Preemies' prospects improve
Thursday, July 01, 2004
Even babies born at 24 weeks' gestation are likely to survive today B y Amy Smith :::::::::::::::::::::::::::::::::photo courtesy of Janet DeSpain At birth, Michael DeSpain weighed 12.5 ounces and could fit in the palm of his mother's hand.
When Michael DeSpain was born at just 26 weeks' gestation, he was so tiny he could fit in the palm of his mother's hand. At 12.5 ounces he was the smallest baby boy ever born in Illinois.
"He is a miracle baby, for sure," says Dr. Gonzalo Argudin-Hernandez, neonatologist at Advocate Christ Medical Center in Oak Lawn, the hospital where Michael was born on Oct. 18, 2002. "Twenty years ago, Michael's chances of survival were zero, to be honest. For a baby like Michael, we would have said there's nothing we can do but keep him comfortable."
According to the March of Dimes Web site, 11.9 percent of babies born in the United States in 2001 were preterm, or born before 37 weeks' gestation, up 27 percent since 1981. The increase in fertilization techniques has contributed to the rise in premature births.
"Increasing the number of fetuses increases the likelihood of prematurity," says Dr. Daniel Polk, vice chief of the division of neonatology at Children's Memorial Hospital.
But luckily, the increase in preterm babies has coincided with an increase in medical advances, which means premature and exceedingly tiny babies are more likely to grow up to lead normal lives.
Survival rates for these tiny infants depend more on age than weight. An average full term for a baby is 40 weeks, and doctors now consider 24 weeks' gestation to be the "point of viability" or the borderline of survival. Before 24 weeks, the chance of survival is slim. By 28 weeks, the chance of survival increases to about 90 percent.
Almost no babies die "Things have gone from no survival to almost nobody dies," says Dr. Robert Kimura, director of neonatology and associate dean of medical sciences at Rush Medical Center. "Even at the point of viability, two-thirds survive."
Zoe Koz weighed just 10.8 ounces when she was born at Edward Hospital in Naperville Jan. 6, 2004, at 27 weeks. Zoe, went home June 9, 2004 weighing 6 pounds, 2 ounces. She is considered to be the ninth smallest baby born in the world, according to The Tiniest Babies registry on the University of Iowa's Web site, though she is not yet listed on it.
Although tinier and tinier babies are surviving with fewer complications, doctors say there is still a lot to learn about treating premature infants.
"The successes only underline the fact that there's a lot we don't know and more we have to do," says Polk. "There is a fair amount of chronic lung disease that's not fully understood. There are lots of things we probably won't be doing in the future."
Once these tiny tots are born, a team of medical professionals works around the clock to keep them alive, Polk says. "These babies are not just small. They need very specialized, attentive care. Touching them the wrong way can break an arm."
Inventions such as neonatal ventilators, which decrease injury to little lungs, as well as better nutrition, have also contributed to better outcomes. "We have the technology to do things littler and littler," says Dr. Marc Weiss, director of neonatology at Loyola University Medical Center.
One major breakthrough is the development of the drug surfactant, which is used to treat respiratory distress syndrome, a lung condition that afflicts many preemies. Surfactant, which was approved by the Food and Drug Administration in 1990, acts in the place of a naturally occurring substance that coats the lungs and makes breathing easier by preventing lung collapse. It is lacking in premature infants.
Dr. Michael Schreiber, associate professor of pediatrics and neonatologist at the University of Chicago Hospitals, and his colleagues recently completed a study of a new therapy to improve preemies' lung function: inhaled nitric oxide. "We have found that nitric oxide improves the outcomes for premature babies," Schreiber says. "It decreases the incidences of chronic lung disease and deaths." Two years have passed since the initial study and Schreiber says that the babies who received the treatment are doing significantly better neurologically than those that did not. A follow-up study is under way.
Healing the tiniest Follow-up care is important to decrease the chances that children will have physical and mental disabilities once they leave the neonatal intensive care unit.
"They've had IVs, been in an incubator, their environmental stimuli is abnormal," Argudin-Hernandez says. "Development can be delayed. In these follow-up visits we have to correct for prematurity."
Michael DeSpain has received developmental, occupational, speech and physical therapy since he was born. His small size is still a concern, and he needs a nebulizer to treat his chronic lung disease. Doctors say they will have to wait and see if he develops more lung problems, such as asthma. Michael is expected to catch up to his peers by age 5.
His even smaller twin sister, Jennifer, lived only a few hours. His mother, Janet, considers Michael to be a miracle. "I didn't want to bond with him because I was afraid," DeSpain says of the hours after his birth. "I figured he was going to die too."
Michael spent almost four months in the neonatal intensive care unit, faced collapsed lungs and needed help breathing and eating. But he was spared the serious complications that often ravage the tiny bodies of preemies, such as brain hemorrhaging and intestinal infection. Untreated, these complications can lead to serious disabilities.
"I'm totally confident he'll be at the same level as his peers in school," DeSpain says. "He catches on really fast."
These days Michael's biggest achievement is crawling.
"The minute he figured it out, he was all over the place," his proud mom says. And he recently had fun at the beach in Florida. "We took him last year, and he was on oxygen," DeSpain says. "This year, he was in the sand. He loved the water."
Whatever the advances, caution is best, doctors say. That is why doctors feel preventing premature births by focusing on treatments to prolong time inside a mother's uterus may be where the future lies. "If you're not mature enough, there's nothing I can do," says Weiss.
Argudin-Hernandez agrees: "Preventive medicine is best. The child should be able to stay in the mom."
Amy smith is a graduate student in the Medill School of Journalism at Northwestern University where she writes for the Medill News service.