn's foot is half the size of her father's thumb. Like her brother, she doesn't have the white coating that covers most newborns. Her mess of fine hair is light; Jacob's is darker, like his dad's.
Dave bites his lip as he watches the neonatal team line up their supplies: plastic tubes, IV solutions and inch-long blood pressure cuffs.
Dr. Al Lantzy, a burly neonatologist in sky blue scrubs and sterile gown, arches over Jacob and inserts a thin, plastic tube into his mouth. He holds it in place with his index finger and slides it through the baby's vocal cords into his trachea. In a matter of seconds, air coming out of the tube will help Jacob to expand his lungs, which are smaller than a tea bag.
Jacob's eyes remain fused. His testicles haven't dropped down from his abdomen to the scrotum. An oxygen pump on a tray next to him is as big as his head. A respiratory therapist pushes a syringe into the tube in his mouth. It contains half a teaspoon of artificial surfactant -- a milky, slippery lubricant that opens the air sacs in the baby's immature lungs to keep them from collapsing.
Experts say the availability of this surfactant, akin to WD-40 for the lungs, is one of the greatest advances in neonatology. They consider it a success when they can deliver the surfactant within 10 minutes of a baby's birth.
“It has improved the survival, especially of the smallest babies,” said Dr. Charles Bender, medical director of Magee-Womens Hospital neonatal intensive care unit. Bender said one of the most high-profile preemies of the last century, the son of President John F. Kennedy, would have survived had artificial surfactant been available in 1963. The baby died two days after his birth. “It has improved the health of those babies who do survive and that's just as important.”
It also helps that Diane was injected during labor with two shots of beta-methasone, a steroid that travels into the baby's bloodstream and triggers the production of natural surfactant.
Katelyn breathes on her own as she waits her turn to be intubated. She draws a few manual breaths with the help of a respiratory therapist who's squeezing a portable, melon-sized rubber bag filled with oxygen. Each compression shoots a teaspoon of air into her lungs. She appears relaxed.
“They would get too tired to breathe on their own right now,” says nurse practitioner Merry Kruger. She dabs the babies' eyes with erythromycin, an antibiotic commonly given to newborns to prevent infection.
The next hours will be critical.
The babies may unexpectedly stop breathing. Their heart rates may drop. Their skin may turn yellow if they have too much of the pigment bilirubin in their blood. Their organs may become infected.
No one can predict what their needs will be in the weeks to come. Medicine hasn't devised a test -- and probably never will -- to figure out how preemies will fare.
“When you see a baby being born, you don't know how to predict up front who's going to do OK and who's going to develop problems,” said Dr. Rosemary D. Higgins, a program scientist for the neonatal research network at the federal National Institute of Child Health and Human Development in Bethesda, Md.
For now, however, Lantzy is pleased.
“This is pink,” Lantzy says, encouraged by the babies' skin coloring. “This is as pink as you're going to get.”
Dave and Diane are thrilled. Dave leans over Diane and places his head on her shoulders. A nurse lifts up Jacob to show Diane. She won't get to hold him for a few more hours.
“There's Mama's baby boy,” she says, tears rolling down her face.
The words aren't lost on Lantzy, who turns over to Diane, and peers at her from behind his glasses.
“You have a long road ahead, you know that?” he says, shaking his head wearily. “But this is as good as it gets.”