Wayde Van Niekerk: Preemie on the podium

Wayde van Niekerk is now a world record-holder, global sprint sensation and home-grown hero. But before all of that, he was a tiny baby, wrapped in cotton wool, who weighed just one kilogram.

If you watch the Rio 2016 Olympic 400 m final, there is a moment, as Wayde van Niekerk comes round the corner in the outside lane, where he can see the runners next to him. It’s over in a second, and you may have to slow it down: he gets one look, one chance to leave them behind. It’s enough.

“When I saw his record time, 43:03,” says his mother, Odessa Swarts, “all I could do was cry. I thought, this is my child. What a gift I’ve been given. I saw the work he put in: the blood and sweat, the tears. Some days he was so down and out, he couldn’t walk.”

But let’s go back a bit, to days even darker than those.

Wayde van Niekerk was born on 15 July 1992, in Kraaifontein, Cape Town. He arrived 11 weeks early and faced a few medical challenges from the start. He was dangerously underweight, had jaundice, needed a blood transfusion and was fighting an infection, all while being too small to breastfeed.

“The first 24 hours after he was born were touch-and-go,” Odessa remembers. “There was no warning that he might come early. Everything just went the wrong way. I was young; I was terrified. I thought I’d have more time to prepare for this.”

Doctors told Odessa they were sure he would die within a day or two of being born, and that if he survived, he would grow up disabled. “They warned me he might be blind, or deaf – but they also said there was a chance there would be nothing wrong.”

One chance. It’s enough.

For two weeks after giving birth to her first child, Odessa didn’t know if Wayde would live long enough to come home. “Wayde was in ICU for two weeks after he was born, while the nurses and doctors took care of him. I was allowed to see him, but not touch him,” says Odessa. “That was the hardest part: that I couldn’t hold my child.”

Premature babies face a very real struggle for survival, explains Dr Netta van Zyl, Principal Medical Officer at the High Risk Clinic, Department of Paediatrics at Tygerberg Hospital, who has been researching premature birth outcomes for almost 30 years at Stellenbosch University.

“The womb has everything a baby needs – oxygen, nutrition, protection – and all of this is provided in a safe, warm, controlled environment. This is why we look at premature births as a process of ‘being born while being under construction’: nothing functions yet as it should, or as it would at full term,” she says.

“The earlier a baby is born, the higher the risk of severe complications,” agrees Dr Aziza van der Schyff, a paediatrician at Mediclinic Constantiaberg.

A preterm infant’s internal organs are immature and this can make it difficult to maintain a healthy body temperature – with devastating effects. “The lungs can struggle to stay open; blood vessels in the brain are very thin and susceptible to intraventricular bleeding; the brain is underdeveloped and vulnerable to damage; even the bowel can become perforated.”

Odessa remembers how her hope started to build over the two weeks Wayde remained in intensive care – that he would make it out alive, that she’d be able to take him home. “But that was scary in its own way: in hospital, there were experts everywhere who knew how to help; at home, I didn’t have that medical expertise or the personal experience to guide me.”

Family stepped up. “We have a very close-knit and supportive family,” says Odessa. For the first few days, we kept him wrapped in cotton wool. The older members of the family believed that if a newborn child has jaundice, you must keep them in the sun as much as possible. So he was this precious little bundle, a small Eskimo, always in the sun.”

One memory stands out as the moment Odessa began to feel Wayde was over the worst of it. “One day, when he was seven months’ old, I was sitting in a train with my mom, with Wayde on my lap, on our way to town. A lady sitting across from us kept looking at him. Eventually, she asked, ‘Was your boy born on 15 July?’ We said yes, and she explained she was one of the nurses who had looked after him. She couldn’t believe that the tiny, frail body she saw had grown into a chubby, healthy boy.”

Like many premature children who grow up smaller than their peers, Wayde was picked on at school. “Bullying was something that was just always there,” he remembers. “I’m not sure why, or what about me attracted that kind of thing. I tried to not let it in. I just thought, it is what it is. And when we got to the sports field, any sport, it didn’t matter, that’s where I found my strength to fight back. That’s where I got my revenge.”

The 400m is widely regarded as the hardest of the sprint distances. In comparison, a 100m sprinter can run at a suicidal rate, knowing it will be over in 10 seconds; 200m runners fight the rapid build-up of acute pain as their lactic systems are overwhelmed and their bodies threaten to shut down. By the time you reach 300m, all you have left is willpower.

To run 400 metres in 43 seconds, you have to run through fire.

“You have to run a sub 31-second 300m, which has been achieved by only three people in history – Wayde, [former 400m record-holder] Michael Johnson and Usain Bolt – and then have the mental strength and fortitude to hang on; to push through extreme pain for another 100m under 12 seconds,” explains Niel Michau, Senior High Performance Consultant at the Sports Science Institute of SA.

Wayde is now only three-hundredths of a second away from breaking 43 seconds in the quarter-mile: a number most athletics experts consider the last great barrier in sprinting. Clearly, you need something special to break a record that has stood for 17 years, but what does special mean to a man who was born too small to drink his mother’s milk, too sick to breathe on his own?

“The 400m is my gift,” he says. “I think it was given to me by God. So I give it everything I have; at the finish line, there is nothing left. Knowing I have a gift to run this distance is what motivates me – I know I can’t let this blessing go to waste.”

Wayde was always quick, as his coach, Tannie Ans, likes to joke: first to arrive in the world and then to cross the finish line.

He was also strong, in mind and body. “He was always a fighter,” Odessa remembers. “One of the doctors who helped us in those early days told us Wayde was one of the strongest babies he’d ever seen. And you know, after he came home he didn’t see a doctor again until he was 18 when he picked up German measles.”

“I was a bit of a late bloomer,” Wayde laughs. “My height and size was definitely something I saw as a disadvantage, but it never held me back from competing. And I had the speed to keep me competitive. Growing up, being fast played a big role in my sense of confidence and growing my self-esteem.”

And maybe that’s the secret ingredient to Wayde’s success story. “I came outof the hospital so scared, but I never stopped believing in him,” says Odessa. “Whatever it was that he wanted to do, we just said go for it. We have a big, supportive family, and we didn’t want Wayde to feel like we were holding him back, or were scared for him.”

Any mom would be immensely proud to see her son on an Olympic podium, but it’s not the gold medal that impresses Odessa; it’s something far more important.

“I’m proud of the choices Wayde has made in his life. As a family, we wanted to live as role models for our kids and hoped they would grow up holding onto our family values. So I’m proud of the way he has brought good people into his life and made good decisions.”

Odessa was able to shield her boy from the trauma of her own experience and focus on the future. “It would have been easy to live in the past, or think, he might be blind, he might deaf, and hold him back, or be overly protective,” she says. “But that’s not how it should be. No matter how someone came into the world, he or she deserves the best chance they can get. That’s what we tried to give our boy.

“Each and every day I had my child with me was a gift,” says Odessa. “It’s a privilege for me now, after everything we have been through, that I can say: This is my son, this is someone I look up to and admire. This is my hero.”

Wayde’s 100 m splits during his world-record 400 m:

1. 10.7sec
2. 9.8sec
3. 10.5sec
4. 12.0sec

The 400m record lasted 17 years before Wayde broke it in Rio 2016. He ran those 400 metres in just 163 strides.

Prematurity and advances in neonatal care

The majority of children born early do function within the normal range but they are also at higher risk of developing a whole spectrum of disabilities, says Dr Van Zyl. “Cerebral palsy, developmental delay, intellectual disability, learning problems, attention deficits and hyperactivity, deafness …
the list goes on.”

The survival rate of premature infants is improving, both in South Africa and worldwide, thanks to expert care in the neonatal critical care unit (NCCU). “When we receive a premature baby we will delay clamping the umbilical cord for about a minute. This has been shown to give premature infants more stable blood pressures and decreases intraventricular bleeds. We will also warm the theatre environment and wrap the baby in a plastic bag to prevent heat loss. A device known as a CPAP- driver helps to keep the lungs from collapsing. If needed, we will place a tube through the vocal cords into the lungs to support breathing.”

Next step: nutrition. “Proper nutrition is vital for a baby’s brain development. Mother’s milk is essential: initially, we will use a tube through the mouth and into the abdomen to deliver the milk. After that, we can use a small cup, and eventually, once the baby is big enough, he or she will graduate to breastfeeding.”

Advances in neonatal care and treatments for preterm babies have greatly increased the chances for survival of even the smallest infants, Dr Van der Schyff says.

Kangaroo mother care (also known as skin-to-skin care) is encouraged as soon as the baby is stable, even if he or she is still on nasal CPAP. This is known to help regulate the baby’s body temperature, and also helps to strengthen the bond between parent and child. “The mom is a valuable part of this team,” says Dr Van Zyl.

In the NCCU

Mediclinic’s world-class neonatal critical care units feature high- frequency oscillatory ventilators to minimise lung trauma in babies born prematurely.

A baby weighing just 390g survived thanks to the expertise of Mediclinic’s highly qualified paediatric staff and associated specialists.

Life support, feeding, incubators, kangaroo care, nesting, noise and harsh light limitation: these are all part of optimal neonatal care in the CCU or NCCU, says Dr Van Zyl. But an equally important factor kicks in once the baby moves out of hospital, she explains. It is important that a premature infant’s growth and development should be regularly checked after discharge – early diagnosis and management of problems can make a big difference in outcome. “As a parent, you need to learn as much as you can about normal child development and stimulate them accordingly.

You need to teach them that nothing in the world can hold them back,” she says.

Prematurity by the numbers

• In 2010, more than one in 10 of the world’s babies were born prematurely.*
• Over one million died as a result of their prematurity.
• Prematurity is now the second-leading cause of death in children under five years and the single most important cause of death in the critical first month of life.
• For babies who survive, many face a lifetime of significant disability.
• Premature is defined as before 37 weeks of gestation.