Mighty Mites

When last we left our soon-to-be twins, my nephew’s in-utero munchkins, the first babes of a new family generation, it was the day of their big reveal ultrasound. That day their parents, grandparents, friends and family were presented with two beautifully decorated pink cakes which had been pre-arranged by the ultrasound tech and the bakery to reveal the gender of each of the developing, precious little … GIRLS! Joyful celebration followed as the magical images of the twins became more and more real.

A few short weeks later, what had up until then been a nearly perfect textbook multiple pregnancy raced to a crashing and unexpected finale when the baby girls were born early — way early at 24 weeks gestation.

24 weekers dance on the edge of viability. They’re called micropreemies, and they face a long list of monster hurdles while we do our best to support them in an environment that’s as womb-like as possible while they continue to cook. None of their organ systems are ready for the outside world yet.

They typically weigh just over a pound and measure about 8 inches long.

They can’t regulate their body temperature and lose heat and fluid rapidly.

The blood vessels that feed their tiny brains are hair-thin and fragile. A simple sneeze or hiccup can be enough to start a bleed inside the brain that may be devastating.

Their eyes are still fused shut.

Their skin is thin and gelatinous, with visible veins.

Their lungs aren’t developed enough to transfer needed oxygen to their blood.

Their little immune systems haven’t shifted into gear and they’re prone to overwhelming infection.

Their GI tracts can’t absorb nutrients from breast milk or formula, and they’re no longer getting nutrition through the umbilical cord.

They don’t look anything like babies, but much more like tiny baby chicks.

The goal for micropreemies is to keep them alive and dodge as many crises as possible until they make it to, or beyond, their due date, when they just might be big enough and stable enough to leave the neonatal intensive care nursery. In the meantime, it’s scary as hell: an endless roller coaster ride where the stakes are life and death.

And so it was for our girls. M (Twin A) was a few grams bigger than C (Twin B). And feistier. With attitude. Through the weeks to come she would emerge as a leader, blazing the trail while her smaller sister stayed right on her heels.

Both girls fought their way through their first surgery at 10 days old to close an errant connection in the heart (one that normally closes at birth, but not in micropreemies).

When M began taking tiny volumes of her mom’s breast milk via a tube passed down into her stomach, and quickly doubled and tripled her intake, C was there demanding (in preemie language, of course), “me too!”

When M was weaned off the ventilator WAY sooner than any of the medical staff expected, C was not to be outdone. Within days she was off the machine.

Last weekend, when the girls would have been right at 37 weeks gestation, I flew out to see them. M had been discharged home just the day before, 3 weeks ahead of her due date. C will soon follow. They are perfect.

They are some tough cookies.

They’ve dodged every conceivable bullet. No brain bleeds, no infections, no obvious damage from the ventilators, no vision problems, no developmental delays. They’ve sailed through the minefield virtually unscathed. And beat the expectations for every conceivable milestone and benchmark.

Their Mommy and Daddy weathered the stomach-lurching drops and curves as gracefully as anyone could. Their families were there to step up, hold back and provide whatever was needed.

This, my friends, is the definition of resilience.

How much is luck? How much is great genetics? How much is the vigilance of parents and extended family who will do anything to make sure they beat the odds? How much is expert, excellent medical care? I have no answers, but I will say that I’m amazed and proud.

As I hold our beautiful little girls, and whisper to them how much they are loved, I’m so grateful for their strength. And for the power of life.




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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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