“Life is unfair,” is more than just a cliché. What is the essence of the gift of life if the odds of survival is 90 against 10? What is the essence if every single intake of breath is equivalent to hard labour in a maximum security prison; if every single second is a struggle to breath, a fight to stay alive?



I don’t have the answers. Maybe you do.



Good Friday. As I finished reviewing the very-low-birth-weight [born with a weight of less than 1.5kg] premature Neonate under my care, I had a huge smile of satisfaction plastered on my face. After 21 days on admission, he was already out of the woods,and was just “awaiting weight gain.”



I absent-mindedly told myself that I hope I won’t be getting another preemie anytime soon. Taking care of those little cuties is a back-breaking task that leaves you drained, both physically and emotionally. Especially in a resource-poor setting.



If only wishes were horses! Unknown to me, the universe, ready to Bleep me over, was sending another one, a more delicate and complicated case. I was still documenting in the child’s case note when this family came in, with what I presumed was a baby carefully wrapped up like a Burrito. From the way he was wrapped up, and the apparent size, I instinctively knew it was a preemie.



The 38 year old mother, who already had 6 other kids, had suddenly broken her water at 35 weeks of gestation, and had gone into labour proper after 5 days of draining colorless fluid, with the resultant delivery of the preemie.



35 weeks? Not so bad, I had thought. If I could take on 30-week olds, a 35-week old should be a walk in the park. The major problem I would have to watch out for was sepsis, as draining of liquor means a vent in the baby’s protective covering, and having it drag on for 5 days, before delivery, would mean infectious organisms could easily ascend the mother’s genital tract to infect the baby.



I was still questioning the Mom, when the nurse came back to tell me that she just weighed the baby, and the weight was 0.98kg. My heart sank. And it did so for two reasons. One; the chances of survival for preemies is directly proportional to their weight, and 0.98kg is Extremely-Very-Low-Birth-Weight — the type with the worst prognosis. Two; at 35 weeks, the baby should at least have been up to 1.5 kg. So, being 0.98kg means we weren’t only dealing with prematurity; we were also dealing with SGA [Small for Gestational Age]! The stakes had just gotten higher, and his chances of survival slipped a few because of it.



When I examined the child it was apparent why the weight was that small compared to what was expected at his age. He had an abnormal facie, and a grossly deformed left hand: the wrist was bent back on itself, in an impossible angle, with the fingers almost touching the forearm. And he was in respiratory distress, finding it difficult to breathe.



As a rule of the thumb, one Congenital malformation is an indicator to look for another, as they usually come in groups. And with the mother being more than 35 years [reminds me of the discussion we had on Florida’s wall 3 days ago about risk of fetal anomalies increasing with maternal age], and not attending antenatal, one would be stupid not to take a closer look.



The spine seemed okay. And so did the anal opening. But the abdomen was slightly distended [with no jaundice, nor engorged superficial veins to suggest a liver pathology], with no bowel sounds, and he was yet to pass meconium [the dark colored, first faeces passed by babies], all suggestive of some form of obstruction in the lower intestine. Too early to tell though.



There were ballotable masses on either side of the midline, just a little above the pelvis: what I presumed to be the kidneys...read on Syncityng.com (under guest columnist)