By Iva Skochová

Staff Writer

She barely remembers going to her doctor with a pain in the abdomen. The series of events that followed were a blur.

When her water broke, Lída Scherrerová, then 43, was already in the local hospital in Moravia on an IV drip. Minutes later, an ambulance was rushing her to the nearest specialist clinic 80 kilometers (50 miles) away in Brno, south Moravia, so she could deliver her baby in intensive care.

"This cannot be happening," she kept thinking. She was only five months pregnant.

"Don't get your hopes up," a doctor told Scherrerová as they placed her in an emergency vehicle equipped for premature deliveries with an incubator on board. "The fetus is too small."

Because she was just 25 weeks into the pregnancy — a critical week for differentiating miscarriage from birth — hoping was about all she could do. The doctors told her that if her baby girl survived, she would need special care, possibly for her entire life.

On Jan. 23, 2004, Scherrerová delivered her baby, Lenka.

She weighed just 600 grams (1.2 pounds) and was 29 centimeters (11.4 inches) long, or about a sixth of average baby weight, but she was alive.

Only 0.4 percent of all babies born live in the Czech Republic that year — 411 including Lenka — had a birth weight lower than 1,000 grams. Hospitals saved 304 of them. In 1993, the chances for survival would have been only 33 percent. Each year, the survival chances increase.

Today, three out of four severely premature babies survive, making Czech perinatal care among the most successful in the world.

Saving the children

Last month, the U.S.–based organization Save the Children released a report compiled by the World Health Organization ranking the Czech Republic as the country with the second-lowest infant mortality in the world, tied with Finland, Iceland and Norway. Only Japan has a greater survival rate.

Researchers noted that culturally homogenous countries like the Czech Republic scored significantly better, whereas industrialized countries that are more racially and economically diverse, such as the UK or the United States, find it more challenging to provide health care for everyone. Among developed countries, the United States ranked 32nd out of 33, with only Latvia trailing it.

According to the report, infections are the leading cause of infant mortality in developing nations, accounting for 99 percent of the annual 4 million deaths worldwide of babies in their first month. Premature births and low birth weight are main culprits in industrialized countries.

Zbyněk Straňák, head of the neonatal clinic at the Ústav pro péči o matku a dítě (ÚPMD) clinic in Prague 4, says the infant mortality rate here is so low not because Czechs have access to any amazing technology, but because perinatal care here is so well-organized.

"We have three levels of care," he says, explaining that all hospitals are equipped to handle routine low-risk births and most hospitals have facilities to handle Type 2 deliveries, which include incubator care for premature babies. Only 12 facilities in the country handle Type 3 high-risk premature birth.

ÚPMD is one of the latter clinics, serving women brought here from as far as north Bohemia. They handle 40 extremely premature deliveries a year and save the lives of babies weighing as little as 450 grams.

"The gestation age of the fetus is more important than the birth weight," Straňák says.

The Czech Republic, unlike Japan, considers babies born in or before week 22 too underdeveloped to revive. In births during the 23rd or 24th weeks of pregnancy, the baby's fate is based on its viability — defined as the ability to survive, grow and develop normally, as opposed to merely showing signs of life — and a doctor's consultation with the parents.

For all babies born in or after the 25th week, Czech doctors must provide care.

This rule apparently presents a challenge for some parents, who do not want to — or cannot — take care of babies who may require tremendous care or who could be physically or mentally challenged.

"Parents are not allowed to refuse medical care," says Straňák.

They are, however, legally allowed to leave the baby in the hospital. Scherrerová says she was shocked when she found out that "some mothers never came back to see their babies." Those babies, after they no longer need incubator care, are sent to state institutions. Often as a result of this practice, some 5,300 children currently live in Czech orphanages.

Straňák says that mothers do not abandon premature babies as often as they leave visibly disabled babies, such as those with spondyloschisis, a congenital spinal deformity.

"Premature babies look like dolls in an incubator," he says. "Their disabilities are typically not visible."

After the delivery, Scherrerová first saw her daughter huddled in her doctor's large palm. The next time she saw her, Lenka was already strapped into an apparatus so complex it made her look like a peanut. For the following three months, Scherrerová was only able to see her daughter through the incubator glass.

Although she thought the doctors and nurses were wonderful, she was upset by the clinic's rule that she could only see her baby for one hour a day.

"I think she really needed me there," she says. "I know other clinics let mothers be with their babies even in intensive care."

All she wanted was for Lenka to survive. "The first weeks were the worst. She was on the verge of dying every day," she says. "She rejected all food and kept getting smaller and smaller."

Then one day, she and her husband came to visit just as Lenka's heart monitor went flat. "That's when my heart stopped, too," she says.

The medical team on duty resuscitated the baby. But they were concerned that after a couple of months she still was not breathing on her own.

"She had been on an oxygen respirator for too long. That was bad news for her development," Scherrerová says.

Four months after Lenka was born, her parents were allowed to take her home. She was breathing on her own. They exercised with her for several hours a day using Vojta's Method, a form of physiotherapy for cerebral-movement disorders.

For months, her prospects were still uncertain. A high percentage of premature babies turn out to be blind, deaf, mute or paralyzed. Cerebral palsy (CP), a disorder that normally occurs in about two of 1,000 births, is significantly more common in premature babies. According to Straňák, the occurrence of CP in premies is as high as 10 percent.

Lenka is now 2 and a half years old. She can see and hear well. Neurologists have ranked her mentally on par with her peers.