...of Prematurity

Premature infants face many obstacles in their first weeks of life.  For example, due to the immaturity of their brains, premature babies often 'forget' to breathe.  They call this apnea of prematurity.  During these respiratory pauses, heart rates often drop concomitantly.  They call this bradycardia of prematurity (brady = slow; cardia = heart).  Due to the immaturity of their bone marrow, many pre-term infants develop anemia (low red blood cell counts).  They call this.....you got it....anemia of prematurity.  Edward has suffered from all three of these things. 

He has gotten a few blood transfusions along the way.  The neonatalogists must walk a delicate balance of ensuring that he has enough red blood cells to deliver enough oxygen to all of his organs as they develop while not suppressing his own internal drive to make more red blood cells.  If they simply pumped him full with blood transfusions, his own bone marrow would not be stimulated to make his own red blood cells.  This past week, they checked his hemoglobin and hematocrit (laboratory measures of his red blood cells) and they were slightly low.  But not quite low enough to trigger a transfusion. As he grows, we hope that his bone marrow will continue to develop along with him and his anemia will resolve.

Since his birth, Edward has also struggled with neutropenia.  White blood cells are the cells of the body's immune system which help protect from infection.  Neutrophils are a specific type of white blood cell that are particularly important in fighting off acute bacterial infections.  When there are not enough of these types of white blood cells, this is called neutropenia.  For example, chemotherapy often temporarily wipes out these types of cells (sometimes all the way to essentially zero), which is why cancer patients receiving chemo are so susceptible to infections  Since the beginning, Edward's neutrophil count has been slightly low.  Not dangerously low thankfully, but less than the lower limit of normal.  Not terribly surprising given his prematurity, but similar to his anemia, we hope that he simply grows out of this.

Edward also gets his eyes checked on a regular basis.  He had his first check about 3 weeks ago.  What the pediatric ophthalmologist  is looking for is retinopathy of prematurity.  In a regular full term infant, the retina matures while the baby is in the womb and at birth is fully vascularized (ie all the blood vessels it needs have been formed).  In contrast, pre-term infants must complete this process of retinal vascularization outside the womb.  For reasons that are still unknown, this maturation of these blood vessels can proceed abnormally in a disorganized fashion.  This is called retinopathy.  Best case scenario, this retinopathy can totally resolve on its own.  Worse case scenario, it can lead to blindness from retinal detachment.  Fortunately, modern medicine has made the worst case scenario extremely rare. 

On his first check, Edward did not have any retinopathy at all and obviously we were thrilled.  Unfortunately, on his second exam, he had developed Stage 2 (of 5) retinopathy.  The meaning of this remains unclear because these findings can either resolve spontaneously on their own without any long term consequence or they may progress to further stages requiring treatment such as laser ablation.  For now, the ophthalmogist will come by on a more frequent basis to monitor his progression.  We are hopeful that Stage 2 will be as high as he goes!

In slightly better news, Edward is now 2 months old and he is 4 lbs 4 ounces!  He also enjoyed his first St. Patrick's Day.  I am having some technical difficulties at the moment and cannot post any recents pictures!  I will try to add some later this afternoon....sorry!