Until the 1980s, it was generally accepted in the medical community that premature babies born at 28 weeks or earlier would face an almost impossible struggle to survive. In the 40 years since, pediatrician and ICU specialist Dr. Michael Apkon has seen that number go down to 24 weeks and even earlier.
“That’s an appreciable impact,” stressed the former CEO of Tufts Medical Center in Boston. Dr. Apkon has also served as CEO of the Hospital for Sick Children in Toronto, Canada; Chief Medical Officer of the Children’s Hospital in Philadelphia and Vice President of Yale New Haven Children’s Hospital during his long career.
“I know of many preemies born at 24 weeks — four months early — who are now young adults,” said Dr. Apkon. “We’ve become better at understanding the mechanisms of extreme prematurity and better at treating those complications.
"We’re better at managing pre-term labor and better at reducing retinopathy, lung diseases, GI complications — so not only has that promoted a better chance of survival but it’s improved outcomes beyond survival.”
“We’ve become better at understanding the mechanisms of extreme prematurity and better at treating those complications."
Kangaroo care, the rise of medicines like surfactants that help premature lungs develop and the regionalization and centralization of concentrated, specialized care have increased odds of survival, but they’ve also, in some ways, according to Dr. Apkon, created a greater burden on the families — socially, emotionally, financially — who are often separated from their newborns, homes, and support systems for extended periods of time.
“The consequence of this regionalization and improved survival is also a longer hospital stay, so babies are separated from their parents and parents are separated from other children and family.”
Dr. Apkon got to know Ted Yang and his wife Christine during Yang's preemie triplet’s stay at Yale New Haven Children’s Hospital, as described in the memoir, Table for Five, A Father's Story of Life, Love and Loss.
Yang and his family’s neonatal intensive care unit (NICU) experience was quite different from when Dr. Apkon first started his practice.
In the early 1990s it was still common to have 20 or more isolettes arranged in a NICU. There were no private rooms for families. There was no skin-on-skin contact (kangaroo care) for mothers let alone fathers to bond with their babies.
“When I started my training, the NICU was more sterile,” recalled Dr. Apkon.
Today, according to Dr. Apkon, the trend is for NICUs to move to individual private baby rooms, which not only promote greater family connection and offer more privacy but provide a safer environment for family members to visit without endangering other babies. Some NICUs even let parents stay overnight so they may have a more “typical” parenting experience.
Yang and his wife Christine helped Dr. Apkon see what the hospital system of care was like through a parent’s eyes.
“We don’t always know how our system of care is experienced — how well we communicate and how well we help parents who are dealing with children in hospitals,” he explained. “Ted’s input was valuable. We’d bounce ideas off each other and we became friends.”
With 1 in 10 births defined as premature (born before 37 weeks), chances are we all at least know of someone who spent time by a preemie’s bedside in a hospital.
“Ted and Christine’s story is not unusual,” Dr. Apkon said. “While every baby’s story is a bit different, the kind of experience Ted has written about in his book is a very common experience. What’s unusual about it is that not many fathers tell their stories. That’s very valuable.”