Pediatrics: Miniature Maharajahs in the Taj Mahal

Only the doctors and nurses specially assigned to the new unit at Palo Alto-Stanford Hospital Center were allowed to enter it, and even they had to “scrub up” first and put on a sterile gown, cap and mask. Lining the pale green wall was a row of Plexiglas-covered incubators. The babies who wriggled and squeaked in them last week were being treated like miniature maharajahs, with the most expert and intensive care around the clock. To diaper them with out changing the balmy temperature of their isolation, nurses worked through armholes in the incubator sides. Some of the babies were no bigger than a man’s two fists, and all were tiny. Since their weight at birth was less than 5½ Ibs., they were classed as premature.* From these wrinkled, red blobs of humanity, investigators at the Clinical Research Center for Premature Infants hope to glean basic medical knowledge to be applied in the saving, care and feeding of preemies everywhere.

Historic Hiccup. Half a century ago, doctors thought that prematures just died, and there was nothing they could do to prevent it. Now all major U.S. hospitals have special incubator units for them, and the death rate has been drastically reduced. But it is still 17.3%, or 20 times as high as that for normal babies. If that death rate is to be reduced still further, medical scientists must have new, fundamental facts.

Conceived by Stanford’s imaginative Professor of Pediatrics Dr. Norman Kretchmer and Dr. Sumner Yaffe, the new unit on the third floor of the Stanford Medical Center (whose ornate design by Architect Edward Stone leads townsfolk to call it the “Taj Mahal”) is intended to win that kind of basic knowledge. Since Dr. Kretchmer and his colleagues want data that can be applied to all premature babies, they are studying an average run of preemies. Most are normal except for their size, though last week one had to be fed by a tube leading directly into its stomach through an incision above the navel. It hiccuped constantly, prompting a nurse to remark: “That ruins the theory that eating and swallowing air cause hiccups —that little fellow never swallowed anything in his life.”

One research project will investigate the phenomenon by which the infant makes energy by metabolizing only sugars in the first 36 hours of life, then apparently switches over to fats and proteins. At the same time, instead of exhaling only as much carbon dioxide as the oxygen it inhales, the newborn child begins to change the ratio and soon puts out ten volumes of CO² for seven volumes of inhaled oxygen. Nobody understands just why, but with uncannily delicate instruments, which will measure gas ratios to an accuracy of one part in a million, the Stanford researchers hope to learn more about it. And then, more important, they hope to use this knowledge in setting ideal oxygen concentrations for babies in different stages of prematurity.*

Incubator Emotions? Another puzzle under study at Stanford involves the workings of the brain of an infant ejected prematurely from the womb. Its electrical discharges are different from those of a full-term baby’s brain, and to find out just how the preemie’s brain waves change, Dr. Kretchmer’s group has devised a special electroencephalograph connected to babies’ heads.

After a preemie goes home, the Stanford center’s researchers will make periodic checks on its development for at least two years, and even longer in special projects. One of these is to find the answer to a baffling question: Is the fact that prematures tend to have more than their share of emotional troubles in later life a result of being denied motherly cuddling during those first few weeks in an incubator?

* Doctors no longer try to determine prematurity by estimating how far gestation has progressed, but have set an arbitrary cutoff weight of 2,500 gm. (5½ Ibs.). Any baby smaller than that is likely to need special care. A preemie may have had anywhere from 27 to 39 weeks of gestation. *A decade ago doctors learned that too much oxygen in the incubator, followed by an abrupt switch to normal air, was causing thousands of cases of blindness through an abnormal fibrous development behind the eye’s lens (retrolental fibroplasia, or RLF). Now that oxygen concentrations are kept lower and are tapered off gradually, such cases are extremely rare.