By Dr Anna Hedstrom – International Medical Volunteer
Dr Anna Hedstrom, a Neonatal-Perinatal Fellow at the University of Washington, recently returned to Uganda as an ISIS International Medical (IMED) volunteer. While at Kiwoko Hospital, Anna worked on further developing the CPAP project to help newborn babies breathe. Here, she tells the story of baby Ann, whose life was saved by this treatment.
Baby Ann was born two and a half months early, but thankfully, she was brought to one of the few places in Uganda where a baby this small could survive – Kiwoko Hospital. Ann weighed a little over 1100 grams and lacked the insulating baby fat that babies who are born full-term have to keep themselves warm. This meant Ann’s temperature would drop quickly in the open air. Unlike many hospitals in the developing world, the neonatal intensive care unit (NICU) at Kiwoko Hospital has incubators to keep her snug until she grew big and stable enough to be swaddled to mom’s chest. Ann was also not old enough to be able feed at mom’s breast, instead needing a feeding tube and an intravenous drip to ensure she received adequate nutrition for a few weeks.
Unfortunately Ann was born with an additional problem – the same “respiratory distress syndrome” that John F. Kennedy’s premature son died of in 1963. Ann’s tiny lungs were not able to stay open and instead collapsed with each breath making it very difficult and tiring for her to breathe. Dr. James in the Kiwoko NICU had seen this problem before. He had watched many babies born early succumb to this breathing difficulty and had tried countless different ways to help their lungs function and give them a chance to survive. None had been successful. Baby Ann lay in her incubator, using all her muscles to pull in each breath. Her ribs could be counted easily and her nostril flared like a runner finishing a marathon. She had not been able to eat yet because her stomach wouldn’t tolerate food while she was working so hard to breathe. Luckily for Ann, Dr. James now had a new tool to help.
CPAP (continuous positive airway pressure) is a device similar to those used for adults with sleep apnoea to blow air into the nose, keeping the airways open and preventing collapse. This device is used for preterm babies in developed countries to help their breathing until their lungs can develop further. Due to a partnership with the University of Washington in Seattle, Dr. James now had a CPAP unit for use in the Kiwoko NICU. Although the unit had just been unpacked, Dr. James knew that it was Ann’s only hope for survival. With the help of the veteran nurse-in-charge, Sister Christine, baby Ann had a new cannula attached which delivered air pressure into her nose. Instantly, her wild chest movements calmed and her nostrils no longer flared dramatically with each breath. The amount of oxygen in her blood climbed and she relaxed into her blankets, getting a break from a dramatic first few days of life.
The Kiwoko NICU has always been a place where small babies have a chance. The nurses in the unit have thorough and excellent training at keeping babies like Ann alive so they can grow and go home to be with their families and they took very good care of this tiny little girl. With the addition of CPAP the unit became even more capable and already we can see dramatically increased survival among the smallest babies. For Dr. James and Sister Christine, this means more families who entrusted their newborns to the Kiwoko NICU get to take their babies home to flourish.