Caffeine: letting me, and babies, breathe

Dr Sahar Iftikhar is a medical doctor working for MSF in the city of Dera Murad Jamali, in the north of Pakistan. In Pakistan women and children in particular suffer from the lack of access to healthcare and there is an real need for neonatal care. Here Sahar blogs about a very tiny patient...

Millions, if not billions of people, around the world start their day with a cup of java, espresso, tea, latte or cappuccino. The so far legal stimulant, with no maximum consumption limit, has helped us stay awake and, in my case, also stay productive. All these beverages are a rich source of a chemical called caffeine. 
About eight months ago, I did not know that this magic potion in an injectable form, at least twice a day, also helps you keep breathing if you decide to bless the world with your presence at any time before 34 weeks of pregnancy.
Baby Gul is one such baby who arrived at 28 weeks, and made her way to the nursery after being delivered in our maternity ward in Dera Murad Jamali. She was blue, not breathing and very tiny, as babies are who weigh only 1.4 kilos. We got her to breathe (three rescue breaths did the magic), started off oxygen and put her on a continuous positive airway pressure machine; a machine to help her keep breathing.  
Babies born prematurely have a very tough start. First, their lungs are not developed enough to sustain the arduous work of respiration. Second, as they go along they are more prone to develop multiple complications.
Two-thirds of the world’s neonatal deaths occur in just 10 countries. Among these, Pakistan is number three. Infection, preterm birth, and birth asphyxia, account for 87% of neonatal deaths worldwide. 
Babies on the nursery ward in DMJ

Babies on the nursery ward at the hospital.  Photo: P.K. Lee / MSF

Here at Dera Murad Jamali, the neonatal mortality is probably even higher than the rest of Pakistan. Limited access to maternal and child health services, babies born at home, unhygienic birthing conditions, untrained traditional birth attendants and the comfortable practice of very outdated medicine at private clinics are some of the few reasons why it remains high. 
For example, I remember admitting a baby with the placenta still attached to the cord hours after being born, and then there are also the poor practices of dipping babies in cold water if they fail to breathe, giving them black tea or goat milk.  Until recently this area was also devoid of a birthing unit, but a few weeks ago MSF reopened the facility. 
Baby Gul was given all the care that we could to help her breathe during her early days. She did succumb to a few complicated infections. She even went to weighing 995g from her birth weight of 1.4 Kgs, when she suffered from severe necrotizing enterocolitis (known as NEC). 
NEC typically occurs in second or third week of life in premature babies. It is an infection of the intestines where the infant is unable to hold down her feeds. We had to keep her only on intravenous fluids till she made a complete recovery. Gradually we started feeding her with expressed breast milk. We had to start from 1 ml of feeds and now she is tolerating 220mls, which is maximum limit. In addition, she is also breastfeeding once or twice a day. 
She has been with us for more than 30 days now and is going strong. I have seen her mother crossover from a state of hopelessness to the typical “when can I take her home?”. 
Before Baby Gul, her mother had lost babies due to prematurity. I understood her when she was thinking this one wasn’t going to make it either. I have observed Baby Gul’s mother change from not wanting to be too attached to her in her early days of life, to visiting her multiple times in a day. She calls her “the tiny one”. 
We are waiting for Gul to reach at least 1.5 kilos, as well as giving her caffeine till she reaches 34 weeks of life. We’re also keeping our fingers crossed that she stays well. It is naturally very tough for a baby born this premature to live. In the MSF nursery here in Dera Murad Jamali we have had only one other baby born at 28 weeks, who made it through. That was in 2014. If all continues to go well, this one will be the second.
Baby Gul is still fighting one of the highest neonatal mortality rates in the world. The baby who kept breathing against all odds, the baby who has witnessed others much bigger and healthier than her come and go, the girl who made a complete recovery even after multiple complications. 
This baby deserves to go out knowing that the team at MSF did everything they could to fight for the number two spot that she now holds. Congratulations, Baby Gul!