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The breathable liquid comprises perfluorocarbons (PFCs), which carry more oxygen than blood and mimic the properties of amniotic fluid. In theory, you could dive into a swimming pool filled with this liquid and breathe. When put directly into an infant's lungs, liquid ventilation creates a gentler and less invasive environment for the preemie than traditional respirators, which can be harsh and can still engender the kinds of debilitating afflictions that may follow a child for a lifetime. Though the preemie is exposed to the air around her in an incubator, she is actually only breathing the liquid in her lungs. With PFC liquids, a premature baby's tiny organs are treated more like they are still in the womb. And after roughly 24 hours of liquid ventilation, the PFC liquids simply evaporate.While Greenspan used a syringe to get the liquid into Adrianna's body through a tube that reached from her tiny mouth to her lungs, Mancini prayed. She prayed for the strength she would need if her child died. She prayed that if Adrianna did die, her life would have been useful to science, that another preemie might benefit from Adrianna's short time on earth. She prayed for the strength to cope with a severely handicapped child. But mostly she prayed that God would spare her small daughter.
Mancini watched the clock and felt the seconds being taken from Adrianna's life. Somehow, she finally fell into a deep sleep, not yet knowing that the liquid ventilation had produced immediate results. Within an hour of breathing the PFCs, Adrianna improved: Her lab work showed a complete turnaround. Her blood pressure was normal, and her heartbeat had stabilized. At 5:00 in the morning, Mancini was brought to the neonatal intensive care unit. She saw relief and astonishment on the faces of the many doctors, nurses and hospital staff who had been on Adrianna's team, and she realized that her daughter had made it. "I knew that I was watching medical history being made," Mancini recalls.
Although Shaffer's work has saved 12 infants so far, and can stave off much of the brain damage and respiratory problems usually associated with extreme prematurity, it has not received the funding it needs to become available to all the newborns who could benefit from the therapy. "We can have 70 percent of babies weighing less than 750 grams survive, instead of 30 percent," says Shaffer.
Some critics argue that liquid ventilation is a distraction. Their concern is that if PFC liquids were widely available to save extremely premature babies' lives, there will be less attention paid to the problems that lead to prematurity, such as drug and alcohol abuse during pregnancy.
"Sure," Shaffer exclaims, "let's give everyone college educations, clean up the environment, and get rid of drugs. But until then, we have mothers who will deliver in a toilet and babies born addicted to crack. Let's do what we can while this is happening." Besides, if extreme preemies survive with compromised brain function, the cost to society for their care is surely greater than preventing the problem with liquid ventilation.
Of course, not every preemie is the product of a bad environment; sometimes babies are just born too early, as Adrianna Mancini was. Toni Mancini is a nurse, had excellent prenatal care, and was healthy. Luckily, Adrianna is healthy too. Not only did Shaffer's liquid ventilation save her life, it saved her from a life of brain damage and limited options. Adrianna isn't just mentally healthy; she's gifted. In addition to scoring in the 95th percentile on standardized tests, Adrianna won acceptance to a Philadelphia magnet school for the academically advanced -- which she attends when she isn't ice-skating or taking dance classes. For Adrianna, being perfectly normal is extraordinary.
It's exactly the outcome Shaffer had hoped for. It's also why, when Shaffer sees a preemie brought in to the neonatal intensive care unit, he's frustrated that he can't offer liquid ventilation. Shaffer and Temple University Hospital are still fighting to win financial support for this technique so that they can complete clinical trials and conclusively demonstrate its effectiveness to the Food and Drug Administration.
In the meantime, as a medical professional, Toni Mancini shares Shaffer's frustration that after all these years, liquid ventilation is still not an accepted, available therapy. Mancini recalls a set of twins, a boy and a girl, born far too early. "The girl did great," says Mancini. "She was a tiny growing preemie." But her brother was in constant danger, facing everything from dramatic respiratory problems to potential brain damage. Mancini watched the anguish of the twins' parents as they struggled with the decision of whether to take their son off life support. And she felt a private anguish as well, knowing that liquid ventilation might be the only chance he had.
After two months, the little boy died. "When I see a baby in severe respiratory distress," an emotional Mancini says, "I can't help but wonder what could be. I just refuse to believe that liquid ventilation will never have a place in neonatal care. All we went through has a purpose. Adrianna has a purpose."
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