Nine-year-old Jeremy Felton is one of the patients whom doctors and nurses at Valley Medical Center point to with pride.
Jeremy, who was born 10 weeks early and weighed less than 3 pounds, is legally blind but can see somewhat with corrective lenses. He gets around in a wheelchair, but can stand and walk if someone helps him.
Although his speech is almost incoherent, he can speak and understand what other people are saying. He can feed himself, although he has difficulty controlling the spastic movements of his limbs.
Jeremy is one of the lucky ones. He owes his life to the miracles of modern technology.
Technology Spurs Debate
Recently, however, a debate has been growing over the use of that technology. At what point is a premature baby worth saving, especially if saving the baby would risk the life of the mother?
Hundreds of premature infants each year are born far worse off than Jeremy--many with underdeveloped brains that prevent them from seeing, hearing, talking, eating or even knowing they are alive.
Should Jeremy have been saved?
"Yes," says Vickie Meyer, head nurse at the neonatal intensive care unit at Valley Medical and one of the nurses who cared for Jeremy during his first year.
"Jeremy is loved and he loves, and he's happy and he's healthy. The value of life outweighs the cost. Jeremy is such an important example of all that," she said.
But many parents, those with children worse off than Jeremy who require constant medical attention, do not share Meyer's opinion.
"With hospital bills that range between $100,000 and $250,000, a lot of people say, 'Why are you wasting your money?' " Meyer said.
Ten years before Jeremy was born, the chances of his surviving would have been almost zero, but neonatology has been advancing at a rapid rate.
Ten years ago, 9 out of 10 babies born at less than 2.2 pounds died. Today, their survival rate among newborns at Mt. Zion Hospital in San Francisco, for example, is 78% among those weighing between 1.65 and 2.2 pounds and 67% among those weighing 1.1 and 1.65 pounds.
"Although we're saving more babies, the goal is to save more babies who are intact, not more babies with problems," said Dr. Roberta Ballard, a neonatologist and head of the newborn intensive care unit at Mt. Zion.
Fewer than 20% of babies born at less than 2 pounds are developmentally disabled.
When President John F. Kennedy's son was born in 1963 one month early and weighing less than 5 pounds, not even the power of the White House could save him. The family called in the best specialists, who did everything they could, but the baby was dead within 24 hours.
"Today that baby would not have died anywhere in this country," Ballard said, adding that some babies born today weighing slightly more than 1 pound grow up to lead healthy, normal lives.
Perhaps the most significant advance in neonatology since then has been the ability of doctors to keep babies breathing long enough for their lungs to produce enough surfactant--the material that coats the lungs and keeps them from collapsing, thus allowing enough oxygen to get into the bloodstream to keep the baby alive and prevent damage to the brain.
New Types of Respirators
New types of respirators and methods of feeding tiny infants intravenously have helped, and so have the high-tech scanners that monitor everything from pulse rate to oxygen flow.
"It's not all technology, however," Ballard said. "Part of it is an improved ability to work with women prenatally. With that aspect, there's still a big problem.
"It's a societal problem," she said. "A third of women in Calfornia still receive no prenatal care. There is not enough access. Cocaine is also a problem, particularly 'crack.' It produces a lot of pre-term babies with bad problems."
There are also things that can be done medically, both to prevent premature birth and to prevent developmental disabilities once the woman goes into labor.
"We're getting better at stopping premature labor," said Dr. Ron Cohen, head neonatologist at Valley Medical, who added that a number of newly developed drugs can be taken both intravenously and orally to prolong pregnancy if the labor is caught at an early enough stage.
There are also steroids that can be injected into the fetus to enhance growth and prevent later developmental disabilities.
For Jeremy Felton, none of that was possible.
Jeremy was born at a house in the Santa Cruz Mountains. He was transported to Valley Medical by his young parents in a pickup truck, and his face was blue by the time doctors got hold of him. Jeremy now lives with adoptive parents and despite his disabilities, he is making progress.
There are a growing number of programs designed to help children like Jeremy cope with their disabilities and enjoy life.
He returned to Valley Medical recently for the first time to visit some of the people who helped bring him into the world. "He'll be standing and walking before you know it," Meyer said.
One problem with making life-or-death decision about premature infants is that one usually has no idea if the child will grow up disabled. Another is that if the decision is made before birth, it often involves choosing between saving the baby, even though it may be disabled, and risking the life of the mother--a difficult decision for a first-time father.
"There are both families and doctors who say they aren't going to stop no matter what," Ballard said. "My personal belief is to sit down with the family and try and determine the outcome."