Our first group email

Below is the text of the first group email, which we first sent on Friday, 2/15, two days after Karen went into the hospital. Since then, the non-stress tests, which happen once daily in the morning, have all come back OK, with a couple of second-level confirmatory tests (called bio-physical profiles, or BPPs) required from time to time. As long as these continue to come back OK, BL (as some of you know, we have a name, but Karen is superstitious about using it too widely, so for now on this blog, "BL") will stay in utero. The longer he stays in, the better his chances. Having now spoken with at least 15 doctors (not kidding) over the past six days, we're not quite as confident about the percentages I quoted below. Despite the lack of concrete numbers, though, we're feeling good about things on the basis of the info we've been able to gather, and better every day.

2/15 EMAIL:

All- Just wanted to give a quick update. The basic deal is that he's staying in utero as long as he continues to perform well on his "non-stress tests", which are tracings of his heart rate over a period of 20 minutes to an hour. The decision to keep him in carries a risk of stillbirth if something goes south quickly, but that risk is something like 1/2000, and the doctors feel that the benefits to be gained from the additional development outweigh the risk. This morning, he had a tracing that was not as "reactive" as the ones he had yesterday, meaning that there were not as many accelerations and variations in the heartrate. That meant that we needed to go do a special ultrasound exam, on the basis of which he was scored on four categories. He scored a 6 out of 8, missing only on the "breathing" function (they look for movements that indicate that the baby is practicing breathing). At this gestational age, the breathing movements they were looking for happen only sporadically, so it wasn't particularly troubling that they didn't see any during the 20 minute observation. Everything else, including movement, looked good, so on balance, they weren't overly concerned, but wanted to make sure it wasn't a trend downward from yesterday's excellent performance. Accordingly, they did another tracing a couple of hours after the ultrasound, and he knocked it out of the park. Exceptionally reactive.

The best news of the day is that we are officially through the critical 48-hour period during which the steroids they started administering on Weds night are supposed to act on the lungs. The doctors would of course love for him to get as much time in utero as possible, and would feel most comfortable if he could get to 32 weeks, but this is a huge step. Our sense is that we will be lucky if he continues to do well enough to stay in for more than another week.

Here is some of the critical info that we've gathered so far:

- At this gestational stage and this size (1lb, 10oz!), mortality is about 15%. Gestational age is more important than size, but size makes a difference too.
- Of the 85% that survive, 10-15% have long-term problems.
- The biggest categories of serious risks for premies are (i) breathing problems due to lung immaturity, (ii) bleeding inside the head (various degrees of seriousness), (iii) digestive and bowel problems.
- They don't know why the placenta is not functioning properly. The two most likely causes are (i) improper attachment with the uterus from the beginning and (ii) chromosomal abnormalities. There is about a 5%- 8% likelihood of category (ii), and a huge range of possible manifestations in that case. The likelihood of the three most common chromosomal abnormalities (trisomy 13, trisomy 18, and downs) is very low, as we've been screened for those already.

Tomorrow, we expect to get another tracing in the morning and take things from there. To borrow the tiredest cliche in the sports-interview lexicon, we're just taking it day-by-day. We're in a much better place psychologically than we were when we left the obstetrician's office on Weds, and his chances have already improved dramatically.

Thanks to everyone for the thoughts and prayers, we feel extremely well loved.

We'll keep you all posted and talk to you soon. Please feel free to forward this along to any of our other friends and family who might be looking for an update.

Love,
Joe and Karen