At 26 weeks of gestation, weighing 815 grams and with a length of 33 centimeters, Daniela was born. "It's a miracle," says her mother, Cori Vázquez. A few days after she was born she weighed 740 grams, just over half a kilo of life to which Daniela clung tightly to get ahead. Also her mother, for whom things were not easy. Now, more than four years later, they are both in good health and consider themselves "very lucky" after all.
Cori barely enjoyed her pregnancy for about two months. When she found out that she was expecting a baby, she was already four months old as a result of a general malaise that she had felt for several days. "Only two weeks after finding out she was pregnant we were told we were going to have a beautiful girl. It was all happiness and joy, what could go wrong?" she states. But it didn't last long. Barely a month after receiving the good news, Cori sensed that something was wrong. "In February I started to feel bad. My stomach hurt a lot and I went to the midwife and she told me it would be heartburn, but I knew it wasn't that. I went to the ER and they told me that first-timers were very complainers With those I returned home," he says. But the discomfort worsened with severe headaches. On March 7, Daniela was born by an emergency caesarean section at week 26, entering the category of those called extremely premature, due to circumstances in which neither she nor her mother, who suffered preeclampsia from who went into a coma. "Upon arrival at the hospital they told my partner who they were going for, he said that for me, but the doctors promised to do everything possible to save us both. Daniela was born dead, but they revived her and came to life . I went into a coma. When I woke up I didn't know where I was. I had to learn to eat and walk," he explains.
Seeing her daughter gave him hope. "About a week passed since I woke up when they took me in a wheelchair to see my little girl. When I saw her so tiny and full of cables, I only knew how to ask God to help us," she says. Here began an ordeal. "They had to give her blood three times because she had anemia and she caught a bacteria. She had to have an emergency eye operation because otherwise she would go blind. She needed constant oxygen. The doctors gave us good news, but then bad news. We clung to God's help and I asked my two grandmothers María and Coro to help me from heaven", says Cori excitedly.
According to data from the INE, in Spain around 27,000 premature babies were born in 2020, that is, they arrived in the world before the 37th week of gestation. At the Virgen Macarena Hospital, where Daniela was born, they represent 7% of all births per year. The Neonatal Unit that is responsible for ensuring their survival resolves with a high rate of it, higher than 98.7% in the last year, of those born before 37 weeks of gestation.
An integrated care
But not all pregnancies of women who give birth to premature babies are the same, nor do all newborns with this condition have the same characteristics. Pediatrician Leonor Bardallo, from the Macarena neonatal care team, points to "multifactorial" causes as the keys to the greater number of premature births today, related, above all, "to the lifestyles of the mothers."
Living conditions in the first weeks of a premature infant also depend on multiple factors. The most important: the gestation time. Professionals make great differences between late preterm infants (from 32 to 37 weeks) and very extreme premature infants, with less than 28 weeks of gestation. "It is logical that the lower the gestational age, the greater the complications it develops," adds Dr. María Jesús Rodríguez, who clarifies that, at birth, respiratory complications are the most important, while, with the passing of days, the evolution of the minor "will depend on other issues such as possible cardiovascular sequelae, tolerance to food or possible infections," he highlights.
The largest number of premature babies are born between weeks 34 and 36. In general, in this type of child there are usually no serious complications. The really important problem of prematurity is the children who are born before the 28th week and weigh less than a kilo, the professionals emphasize.
As for the care these children need until they can go home, the professionals of the Neonatal Unit describe it as "integrated care". Also a doctor in the unit, Jessica Gómez, highlights the importance of family participation in the care of children from birth, in addition to a multidisciplinary team. That is why techniques such as the Kangaroo method are becoming very important in the center, as well as the establishment of rooms adapted for parents to spend as much time as possible with their children. Along these lines, other resources available to the families of premature babies are added as the hospital is a satellite center for breast milk.
Elijah and Noel
Like Daniela, Elías and Noel are two other of those heroes who are ahead. Warriors who have taken a good bite out of life and fight with all their might to survive. The pregnancy of Ana María Gómez, her mother, came at a time when she was about to throw in the towel. After three years of fertility treatment, on the fourth attempt she managed to get pregnant in December 2020. "Not only had we managed to get pregnant, but we also had two, so the illusion was double. We did not hesitate to go ahead with both" , recounts.
In the case of Ana María, it was 27 weeks and six days of gestation and her babies were very premature. At week 19 she woke up one night "very wet". She had ruptured one of her twins' sacs and she was leaking amniotic fluid. From here, the birth of one of her children is practically lost. "I went to the hospital and in High Risk they told me that this would be an abortion and that in about two days they would have to take them out. I did not understand why if one of the children had a good bag, why would I have to lose it too. My world fell apart " , manifests.
But Ana María clung to the minimal possibility of less than 5% that the professionals gave her of being able to save at least one of her children. Here began a battle in which the mother of Elías and Noel spent 63 days bedridden avoiding any movement that would complicate the possible future of her children, then only 200 grams in weight. Just as Ana María's uterus regenerated liquid, she was automatically expelled due to the rupture suffered by her bag. This is how the days passed until, in the 25th week of pregnancy, the bag of the second child broke. Two weeks later, when Ana María was not expecting it, she suddenly went into labor. Noel weighed 750 grams. His brother, Elías, 835. They went directly to the neonatal ICU. "If I thought that the 63 days that had passed before they were born was the worst, the 79 that we have been with the hospitalized children, dying until the last days, were hell. We have been through a lot, but my children brought a great instinct of survival and with the help of the hospital staff and the advancement of medicine, today we can enjoy them", says Ana María.
The universe in which the professionals of this unit work as a team, side by side, to manage to generate an atmosphere of humanity that is key in the management of children and also their parents is one that nurse Ana Asunción Rosado has been "enjoying for almost 40 years". ". For her, working with newborns "is lucky." In her long experience she has seen how everything has evolved. From the sad look of the parents through a glass to the moments of "skin with skin". "They are parents who are confused, who await their babies with great enthusiasm and find that everything is complicated and they cannot take it home and that everything gives bad information. Having advanced so much and now being able to be with the children it is very important," says the nurse, who highlights how the unit works in a "family" atmosphere between professionals and families. "In the farewells home there are usually tears, we feel that they are our children," she says.
Her supervisor at the plant, Isaac Garcés, highlights the dedication "24 hours a day" of the nurses "at the foot of the incubator" to ensure the health, not only physical, but also emotional of the children. "We can say that we are the doorway to a mother's knowledge regarding her child in a situation as special as having a premature child. Many doubts arise and, there we are, too, a little, like that necessary emotional support ". In her day to day, between hard times and joys, she always weighs more the latter.
That humanization that characterizes her professionals is the basis of today's celebration of Premature Children's Day in the center. A day of coexistence in which Lidia Ruiz, also the mother of a premature girl, Daniela, is the forerunner together with the professionals. "It was a challenge that I set for myself since I had my little girl. On the one hand, as support for those who are going through it right now, so that they see that there is a way out; and, on the other, to reflect in society that these children are some real warriors. Being premature is not being born with a low weight and spending time in an incubator. They are children who, as soon as they were born, have faced incredible fighting situations, "he highlights.
In addition to the information that health personnel make available to families, for Lidia it is very important to make visible the need for more resources for these children. "They need continuous monitoring with many trips to the hospital and, in some cases, many more therapies are necessary, sometimes very expensive that many parents cannot afford," she claims. "We also miss more psychological support," she adds.
Her partner in her unit, Maleni Zarallo, coincides with her. This auxiliary nursing care technician (TCAE), now, specifically, at the Donated Human Milk Satellite Center, highlights, from her position, the importance of giving encouragement in the face of uncertainty and fears of families. "No one has prepared them for this moment. The normal thing is to think that you are going to have a full-term, healthy child and that you are going to go home in two or three days, but that is not always the case," she says. "The problems of premature children are not only due to lack of weight, as one might think. The complications go much further. There are many organs that have not finished forming," she adds. Hence the importance of psychological support. "A helping hand that comforts and helps and is missed," she says. She also claims more help for families to be able to face discharge therapies, on many occasions, "very expensive".
The return home
After three months in the hospital, Daniela was able to leave. She already weighed 2,400 grams. "Three months later, Daniela was still in the ICU. But they transferred her to the ward and they told me that I could take her with me, but that we had to put her on oxygen. We were terrified. Although they told us that Daniela could be on oxygen for life because she has pulmonary dysplasia, having my little girl in my arms and being able to take her home was the happiest moment of our lives. It wasn't easy. I look at her and it seems like a lie," says Cori.
Elías and Noel left the hospital before three months of admission. They came out with 2,500 grams. In their case, they were prescribed a treatment with oxygen therapy. "I have a house in my house that looks like a hospital with oxygen cylinders everywhere, but, thank God, they haven't needed them. They carry that immaturity for having been born three months earlier, but they are developing normally," explains Ana María.
The follow-up of a premature baby during its first years of life requires specialists in neonatology, pulmonology, ophthalmology, as well as occupational therapists, physiotherapists, and nutritionists. "In general, they are quite individualized follow-up plans because they must be adapted to the needs of each child. Professionals from different specialties involved in the proper development of the child participate in it," concludes Dr. Carmen Salamanca.
