SURVIVORS
Low-birth-weight babies buck the odds so their mothers could tell their stories with a smile
By Deedee Santa Cruz-Espina
"Parang butiki (like a lizard)," said the mother of how her son looked like at birth. She went on to say that his son's arm was two-thumbs thick. "He was like a small bottle of Pop Cola," she continues.
Born at 6.5 months weighing less than one kilogram, Mark Anthony Puchero, now 13, was one of many who gathered one morning for a reunion with other children born low in weight. Yolanda, Mark's mother, who delivered by C section, recalled that she didn't think the baby would survive. "We both had infection. Both of us had transfusion and our lungs had to be drained of water," she related. Mark was intubated for 40 days and stayed in the incubator for a month. Mark now weighs 45 kilograms and hopes to become a doctor or an accountant.
Seven-year old Leonardo Gabriel Calma was born at six months and three weeks. He weighed one kilogram. His mother recalls that she had eclampsia, her blood pressure reaching 200/180. Leonardo was born dead, she remembers and that he had apnea, a serious condition that required him to stay in the hospital for three months. Leonardo was intubated for 13 days. "He couldn't be carried; he couldn't feed by himself," the mother recounts. "The doctors said that the baby should reach three kilograms for the apnea to disappear," she adds.
Leonardo had recurring illnesses in his first three years. "He was vulnerable to sickness," says his father, adding that his son had asthma and primary complex. He had very weak health, as Leonardo would be in the hospital every week. "But when he started school, he improved a lot," his mother narrated.
Born 29 weeks through normal delivery, Joemart and Armay dela Rosa survived their sibling; the third of the triplets was stillborn. The triplets were conceived through a single dose of chlomiisphere. But the pregnancy was difficult, requiring the mother to undergo bed rest. She had premature contractions. The third baby, a boy, was already dead on the fourth month of the term. "They waited until the other babies were ready for delivery," the mother recalls. "We had a 50/50 chance, because the toxicity level was high," she adds.
Joemart stayed in the hospital for a month while Armay spent only two weeks. "They are okay now and are on the top of their class," the mother proudly says.
Tiny No More
And there were lots of other babies who have grown from the tiny bodies they were born with. They had a reunion one day to see how they have fared the last time they saw one another in a previous gathering. This year, they were the main characters in the reunion Bata, Bata, Kumusta Ka Na?, a gathering of high-risk mothers, their children, and their caregivers, at the perinatal center of the Philippine Children's Medical Center (PCMC).
Eight-year-old triplets Abegail, Jacklin, and Carissa Madrid. Abegail weighed 1,900 grams at birth; Jacklin, 1,880 grams; Carissa, 1,550 grams. They were delivered by C section at eight months, were incubated for a week.
Twins Katrina and Kyla Mendiola. Katrina's birth weight was 2,160 grams; Kyla's was 2,300 grams. Their mother has a mitral valve malfunction; delivered through C section. Katrina and Kyla have no apparent health problems, now at one year and four months.
Lhey Andre de Honor could fit a shoebox, according to the mother. Delivered normally at seven months, he weighed 1,860 grams at birth, and spent less than a day in the incubator. A kidney problem interfered with the pregnancy.
Born at 970 grams, Maria Dana Rodriguez, now one year and three months, spent 41 days in the intensive care unit. A product of a fertility work-up for six years since the mother was 31 years old, Maria Dana now weighs 6.6 kilograms. Neurodevelopmental tests revealed that she lags two months behind, but is now catching up. The mother's diligence in having her baby checked regularly helped a lot. She advises other parents to be diligent for follow-up check-ups.
Born ten minutes apart, twins John Paul and Jeremiah del Fierro are now six years old. John Paul weighed 1,540 grams at birth; Jeremiah 1,600 grams. They stayed in the hospital for two months, three weeks in the incubator.
9,000 and Counting
On an average of 50 admissions per month, the PCMC to date counts about 9,000 babies born low in weight who had been under the center's management, according to obstetrician- gynecologist-perinatalogist Corazon Yabes-Almirante, head of the PCMC perinatal center.
"It is all about facilities and knowledge," Almirante says of the success of the PCMC perinatal center, the first in the country and in the world. "It is the only perinatal center in a children's hospital," she says. Other perinatal centers are in general hospitals or medical centers, she adds.
Housing a perinatal center in a children's hospital has the advantage of being able to monitor high-risk pregnancies and low-birth-weight babies born of them. Almirante vividly remembers a case of abruptio placenta. The availability of the facilities that enabled them to monitor the pregnancy made the difference. "The baby was alive," she recounts. She adds that the available facilities and the knowledgeable staff in the center help prolong high-risk pregnancies to enable the mothers to deliver normally.
Now 15 years old, the PCMC perinatal center focuses on the survival of babies of high-risk pregnancies. Though the PCMC has only 12 beds for mothers and therefore the same number for babies in the neonatal unit, it boasts of a 1:1 infant to nurse ratio for high-risk babies and a 1:3 ratio for intermediate cases. To date, the PCMC has graduated 15 perinatalogists, 11 are in Manila and two each are in Davao and Bacolod.
The center is sometimes confronted with admissions problems since it has a referral system that necessitates them to admit patients from hospitals and medical centers in their network. However, due to its continuing fellowship and training programs, its is able to extend its assistance without necessarily physically transferring the patients to the center.
Called the Safe Motherhood Referral Network in Quezon City, it is a network created under the Perinatal Council in 1986, two years before the PCMC perinatal unit was put up. This network consists of four hospitals and one perinatal center and the Quezon City Health Department's 48 health centers and four lying-in clinics.
The four hospitals include the Quezon City General Hospital, Veterans Memorial Medical Center, Quirino Memorial Medical Center, and E. Rodriguez Memorial Medical Center. The network also includes specialty hospitals like the Philippine Heart Center, National Kidney Institute, and Lung Center of the Philippines. The PCMC perinatal center is the lead agency.
The network drastically reduced maternal mortality rates by 42 percent in Quezon City in its first ten years of existence. The perinatal mortality rate, on the other hand, dropped by 61 percent. The referral network involves the transport of either the mother or the infant. In its study, transported babies stay longer in the hospital, about seven days, while maternal transport reduces the stay to about four days, according to Almirante.
The Council also defined standards in perinatal care among hospitals and medical centers. Level 1 units are able to deliver normally and resuscitate both mother and child. Level 2 must have Level 1 capability plus diagnosis and treatment of high-risk pregnancies and neonatal problems; initiation and acceptance of maternal and fetal transport, and residency education. Level 3 must have the capability of Levels 1 and 2 plus neonatal surgery and intensive care for patients with significant complications.
Almirante notes that in the past a baby must be born at least at 28 weeks of gestation to have a good chance at survival. "Today, at 26 weeks [gestation], babies can survive. The very recent delivery at the PCMC [weighed only] 650 grams," she says. The baby was normal and doing well.
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