The Better Half On the Genetic Superiority of Women - Sharon Moalem Page 0,1

call, met me at the sink and briefed me on two preemies who had been admitted a few days before. Fraternal twins, Jordan and Emily were born at just twenty-five weeks of age—more than three months before their official due date. I put on a clean gown, blue nitrile gloves, and a mask, as the last thing these babies needed was to be exposed to anything I may have inadvertently tracked in from the hospital atrium, where I’d been sitting just a few minutes before my pager went off.

Rebecca had been on staff with the hospital for more than three decades, and despite the long hours and the very difficult work in the NICU, she looked much younger than her sixty-odd years. Rebecca had one of those voices and ways of being that left you feeling reassured, no matter how dire the situation. Most of the staff, including many of the physicians, often deferred to her when thinking about changing a medical care plan for the hospital’s smallest patients. The senior nurse in the Level 4 NICU, Rebecca truly was a preemie whisperer. And what she said to me that night would change the course of not only my research but also my life.

Thankfully, most of us are not aware of the struggles that newborn premature babies must endure just to make it through the day. Tiny and frail, they have to fight to survive, alone in their diminutive translucent homes. Those incubators, crudely conceived artificial wombs, serve as their controlled environments until the babies are old and strong enough to not need them anymore.

A Level 4 NICU usually houses the youngest and sickest of the premature newborns. Many of the incubators used here have an air-filtration system that keeps the risk of infection lower by protecting the babies from the outside world. The incubators also produce the right amount of moisture in the air. When babies are born very early, their skin often hasn’t finished forming yet and is unable to provide the proper barrier needed to avoid dehydration.

An immense amount of technology and human capital is invested in the precious few who occupy these Plexiglas enclosures. Nurses, doctors, and family members are caught up together in a constant struggle to help keep the babies alive, to encourage them to grow and thrive.

You never really get used to the sounds of the equipment in the NICU. The fans hum, the monitors buzz, and occasionally an alarm beeps loud enough to disorient even the most hardened of medical staff. It’s no wonder research has shown that the light and sound spectacle of modern medicine can have a negative impact on the health of premature babies (it’s something doctors are trying to fix these days).

My introduction to the NICU was hard and fast, first as a medical student and then as a physician. My time there oscillated between pure awe and utter terror, and I often experienced both emotions in quick succession—and sometimes simultaneously.

Mostly, though, there is a lot of waiting. With all the medical advancements we’ve made over the years, it’s still time, more than anything, that these young bodies need. The babies are in the ultimate inverse of a race against time—their biology needs as much time as it can get to mature. They end up in the NICU for all sorts of reasons, of course, but in many cases they’re there because a premature birth endangers the brain and lungs, which take longer to develop than the other organs do.

Often one of the biggest challenges for the youngest preemies, and one that determines their chances of survival, is the degree to which their lungs have developed. The lungs of premature babies have to acquire oxygen and release carbon dioxide at a rate that is compatible with life long before they are meant to. We’re still not sure why some babies are born prematurely, but thankfully, over time, we’ve developed improved interventions to increase their odds of survival.

Regulating body temperature, as well as keeping in check the trillions of microbes always on the lookout for an easy target, can prove to be too much work for some preemies. It’s a miracle that these babies, separated from the protective envelopment of the womb long before they’re ready to face external challenges, can survive months before their due dates. But survive they do. All sorts of things can ultimately contribute to the death or life of a premature baby—from gestational age at birth to unanticipated bumps along the road. And surprisingly,