The metal crib is rolled out and the dialysis machine ready when nurse Rosa Diaz summons her next patient by singing his favorite song.

“Oh, oh! Caso cerrado. Oh, oh!” Diaz croons, dancing to the catchy theme of Case Closed, the Spanish-language court TV show.

Flashing his toothy grin, 2-year-old Anthony Suarez throws his arms in the air and bounces in his mother’s lap. “Oh oh!” he responds in delight.

“Caso Cerrado” is also Anthony’s theme song, the tune that primes the toddler for his visits to the Pediatric Dialysis Unit, operated by doctors at the University of Miami’s Leonard M. Miller School of Medicine and nurses from Holtz Children’s Hospital at the University of Miami/Jackson Memorial Medical Center.

Four times a week, three hours at a stretch, Anthony is connected to a high-tech dialysis machine that must perform the job of his defective kidneys until he receives a transplant. The dialysis machine withdraws blood, removes toxins and excess fluids, and restores it to his 27-pound body via two tubes inserted in a catheter in his chest.

“When we say ‘dialysis,’ he sings the song,” says Anthony’s mother, Beatriz Suarez. “He looks forward to coming here. He smiles. He jokes. This is his second home.”

Most of the 41 other South Florida toddlers, tweens, and teenagers who spend much of their lives at one of the nation’s largest, busiest, and few pediatric-only dialysis centers feel the same. Dialysis is no fun, but the unit is their sanctuary, a place of hope and compassion where commitment pays a big dividend.

“It is a job,” says Autoya Hollis, a high school senior who spends three 12-hour days a week riding Tri-Rail from Palm Beach County to Miami for treatment. “We just don’t get paid. All we get is life out of it. You can’t beat that.”

Tucked in a small suite on the first floor of the Holtz Children’s Hospital, the six-station unit is a core service of the University of Miami/Jackson Comprehensive Children’s Kidney Failure Center. A state-supported and designated “Center of Excellence,” it was established in 1975 for patients under 21 who have lost at least a quarter of their kidney function and are, sooner or later, destined for renal failure.

When UM’s Division of Pediatric Nephrology was founded by pediatrics professor emeritus Jose Strauss in the early ’70s, such a diagnosis was a death sentence for children under 5. Dialysis was considered “experimental” and “prohibitive.” But through research and clinical experience, UM specialists have transformed kidney failure from a fatal to a chronic disease.

That’s true even for some of the youngest and sickest patients who, like Anthony, are born without functioning kidneys, according to a study of 52 infants treated over a quarter-century by UM’s pediatric nephrologists, or kidney disease specialists.

A study published in The Journal of Pediatrics, “Twenty-five Years of Infant Dialysis: A Single Center Experience,” reports that nearly half—24, or 46 percent—of those infants born with kidney failure and dialyzed at the center between January 1983 and January 2008 survived.

Most began dialysis during their first month. The oldest is 25. Seventeen have successful transplants.

“We’ve gone from having an almost uniformly fatal disease of infants to a chronic illness of childhood,” says Steven E. Lipshultz, chair of the Department of Pediatrics and chief of staff at Holtz. “It’s allowed us to think beyond survival to the complications and late effects of treatment. That is a magnificent achievement. Many centers have such poor success they debate whether it’s even ethical to intervene.”

Still, mortality remains high. Fifty-four percent, or 28, of the study infants died, 20 of them in their first year. Despite the achievements, the study found little difference in survival for babies treated in the early 1980s and ’90s, and those treated after 1995. Researchers cited advances in neonatal care. In the past, the tiniest and sickest premature babies died. Today, they often live, but their problems are more challenging.

More frustrating is the absence of technological advances. Infants comprise just a fraction of the more than 354,000 U.S. patients sustained by dialysis, according to the U.S. Renal Data System. As a result, manufacturers have no incentive to produce automated dialysis machines small enough to accommodate them.

Instead, their lives depend on manual cyclers, which increase infection, require skilled nursing, and restrict parental involvement.

“They don’t even make the catheters,” says professor of pediatrics Carolyn Abitbol, medical director of pediatric dialysis, who co-authored the study with five other doctors. “We have to allow a full week lead time to make a special catheter and, of course, it costs ten times the normal one.”

Given the expense and limited success, many pediatric nephrologists recommend delaying dialysis until newborns reach their first month of life “to see if they make it on their own,” Abitbol says.

At the University of Miami/Jackson, there is little waiting. Abitbol and her colleagues counsel parents willing to shoulder the emotional and financial burdens to gamble on dialysis. If they lose, at least they won’t be saddled with the guilt of having done nothing.

“We say, ‘Let’s give it a try. Let’s see if he or she is a survivor,’” says professor of pediatrics Gaston Zilleruelo, director of the division and one of the co-authors. “Because we don’t know. Miracles do happen.”

Anthony’s parents have lost count of their miracles. Ten weeks after Beatriz Suarez conceived her second son, doctors discovered the baby’s bladder was blocked and would not produce enough amniotic fluid for his lungs to develop.

When the Suarezes ignored advice to terminate the pregnancy, doctors warned them Anthony would die within 30 minutes of his birth. That May day in 2006, a priest stood by.

But instead of dying, Anthony let out a feeble wail. His lungs were fine, but his kidneys were in terminal failure. His mother made a deal with the amazed doctors: “I told them, ‘You do your thing, and we’ll pray,’” Beatriz recalled. “‘Use all the knowledge and skill possible to save his life, and we’ll give him all the love and care he needs.’”

Upholding the bargain has not been easy. Anthony’s care is a full-time job and a family affair full of disruption and sacrifice. To be near the hospital, the Suarezes moved to Miami from the Florida Keys, where Anthony’s father, Joe Suarez, still commutes to his job as a commercial fisherman. Older brother Edward, 8, switched schools and left his friends. Beatriz quit her bookkeeping job to devote time to Anthony’s care. When he isn’t in dialysis, she takes him to occupational, physical, and speech therapy. She’s lost count of the infections, operations, and setbacks he’s endured; but her family, which recently grew by a healthy baby boy, doesn’t regret its decision.

“You pay a high price,’’ she says. “But it’s what you’re willing to give for someone’s life. As long as he’s here, we’re willing to take it one day at a time.”

As Autoya Hollis knows, the road ahead is bumpy, and uncertain. Now 19, she began dialysis 11 years ago and is intimately familiar with what the study calls the “chronic unrelenting and complex nature” of kidney failure. She knows how the disease sets her and her “sisters and brothers” in the unit apart from healthy peers.

Their growth is stunted, their veins brutalized, their bodies scarred, and the restrictions on their activities and diet torture. Swimming is taboo. So are pizza, Coke, chips, French fries, and other childhood favorites.

High blood pressure and cardiovascular complications are frequent companions. So is heartbreak. Eight months after receiving a donor kidney at age 13, Hollis’s body rejected it. There was, however, a silver lining. She had to return to the dialysis unit, where she’s at home.

“I feel safe,” Hollis says. “I know everybody. Everybody knows me.”

At first glance, the dialysis unit hardly seems inviting. Faded prints of jungle animals on the pastel blue walls are the only bow to childhood. The leather recliners, where kids doze, watch TV, and finish homework with toothpick-size needles in their arms, are yellow with age. The dialysis machines beep incessantly. An antiseptic smell infuses the air. But what the center lacks in ambience, it makes up for in skill, compassion, and warmth bred by familiarity. Patients and caregivers consider themselves family and, literally, grow up together. More than half the unit’s 11 nurses and five doctors have worked there for more than two decades, sharing many milestones with their patients.

“We go to their quinces. We go to their Sweet 16s. We go through their proms and boyfriend troubles,” says nurse manager Sheila Coakley. “And we go to their funerals.”

They also celebrate the miracles.

Another came this spring when Anthony led his family into the dialysis unit, giddy with triumph. He wasn’t holding Mama’s or Papa’s hands, or leaning on the toy car that doubled as his walker. He bounced to Caso Cerrado on his own feet. Then he counted to ten, a skill he’s learned by handing his mother the ten syringes she uses twice daily to inject medications into his stomach tube.

“Our dream was for him to walk in here, and he can,” his father says. “And to think they only gave us half an hour.”

Editor’s Note: At press time, days before his 3rd birthday, Anthony Suarez received a kidney transplant.

MAYA BELL is a writer living in Miami.