By John Kelly
Wednesday, December 16, 2009; B02
Tara Taylor's colleagues know that when they arrive for a meeting she will already be there. Try as they might to beat her, she's always the first one to take a seat.
"I was born early," she says. "I've been early ever since."
Tara was born at 32 weeks, a fact that must give her some empathy for the tiny patients under her care at Children's National Medical Center, where she's director of neonatal intensive care nursing. The hospital's new neonatal intensive care unit, or NICU, opened in May, serving the tiniest humans you'll ever see.
I won't see them today, however. Concerns about the flu mean only parents and medical personnel are allowed through the doors of the NICU, where on this particular morning 56 babies are being cared for, two shy of the unit's capacity.
"It's a lot of babies," Tara says.
Babies that once would never have survived can now be saved. Machines such as the ECMO can serve as a sick newborn's lungs. A practice called total body cooling -- where newborns are placed on chilled pads -- can help recover brain function lost when babies are denied oxygen during birth.
Tara shows me a photograph of a newborn whose body is dwarfed by the adult hand next to it. The baby was born at 23 weeks, and her tiny right fist is wrapped around the grown-up's finger. The fist is too small to encircle the knuckle.
"That's my hand," Tara says. "And I don't have a very big hand."
A poster on the wall near the doors to the NICU reads: "Please keep your voices low so that our babies can rest."
"Most should still be in the womb," Tara explains. "We don't want them exposed to light and noise."
Premature babies are what Tara calls "foot-bracers": They like to have their little feet pushing against something, which is why nurses nestle them in soft nests. In the NICU, the nurses encourage parents to practice "kangaroo care," skin-to-skin contact that helps to regulate breathing and body temperature.
"I wish I could show you some of the babies," she says. "Come back after flu season."Ian's story
Tara told me that there's a saying in the NICU: "Never trust a preemie." A baby can seem fine one moment only to be in distress the next.
Ian McNamara was born at 32 weeks and four days -- mom Courtney's water broke while she was writing an appellate brief at the Department of Justice, where she and her husband, Sean, work. Ian was delivered at George Washington University Hospital, and doctors there noticed that a tube inserted down Ian's throat kinked up before it reached his stomach.
The 3 1/2 -pound baby was rushed to Children's, where pediatric surgeon Dr. Philip Guzzetta confirmed the problem: Ian's esophagus stopped at a dead end. It's a condition called esophageal atresia. His esophagus was also connected to his trachea, an abnormality called a tracheoesophageal fistula.
Dr. Guzzetta operated on the 15-hour-old Ian, opening the bottom of the esophagus, joining it to his stomach with seven tiny stitches, and separating it from the trachea. The newborn seemed out of danger. Never, however, trust a preemie.
The patient-nurse ratio of 1 to 1 or 1 to 2 in the NICU allows caregivers to mark the smallest changes in a baby's demeanor. A week and a half after Ian's surgery, nurse Sabrina Robinson-Antoine noticed that he seemed different. He lacked his characteristic energy. His abdomen -- which she measured regularly -- was slightly larger.
"She was on the phone within minutes," Courtney remembered.
Ian had necrotizing enterocolitis, an infection that strikes preemies. It, too, was treated in time.
Ian spent six weeks in the NICU at Children's Hospital. Now he's home with his parents.
"This can't be the same little baby we operated on," Dr. Guzzetta remarked at a recent reunion with the 4-month-old Ian. "He's huge!"
That's just what the parents of a preemie want to hear.You can help
The McNamaras' insurance covered the sizable bills for Ian's treatment. Thanks to donors such as you, the same care can be extended to any child. Please support our annual fundraising campaign by sending a check or money order payable to "Children's Hospital" to The Washington Post Campaign, P.O. Box 17390, Baltimore, Md. 21297-1390.
To donate online using a credit card, go to http://washingtonpost.com/childrenshospital. To give by phone using Visa or MasterCard, call 202-334-5100.