(Photo courtesy of http://www.lunch.com/bbbabies)
There are times in a physician’s life when battles are thought to have been won, only to be conquered later by unexpected turn of events. Say for instance, a cancer that was cured after surgery and series of chemotherapy, only to find out that there was recurrence after five years from the treatment. Such is what happened to a colleague of mine who was initially cured for breast cancer, only to recur and eventually killing her.
In the field of neonatology, idiosyncracies abound, and one cannot always compare a baby to the other, no matter how similar the circumstances surrounding their birth, birthweight, gender, gestational age, or their cases are.
Another example… A 2-kg 32 weeks old male preterm was born with moderate oxygen requirement. He was intubated, but only requiring a continuous positive airway pressure. On his third day of life, I rounded him in the morning after attending to the birth of another baby, then went home for my prep before heading again to work. When I arrived home and just as I undressed to have my shower, the nurses called that baby suddenly had bloody discharge from the endotracheal tube, and they cannot appreciate baby’s heart tones. It took me about 30 minutes to return to the hospital. I resuscitated the baby for around 30 minutes and we were able to revive him. That’s almost an hour of being “dead” and yet I was able to discharge him later fully recovered, as if such event didn’t ever happen to him. I fondly called him “Lazarus” while recovering in the hospital, in reference to the dead man that was raised by Jesus. Sadly though I wasn’t able to follow-up baby as they were not able to pay fully their hospital bill, including my professional fee.
Whilst they say the more premature the baby is, the more resilient they are to lack of brain oxygenation, this is not always the case. When the 25 weeks old baby was doing valsalva maneuver to defecate, the resident was attempting to resuscitate him for 20 minutes before they called me up. I drove to the hospital for almost 5 minutes only, and spent 30 minutes trying to revive him. After almost pronouncing him after about 50 minutes of resuscitation, his heartbeat was back, but baby was having seizures and then became brain-dead in less than 24 hours. What might work for some babies, may not necessarily work for all babies, even if they’re born of the same age, weight and gender.