Miracle babies (25/11/11)
There are some things as a pediatrician you learn in a textbook, but see maybe once in your career. I vividly remember as a resident in Florida hearing of 2 twin babies coming into our pediatric ICU, severely dehydrated, with sodium levels over 170. Normal sodium levels are 135-145 – over 170 is getting pretty dangerous. And the 2 twin babies, severely dehydrated because the new parents just didn’t realise that mum didn’t have any milk, didn’t survive. It was once of those seminal training moments in which I somberly realised that sometimes, children can be so sick that they have passed the point of no return.
Since arriving in Kijabe, I have seen 4 babies with sodium levels of 200 or higher, and countless babies with sodium levels over 170. In the last month alone, we have admitted 3 babies with sodium levels between 160-213. And as the visiting anesthetist said to me with befuddlement on the Friday night we admitted one to ICU together – “that can’t be right… those numbers aren’t compatible with life!?”
Last weekend, Simon (pictured top left) went home with mum. The sickest of all of the newborns, he spent a week in intensive care, gradually turning from a shrivelled, dried chip of a baby to a healthy blooming, breastfeeding boy, looking around for his mother to take him home. When I met him in the emergency department, as soon as I saw his numbers (doctor friends: Na 213, Cr 11.9, K 8.5), I gently told mum we would do everything we could, but I was very worried he wouldn’t make it. We prayed with mum, and we admitted him to ICU. Under Wayne’s vigilance in ICU, he slowly recovered. As did Charity, another week old baby whose shrivelled little face slowly returned to cherubic – she went home the day before yesterday.
These are conditions in which the textbooks give vague directions about how to help, or instructions that end up being actually dangerous – no-one has a ton of experience with this. Jennifer, Immaculate and I have had a trial by fire over the last 7 months in managing these babies – and some babies, like sweet Vivian last week, have not made it. But many of them have.
Our friend Mary Adam is managing a community newborn health project which is, among many other good things, helping educate community workers on how to teach new mothers what the danger signs are, so that these babies come in before they are critically unwell. We really hope that as people in the community are trained in basic newborn care and recognition of danger signs, that we’ll stop seeing these little ones at all. It would be really nice to be obsolete here – for the malnutrition and calcium deficiency and dehydration to be things of the past. But until they are, we are here and happy to do everything we can to help these little ones when they do arrive.