Lessons in Immunity

Last month was prematurity awareness month. Usually during November, I post a lot about how prematurity has affected my children and therefore, my parenting. This year, unfortunately, I was so busy completing my nursing degree that I didn’t have time to post to my blog. Still, as my eldest twins are poised to turn 8 years old next week, I was reminded yet again what it means to be the parent of preemie (or four as it is in our case).

 Over this past weekend, we took a minitrip a few states away to visit family. When we left, our eldest daughter had been in her yellow zone asthma medications for five days. We move from the green zone meds to the yellow zone meds whenever we see signs or symptoms of her triggers. In her case triggers include a seasonal cold (cough, runny nose) and cold weather (which can cause a cough and runny nose). Thus we start yellow meds when she has a cough, runny nose, or other shortness of breath, dyspnea or wheezing… Since our temps this month have averaged around negative numbers (and therefore super negative windchills) it was not at all surprising that she needed her yellow zone medications. 

 Friday she was excited, active, and running around. Saturday she was still active, keeping herself entertained, not running around, but well. By Saturday night I started to have some concerns, namely the tell tale rosy red cheeks she develops when she is about to tank-healthwise. I first noticed them during dinner, when she wasn’t overly enthusiastic about eating. I gave her some Advil and had her lay down. The next morning, Sunday, is when it all hit home. She was lying on the couch moaning and crying. She was warm, but not burning up, still rosy… thermometer read 98.9F. She told me she was dizzy when she stood up and didn’t sleep all night. I gave her some more meds and she fell asleep for an hour or so while we found a local Urgent Care. 

 The urgent care we found was amazing. They got us back to a room quickly and we saw a provider within 15minutes. They did a strep swab, gave her a nebulizer treatment, and took a chest xray. 

 So what does this have to do with prematurity? EVERYTHING… 

 Liv had already developed right upper lobe pneumonia. Her symptoms, a runny nose, began on December 15th. The common cold typically runs its course in 7 to 10 days. Therefore, nurses and doctors often advise patient’s to allow these symptoms 7-10 days to resolve, the principle being that after that time period it is less likely that the causative agent is a cold. So because Liv has asthma, which is a large part due to the fact that she was born 14 weeks early (26 weeks gestation), weighed 1lb 14oz at birth, and was ventilated for more than three weeks during her first month; her body cannot fight infections like yours and mine (typical healthy people). Add to this, the fact that the medications that we have to treat asthma (strengthen ventilation by reducing restricting inflammation within the lungs and dilating bronchial airways) actually also cause immunocompromise by restricting inflammation (the first step in our natural humoral immunity). 

 My point is that within the time the average person takes to fight off and recover from a cold, my child developed a debilitating pneumonia. If this were an isolated case, it might be less impressive, but the fact that she had pneumonia last month (November) and the month before (October) and two months before that (August) and at lest five other times in 2013. The fact that she smiles through it all, doesn’t let it defeat her, works hard in school, plays hard, and just finds everything in life wonderful and amazing… says more about her than me.

 Prematurity is a syndrome, and it lasts a lifetime. In 2008 US News and World Report wrote an article about the lasting effects of prematurity. In it was cited a research report published in the Journal of the American Medical Association in March of that same year. This study concluded that for their subjects born between 22 and 27 weeks gestation the rate of mortality (death) during their early childhood (ages 1-6years) was 5.3 to 9.7 times higher than children born at term and late childhood (ages 6-13) 7 times higher. Other studies have suggested that preemies who live into adulthood are more likely to suffer from COPD, sleep apnea, and other disorders involving their respiratory tract. 

 Alivya will always struggle with lung infections. She will probably always take daily inhaled medications in order to breathe comfortably every day. She will always be more susceptible to colds, flus, and minor upper respiratory infections. Her fate lies in the technology that asthma and pulmonology research develops, but prevention of prematurity can prevent this from being the reality of so many others.