He emerged from the womb gasping for air, his cry so weak it was inaudible. His frail body was pink, but his hands and feet were blue. His skin had the texture of parchment and was covered with downy hair that normally is shed during the final weeks of pregnancy. He weighed two pounds and measured just under 15 inches, not much more than the weight and length of a small loaf of bread.
Matthew Chen was nothing more than a bony, 30-week fetus--"a skinned chicken," as one hospital staffer later put it. His appearance evoked the searing image of starving children everywhere. Only the distended belly was missing. Immediately, Matt was placed in an incubator, an oxygen mask over his face. And even as he was being wheeled toward the intensive care unit, medical specialists already had begun their rescue attempt, wielding what seemed like countless needles and tubes.
That was the vulnerable human being who made Meredith and me parents more than five years ago. Matt was born about eight weeks prematurely. He was delivered by emergency Caesarean section because he could no longer survive in Meredith's womb. She had suddenly developed a mysterious illness called toxemia that was robbing him of vital nutrients and oxygen.
In the months that followed, Matt rode the roller coaster of terrifying conditions that threaten infants born too early and too small.
One such problem is hyaline membrane disease, caused by lung immaturity; it is what killed President John F. Kennedy's three-pound newborn, Patrick, in 1963. Another is brain hemorrhage, a result of underdeveloped and fragile blood vessels. Other common afflictions include jaundice, caused by insufficient liver function, and an intestinal disorder called necrotizing enterocolitis, which can require emergency colostomy. Matt had brushes with all those conditions, and others. But eventually he overcame the terrible handicap of prematurity. And today he is an example of neonatology's proudest achievements.
With little notice, neonatologists--doctors who treat newborns--are now saving babies born as early as 16 weeks prematurely, weighing a little more than half what Matt did.
Twenty years ago, no more than 50% of the preemies weighing between 2 pounds, 2 ounces, and 3 pounds, 2 ounces, lived; today, more than 80% survive. And whereas fewer than 10% of preemies under 2 pounds, 2 ounces, survived before the era of modern neonatal medicine, about 50% of those between 1 pound, 6 ounces, and 2 pounds, 2 ounces, now are being saved. As recently as 15 years ago, any newborn under five pounds--even if carried full term--was considered a preemie. (Each year in the United States, more than 36,000 infants are born weighing less than 3 pounds, 3 ounces.)
Yet such dazzling statistics, as we learned in the months that Matt spent in intensive care, can mask a darker side of neonatology's breathtaking advances.
As increasingly premature and smaller infants are saved, many go on to exhibit physical and developmental problems as a result of the very technologies that saved them, problems with which their families and pediatricians often are ill-prepared to deal. Such conditions include epilepsy, cerebral palsy, blindness, mental retardation, learning disabilities and poor motor coordination. Until recent years, relatively few preemies survived long enough for these problems to surface. Today, disturbing questions are also being raised about the psychological legacy created by an artificial environment of constant lights and noise that, on top of all the medical procedures, must be stressful to a tiny fetus that should still be inside the womb.
Until just before Matt was born, Meredith's pregnancy had been uneventful.
In retrospect, the first warning had come several weeks earlier when Meredith's face and ankles puffed up, as I noticed after returning from a business trip. But we thought little of it. Swelling during pregnancy is not rare; the uterus, in expanding to accommodate a growing fetus, can obstruct the return of blood from the extremities to the heart.
A few weeks later, during a routine examination, Meredith's normally low blood pressure was found to have shot up markedly. Our obstetrician, Katherine F. Carson, immediately ordered Meredith to go to bed and stay there. Why toxemia causes an increase in blood pressure is unclear, but bed rest is one way to reduce it. That afternoon, Meredith quit her job.
The final sign was unmistakable. Shortly after dinner that night, Meredith, then 33, vomited blood. We immediately called Carson, a pragmatic, no-nonsense doctor and, at the time, probably the best-known obstetrician in San Diego, where we were living. As we would later learn, Meredith's liver was being deprived of blood, and the subsequent liver swelling caused the nausea.