At 28 weeks into her pregnancy, Dana Doan’s son was 15 inches long and weighed 2 pounds, 10 ounces. Image courtesy Dana Doan.

By John Perry

Death and deliverance are constantly at odds in the dimly-lit Level 3 neonatal intensive care unit.

The patients are premature babies with underdeveloped brains, hearts, lungs, and digestive systems. Their tiny bodies, violated by tubes and needles, lie cocooned in high-tech bassinets.

Barriers shield the most delicate from light that might stress their fragile systems. Most have left the womb so early that excessive light could raise their blood pressure so high their frail blood vessels, visible under translucent skin, might burst.

Life support monitor screens with palettes of blue, green and red glow in the room’s imposed twilight. Medical machinery hums like a hive of sad bees. Specially-trained nurses care for their charges with delicate diligence.

Parents swallow fear when they step into this place. Their hopes are tangled in dread and personal terror. Their soft lullabies often break into fervently whispered prayers.

Alice (not her real name) has prayed many times at her baby’s side, often finding solace repeating Psalm 139: 13-14.

“Where the psalmist says God ‘knit me together in my mother’s womb’ and ‘my frame is not hidden from you,’” she said. “I prayed he continue knitting my baby together.”

Alice is a participant in the city’s health plan. Her baby was born 26 weeks into her pregnancy and has struggled with heart and respiratory defects.

The average human gestation period is 40 weeks. A premature birth occurs when pregnancy lasts less than 37 weeks.

Alice’s baby weighed less than two pounds at birth.

“Open the palm of your hand,” said Ernestine Pia-Sandoval, spokeswoman for the March of Dimes Houston division. “The baby would fit with room to spare.

“Premature births are the number one killer of newborns in the United States,” Pia-Sandoval said. “One in seven babies born in Texas will die from premature birth.”

Each year in Texas, more than 49,000 babies, about 14 percent of all births, are premature. The overall U.S. rate is 12 percent. (Source: The March of Dimes.)

Modern NICU equipment, which includes high-tech monitors, respirators, bassinets and incubators, is among medicine’s most expensive.

“Because of medical costs, preemies are sometimes called million-dollar babies,” Pia-Sandoval said.

One premature birth cost the city’s HMO more than $1.5 million in 2006. (Source: BlueCross BlueShield of Texas.)

Eleven percent of newborns covered by employer health plans are born prematurely. Employer costs for a premature baby average 15 times higher than for a healthy, full-term delivery. (Source: Medstat’s MarketScan database.)

The emotional costs are immeasurable. For many families, health problems don’t stop once the baby leaves the hospital.

Complications and disabilities caused by a premature birth can hamper a child’s physical and cognitive development for years. Long-term vision, hearing and speech difficulties are not uncommon.

After more than two months in the NICU and another seven weeks in the hospital, Alice’s baby had gained 3.5 pounds when released for home.

“My prayers were answered,” she said.

To start right, start early
Although there are no 100 percent guarantees, proper prenatal care improves chances for a full-term pregnancy and healthy delivery, said Dr. Jerald Zarin, regional medical director of BlueCross BlueShield of Texas.

“If you’re planning to become pregnant, see your doctor for a preconception visit to check for conditions or illnesses that could affect pregnancy,” said Zarin, a pediatrician for 25 years.

Expectant mothers should make an appointment with their doctor as soon as they know they’re pregnant, Zarin said. They should also get regular checkups: every four weeks until the 28th week, every other week until 36 weeks, and then once a week until delivery.

“If problems arise, expectant mothers should see their obstetrician immediately,” Zarin said. “Women who don’t get adequate prenatal care run the risk of undetected complications. And that can lead to potentially serious consequences for both mother and baby.”

Zarin recommends the Special Beginnings maternity management program as a convenient source of helpful information.

“This program also promotes a strong doctor-patient relationship,” Zarin said. “It encourages the mother to keep all her appointments and, if need be, to seek a clinical response to pregnancy issues.”

As part of BCBSTX’s Blue Care Connection, special beginnings provides a registered nurse specializing in obstetrics as a case manager. The service is available 24-7 through a toll-free number.

“The mother collaborates by phone with an RN between regular doctor visits,” said Kathy Gonzalez, director, Blue Care Connection. “Key development issues of each trimester are addressed, helping identify potential problems which could cause a premature birth.”

For example, the mother is educated on lifestyle factors such as smoking or drinking alcohol that pose risks. This is especially critical during the first trimester when the baby’s brain, spinal cord, spinal nerves, backbone, and heart are developing, Gonzalez said.

“The counseling continues after delivery regarding issues such as the baby’s immunization schedule, and screening for post-partum depression,” she said.

Members are given discount coupons and gift certificates to retail stores for relevant prenatal and newborn products.

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