Three-week-old Michael Smith was so small when he was delivered that a knit cap for newborns fit more snugly over his teddy bear's head.
Born 14 weeks early and weighing just 2 pounds, 1 ounce, the Ellicott City boy has been helped by Howard County General Hospital's special care nursery, which has treated more than 1,300 premature infants and others with severe health problems since it opened in July 1990.
Howard County is one of 11 hospitals in the state that provide critical-care beds for medically fragile newborns, including those who are premature, have pneumonia, lung infections or other problems.
"It's raised the general standard of care in the hospital," said Dr. Tuvia Blechman, a neonatologist who oversees Howard County General's 18-bed unit. "We're able to give a total care package."
Before the nursery opened, premature babies and those with serious problems were sent outside the county to Baltimore hospitals such as St. Agnes, Johns Hopkins and the University of Maryland Medical Center.
Now, only newborns who need surgery for problems such as heart or intestinal blockages are sent to other hospitals.
Last year, about 340 babies were admitted to Howard County's special care nursery. The average length of stay for a full-term baby in the unit ranges from three to 10 days, Dr. Blechman said. For a premature baby, the stay can vary from two to four months.
It costs $620 a day to stay in the unit, hospital officials said. That is usually covered by medical insurance.
Many of the infants are too young to breast- or bottle-feed. In the first few days of life, the babies are fed a sugar-and-water solution intravenously. After that, they receive a rich liquid of vitamins, proteins, carbohydrates and fats, a diet known as hyperalimentation.
When the babies are mature enough, they begin consuming mother's milk through a feeding tube that enters their stomachs.
The nursery is staffed by neonatologists, pediatricians and registered nurses with training in the care of medically fragile newborns.
As the nurses care for the babies, they teach parents how to diaper, feed and even install car seats for their infants. They also provide emotional support and encouragement.
"We're caring not only for the baby but for the family as well," said nurse manager Debbie Fleischmann. "We really try to tTC include parents in the care of the babies."
The first three weeks of a premature or sick baby's life can be traumatic for the parents, Ms. Fleischmann said.
"They are hitting the highs and lows," she said. "There's certainly the high of having a baby and the low of having a sick child."
Having a child in the nursery can mean intense joy and fear for parents as they learn to care for infants dependent on IVs, ventilators and other high-tech equipment. Parents say they often don't know what to expect from one day to the next as their children fight for survival.
"It's a roller coaster," said Michael's mother, Michelle Smith. "Fear is a very big emotion. Other days I'm elated because they've taken him off the ventilator. . . . A good day is when he sleeps and I don't have to worry about him not breathing or an infection coming along."
Many times, parents said they feel they are the only ones coping with a sick child.
"With any sort of disease, it can be an isolating experience," said Nancy Carter, a Glenelg mother of two who formed a support group in August 1991 at Howard County General Hospital for parents of premature and disabled infants and others that may require intensive care.
The group meets twice a month and provides informal counseling by matching veteran parents of premature babies with new parents.
"It's very helpful to talk to someone at the end of the tunnel," said Ms. Carter, whose eldest son, Brendan, 4, was born nine weeks early and spent his first month in an intensive care unit at St. Agnes Hospital.
The hospital also provides a medical social worker who meets with parents twice a month and refers them to community resources once their child goes home. And the hospital holds a special-care nursery reunion for parents and children.
In the nursery, parents are encouraged to participate as much as possible in the care of their children.
"Just touching and stroking the baby, even when the baby is very well," is a vital part of nurturing, Ms. Fleischmann said.
Mrs. Smith often strokes Michael's tiny head to calm him. "It makes me feel closer to him," she said.
Because many of the children have to stay in the nursery for weeks at a time, parents fill their beds with stuffed animals. Mrs. Smith outfitted Michael's bed with a bear that makes the whooshing sound infants hear in the womb.
Anne and Scott Johnson of Kings Contrivance, whose 4-week-old daughter, Emily, was born 10 weeks early and with respiratory problems, made a tape of them reading Winnie-the-Pooh stories and singing songs such as "The Itsy Bitsy Spider."
Mrs. Johnson, who has just started to breast-feed Emily, said she can hardly wait for Emily to be home. The family hopes she can go home by late March, if she gets over her respiratory problems. "I'm still a little nervous," Mrs. Johnson said.
Added her husband: "You just have to love your child and hope for the best. You have to keep talking to her and love her very much."