Oklahoma City baby is smallest to survive at Integris children's hospital
Oklahoma City — When Melanie Hollins looks at her infant daughter, she sees a “miracle” who has survived despite weighing roughly the same amount as a can of soda when she was born.
Emily Rose Hollins was born about 14 weeks early, on Feb. 8, and spent five months in the neonatal intensive care unit at Integris Children's at Baptist Medical Center. Hospital officials said that, at 12.7 ounces, she was the smallest baby they have delivered who has lived to go home.
Hollins said she thought it was impossible for a baby to survive after being born so early and so small. Not so many years ago, it likely would have been.
Emily needed oxygen and liquid nutrition through tubes until her lungs and intestines developed, said Edward Co, medical director of Pediatrix Medical Group. Co and other Pediatrix physicians treat babies in the neonatal intensive care unit at Integris.
The team treating premature babies also monitors their hearts, brains and eyes, and teaches parents how to care for their children's needs, Co said. Better technology has increased the odds that premature babies will survive without serious complications, but happy outcomes aren't guaranteed and still require work, he said.
“These are complicated babies,” he said. “They're going to have lots of ups and downs.”
Premature babies face a host of problems. Their underdeveloped lungs need support to stave off collapse, but too much oxygen can damage the delicate tissue. Heart defects can flood their lungs with blood. Their livers aren't yet up to the task of filtering out waste products, and the developing blood vessels in their brains can burst without warning. Even eating is a challenge, because many aren't yet capable of sucking and swallowing.
Until the 1980s, it was almost unheard of for a baby born before the 27th week of pregnancy to survive, said Kris Sekar, a neonatologist who treats patients at The Children's Hospital at OU Medical Center. Now, about half of babies born 23 weeks early survive, though they still are at higher-than-average risk of developmental disabilities, Sekar said. A full-term pregnancy lasts 39 to 41 weeks.
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“For these extremely preterm babies, we've come a long way in the past three decades,” he said.
The first breakthrough came in the late '80s and early '90s, when hospitals began using surfactant, a soapy substance that helps keep the air sacs open in underdeveloped lungs, Sekar said. Other advances include better liquid nutrition; blue light therapy to help the liver break down waste products; procedures to get oxygen to the babies immediately after birth, if needed; and ventilators that supply less pressure, minimizing damage to fragile lungs.
Other advances have been decidedly low-tech: scheduling all the day's tests at the same time so babies aren't stressed repeatedly, and involving parents in their babies' care so they are prepared to meet their needs when they go home, Sekar said.
“It's a different philosophy now than it used to be in the olden days,” he said.
Edward Bell, a neonatologist at the University of Iowa Children's Hospital, said the change in thinking goes even deeper. Until the 1980s, a baby born at 25 weeks wouldn't have received aggressive treatment because it would have been deemed futile, he said. Now, doctors treat those who would have been deemed hopeless in the past, because they've seen successes.
“The first thing is having somebody believe they're viable,” he said.
Bell maintains a registry of babies born weighing less than 400 grams — the smallest of the small. He has collected information about 180 births recorded worldwide since the 1980s, though he acknowledges it probably underestimates the true number of survivors, because not all hospitals send him reports.
While the registry shows very small babies can survive, parents should know it isn't typical, Bell said. Girls are more likely to survive than boys, and babies who have developed for at least 25 weeks have better organ function, even if they haven't grown as anticipated, he said.
A study in the Journal of Perinatology found about 14 percent of boys and 39 percent of girls born weighing less than 500 grams survived the first months of life. http://www.medscape.com/viewarticle/850832 About one-third of those who lived had a major disability, such as blindness, deafness or cerebral palsy.
Hollins said she isn't sure whether Emily's early birth will have any long-term effects, but she's just happy to see her daughter healthy and growing. She's also developing a feisty personality, which Hollins likens to the short French general Napoleon Bonaparte.
“The fact that she's growing is amazing,” she said. “She's so small, but she thinks she can rule the world.”