It was a slow day in the Women & Babies Hospital Neonatal Intensive Care Unit.Designed to simulate the womb, the Women & Babies NICU is home to premature babies for months after they arrive ahead of schedule. It’s quiet, with soothing lights, a leaf pattern pressed into the drop-ceiling panels and gentle hands doing for babies what their bodies can’t.
In one of its spaceship-like incubators rests Cole Stralo. This tiny infant (with a surprising shock of blond hair) was born Oct. 16 at 3:29 p.m. — nearly four months before his expected birth date. But here in the NICU, age is calculated a bit differently. To NICU nurse Cindy Castaldi, Cole is at 28 weeks’ gestation. And right now, Cole’s biggest problem is that he has yet to deliver anything into his diaper.
“We need his belly to learn to digest food because he will gain weight faster eating by mouth than with IV feeding,” Castaldi said. “So our concern for him is why he isn’t pooping.”
It’s Prematurity Awareness Month, and no one is more acutely aware of prematurity’s problems than Cole’s parents, Ryan and Aubrey Stralo, a young Ephrata couple, both teachers, who bear this stressful situation with cautious smiles as they gingerly reach out single fingers for Cole’s tiny hand to wrap around.
“We keep ourselves busy. I have to be busy, or I’ll just zone out,” said Aubrey, who had none of the known risk factors for premature birth, such as smoking or diabetes.
Cole has a better chance of survival now than he would have had just a few decades ago. Although heightened awareness surely has had an impact on survival rates, Castaldi and Dr. Manjeet Kaur, the neonatologist who founded Lancaster General’s NICU in 1984, agree technology has made the biggest difference.
“With the improved technology, it’s the rule rather than the exception that babies go home and do well,” Castaldi said.
During Kaur’s training at Philadelphia’s Medical College of Pennsylvania, now Drexel University College of Medicine, residents were told not to resuscitate babies under 25 weeks’ gestation.
“If the eyes were still fused shut, we did not resuscitate. That’s what we were told as residents. This area of medicine has come a long way since then. The technology is phenomenal. Just look at this bed,” Kaur said, motioning toward a plastic box loaded with tubes and gadgets.
Most lethal to premature babies is respiratory distress, which results because their bodies didn’t have time to naturally produce surfactant, a lung-regulating substance. In the early 1990s, hospitals began using a drug that replaces surfactant in premature babies, resulting in greater survival.
Kaur also credits prenatal steroids with alleviating lung distress in preemies. Now her earliest patients are inviting her to their Eagle Scout ceremonies and graduating from college. One even stopped by her house to break a block after he’d earned his black belt in karate.
Back in Cole’s room, Castaldi changes the boy’s tiny diaper; checks his temperature, heart rate and blood pressure; cleans his mouth with a swab; and situates him with special cushions to simulate what would be his position in the womb. His vital signs are recorded on a giant grid of tiny blocks titled “NICU Assessment Flow Sheet.” But Castaldi said it really amounts to “a day in the life of Cole, so far.”
Across the room, nurse Karen Buchanan feeds, then rocks, a premature baby whose parents have not visited her. Buchanan is new to the NICU after working with adult patients in dialysis. She said the pace is considerably different.
“There’s a lot of sobbing that goes on in here,” she said. “But you don’t even want to go back to working with adults after you’ve worked with babies. Just to have the time to sit like this and hold her for 40 minutes and to get paid for it … it’s a luxury.”
Meanwhile, the Stralos are wrapping up their visit with their son.
“It’s draining — mentally, physically, but it does get easier,” Ryan said.
“Not for me,” Aubrey said.
The Stralos’ first visit to the NICU came at the worst possible moment. Cole was “crashing,” his heart rate plunging, as doctors and nurses tried to bring him back. The experience made Aubrey apprehensive about holding Cole, who wears a complex system of tubes and devices to keep him stable.
These days, Ryan is the go-between with the doctors and nurses. Then he reports and “translates” the information to Aubrey.
“They tell us exactly what’s happening, good or bad,” Ryan said. “And I’d rather hear the truth. Even if it’s hard to hear, I’d rather hear the truth than, ‘He’s fine.’ ”
If there’s a positive, Aubrey said, it’s that she got to see her son sooner than she otherwise would have. But leaving him behind after his birth clearly crushed her.
“It’s like I never even had a child because he’s here,” she said. “That’s three months with him that I’ll never get back.”
Castaldi concedes that when Cole finally goes home — sometime after the holidays, when he’s learned to digest, can sleep in a crib, doesn’t need oxygen and has stable vital signs — it may prove a struggle for his parents, who now depend on hospital staff for his specialized care.
“It is a bittersweet kind of thing when they go home, because that support system isn’t there,” Castaldi said. “It’s so hard for us to predict what their experience will be. There will be good days; there will be bad days. There may be a good hour and the next might be horrible.”
But Kaur’s experience tells her that every day Cole lives his chances for survival increase. And a tiny start no longer means a tiny existence. Her former patient who earned his black belt tops 6 feet tall.
“If there’s anything that should be emphasized, it’s that prenatal care is the most vital thing in prevention,” Kaur said. “In many cases, there’s no known cause (for premature birth). But sometimes they can catch it in time and get the best care for those babies.” Find nursery nurse jobs online.