(CMR) Preterm birth is challenging at the best of times, especially when your baby arrives long before you are expecting it. However, some occasions are more challenging than others, for instance, when the new arrival comes amidst a pandemic, creating a new level of practical and emotional difficulty for the parents and caregivers alike.
That’s the story of little Zoe, and her recent sister, Renae, both born prematurely during some of life’s most challenging times. Zoe was born at just 26 weeks gestation, some 14 weeks early, in Cayman Islands Hospital in George Town, in March 2020, just as we headed into a perfect storm of conditions, and when transfer to a specialist center like St Nicklaus Children’s wasn’t possible. Zoe is now 17 months on from her original due date, and she popped in, alongside her younger sister Renae, herself born 10 weeks early, to see Dr. Sara Watkin from Integra Healthcare Ltd, the neonatologist that cared for them both.
Below Dr Watkin, who has over 25 years of experience as a consultant in the United Kingdom, including as Chief of Service at the world-renowned University College London Hospitals, shares her experience working with both babies.
The Initial Experience with Zoe
Dr. Watkin: This was a scary time for parents and us. I am very used to caring for 26-week infants, having spent most of my working life caring for babies from 23 weeks gestation onwards, but we were all just discovering what COVID-19 was going to mean for us. We knew very little about the disease and nothing about whether it might carry extra risks for preterm babies, especially ones like Zoe when they are already challenged by their degree of prematurity.
Zoe was born when George Town Hospital was also facing the challenge of just how to care for patients in general and, more importantly, how to keep people safe when we were facing a disease that few understood. That meant restricting access to parts of the hospital, and the NICU was one of those.
Having a preterm baby is obviously a traumatic experience when everything is normal, but Zoe and mum found themselves separated for many weeks, a heart-wrenching time for her mum.
Bonding with Baby Zoe
Dr. Watkin: Spending time with your new baby is important for both parents and baby alike, and being born prematurely doesn’t alter that. However, COVID did, and I really felt for what Mum was going through. What I tried to do was re-create some of what would normally be a shared experience by using phone and video technology, which, as my husband always says, is not my strong suit! To try to ensure Mum was always fully aware, I spent time each day explaining all that was going on and how Zoe was doing. We did daily video calls so Zoe and Mum could be together. One of my most striking and moving memories of this time, and a true testament to mum’s determination to be part of Zoe’s life, was that she would chat and sing to Zoe over our calls. I can also tell you that little Zoe’s face would light up when she was doing this.
Zoe’s Care Challenges
Dr. Watkin: At 26 weeks, any baby is going to face a long, sometimes difficult journey. As a neonatologist, I also know that in these early stages, you need the utmost focus on getting things right. Being the tiniest bit off is something that can spiral into a host of more complex issues. For Zoe, that could have been a catastrophe because we were unlikely to be able to access a tertiary center with complicated equipment like nitric oxide or advanced forms of ventilation. At the same time, I was in and out of protective gear multiple times per day, learning to do procedures in my newfound fashionwear, and the stress and newness of this is obviously very tiring. Our neonatal nurses in George Town were facing similar issues too.
Dr. Watkin: In London, I always instilled in my juniors the importance of considering how delicate and partially developed the lungs are at this stage. Zoe’s lungs were not ready for their full-time occupation of providing enough oxygen. However, I know from experience that if you just ‘whack a baby on a ventilator, although it solves the oxygenation challenge, it can have many lasting effects like life-long chronic lung problems or asthma. So, I will try to avoid ventilating unless it is absolutely necessary. In Zoe’s case, we managed to avoid her being ventilated at all, carefully managing her with something more gentle called nasal SIPPV and supplemental oxygen. We actually sent her home just 3 days after her original due date, still on some supplemental oxygen and on breast milk feeding. By that stage, home was where she needed to be, and although some doctors aren’t all that comfortable, I have helped establish home oxygen care in the UK and saw no reason why we couldn’t do this here.
Dr. Watkin: it is always a delight seeing Zoe. Very preterm infants are highly susceptible to various types of brain injury and the center where I was Chief of Service, University College London Hospitals, was a world leader in its brain injury and prevention work. Zoe had regular scans right through her care, and these were all normal. She did need two blood transfusions, intravenous feeding and then feeding through a nasogastric tube, but despite the degree of prematurity and with the facilities, we have here on our tiny Island, we managed to get her home safely. She is now a bonny young lady who I take great pleasure in seeing and who her parents just adore.
And History Repeats… with Renae
One of the risk factors for preterm birth is a previous preterm birth, and Mum was going to be no exception. In August, she gave birth to Zoe’s little sister, Renae, at 30 weeks gestation, ironically just as we were exiting our COVID-free bubble.
Dr. Watkin: Yes, this was certainly a feeling of déjà vu. I have now had the privilege of managing 24 weeks of combined prematurity in the same family! Although Renae did need some supplemental oxygen, she was discharged home at 6 weeks of age. To put that in context, we managed to have her home 4 weeks before she was actually originally due, again on breast milk, and she’s just a beautiful young baby.