One is a first-grader, the other a college student majoring in psychology. Once the tiniest babies ever born, both girls grow up healthy, despite long odds when they entered the world weighing less than a pound.
A medical report from the doctor who resuscitated the infants at a suburban Chicago hospital is both a success story and a cautionary tale. These two are the exceptions and their remarkable health years later should not raise false hope: Most babies this small do poorly and many do not survive even with advanced medical care.
“These are such extreme cases,” said Dr. Jonathan Muraskas of Loyola University Medical Center in Maywood, Illinois. They should not be considered “a benchmark” to mean that doctors should try to save all babies so small, he said.
The report involves Madeline Mann, born in 1989 weighing 9.9 ounces, then the world record; and 7-year-old Rumaisa Rahman, whose 9.2-ounce birth weight remains the world’s tiniest.
The report was released online Monday in Pediatrics.
Muraskas and the report’s co-authors say most newborn specialists consider babies born after 25 weeks of pregnancy to be viable — likely to survive — and so they should receive medical intervention if necessary to breathe. Younger babies are generally in a “gray zone,” where intervention isn’t always so clear cut, the report suggests.
In Japan, doctors have lowered that threshold to 22 weeks. Normal pregnancies last about 40 weeks.
Some US doctors will attempt to save babies at 22 weeks, but that is not done routinely, said Dr. Edward Bell, a University of Iowa pediatrics professor. Bell estimates that about 7,500 US babies are born each year weighing less than 1 pound, and that about 10 percent survive.
Muraskas says his report highlights a sometimes overlooked fact: gestational age is even more critical for survival than size.
Rumaisa and Madeline were both palm-sized, weighing less than a can of soda pop — the average size of an 18-week-old fetus but they were several weeks older than that. Their gestational ages — almost 26 weeks for Rumaisa and almost 27 weeks for Madeline — meant their lungs and other organs were mature enough to make survival possible.
But both required intensive medical intervention. They were delivered by cesarean section more than a month early because their mothers had developed severe pre-eclampsia, dangerously high blood pressure linked with pregnancy. Both babies were hooked up immediately to breathing machines with tubes as slender as a spaghetti strand slipped down their tiny airways.
Rumaisa and Madeline were on breathing machines for about two months, and hospitalized for about four months.
Madeline had mild brain bleeding, common in tiny preemies, but with no lasting effects. Severe cases can cause serious mental disabilities. She and Rumaisa got treatment for an eye condition common in preemies called retinopathy, which in severe cases can cause blindness.
Madeline is now 22 and a senior at Augustana College in Rock Island; Rumaisa is 7 and attends first grade in suburban Chicago.
“I don’t know why, we were just extraordinarily lucky,” Jim Mann, Madeline’s father, said.
(AP)