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‘Fragile Beginnings’ by Adam Wolfberg

BOOK REVIEW

THIS STORY APPEARED IN

February 06, 2012|By Jason Warshof

"Fragile Beginnings" by Adam Wolfberg

When my wife, Diana, went into labor 12 weeks early, I was out of town. On the stunned, early-morning ride to the airport in Baltimore, I was certain our child would either not survive or that the complications would be too severe to imagine. Fending off the grimmest thoughts, I rehearsed writing to loved ones to explain what had happened.

But while I was still in the car I received a call from my father-in-law at Cambridge Hospital, first congratulating me on the birth of my son and then informing me of a “best-case scenario.’’ The baby had received a high Apgar score - a rating of overall infant health - and weighed 3 pounds, 2 ounces, in the 90th percentile for his gestational age. Diana’s father also mentioned the figure 80 percent, which I would later learn referred generally to survival for babies born at 24-32 weeks.

My response to the upbeat call was disbelief. How could an event so out-of-order, so unforeseen, end well?

But, as Dr. Adam Wolfberg explains in his book, “Fragile Beginnings: Discoveries and Triumphs in the Newborn ICU’’ - a page-turner for any parent of a premature infant - today’s enhanced prospects for preemies are grounded in an array of scientific advances. And the successes are well documented. According to one study, the mortality rate for infants born at 28 weeks fell from 70 percent in 1958-1968, to 10 percent by 1988.

Wolfberg’s book begins with the deeply personal story of his daughter, Larissa, who was born at 26 weeks in January 2002, weighing just shy of 2 pounds, and alternates with a broader discussion of recent innovations in care for premature infants. A medical resident at the time of Larissa’s birth, Wolfberg is now a physician specializing in high-risk obstetrics at Tufts Medical Center.

Wolfberg writes that a pivotal case in the modern quest to improve outcomes for premature babies was that of Patrick Bouvier Kennedy, the son of President Kennedy who was born at 34 weeks in August 1963 and survived only two days after developing respiratory distress syndrome, a condition routinely treatable today.

Since then, advances have included the creation of separate hospital units for preemies, along with improved methods of feeding intravenously, more sensitive regulation of oxygen - a cause of blindness when given too liberally - and the discovery of surfactant, a naturally occurring product whose absence in preemies can lead to lung collapse.