The nine-ounce micropreemie

[Hane]

Has anyone else read this story about a nine-ounce micropreemie who has survived until her natural due date and is going home with her parents?

 

Her mother had recently suffered a stillbirth, so I can understand why she wanted heroic measures taken so that this baby would survive.

 

Still, I'm torn: Should a miracle happen, and this child were to grow up without health problems or cognitive issues, will people start demanding that neonatologists perform similar miracles on all babies thrust out of the womb so early? Will parents who decide to let nature take its course and not prolong the child's life face legal consequences, essentially being stigmatized as murderers?

 

Thoughts, everyone?

[JenniferJuniper]

I find it hard to believe she weighed only 9 ounces at 24 weeks - and survived.

Perhaps someone looking to make the record books is exaggerating things a bit?

[Hane]

I Googled "nine-ounce baby" and came up with two other cases, so I don't think this one is exaggerated.

[JenniferJuniper]

I Googled "nine-ounce baby" and came up with two other cases, so I don't think this one is exaggerated.

So you "googled".

Could you kindly direct us to the medical journals?

[Wolfie]

So you "googled".

Could you kindly direct us to the medical journals?

Why the doubt? If you googled the baby's name, you'll get some well known sources like ABC also reporting the same things.

What I would doubt is if they were saying that the baby was all okay and wasn't going to have problems like the Duggars try to claim about Josie. In this case the articles all say that the baby is at risk for many problems now and some that may not show up for several years.

[Maul the Koala]

I've done a few searches and most of the literature is focusing on the long term outcomes of micropreemies now. But I'm being lazy and not doing an in-depth search.

Edited to add: I'm bad at math... move along.

[Deleted07]

Its a rare occurence for a child born that prematurely to survive but of course it can happen.

Below is an article with a lot more information about this story, including side notes about two other babies born at 9.2 oz and 9.9 oz and stating that their progress was detailed in a study published in the journal Pediatrics... so there's your Medical Journal... Really not sure of why the aggressive replies!?

Read more: http://www.dailymail.co.uk/health/artic ... z1iC4NQB1P:

TINY MIRACLES: TWO RECORD-BREAKING BABIES BORN EARLY NOW LIVING HAPPY, HEALTHY LIVES

The smallest surviving baby born weighing 9.2oz is now a healthy 7-year-old and another who weighed 9.9oz at birth is an honours college student studying psychology.

Rumaisa Rahman, pictured right as a baby, now aged seven, was born at 26 weeks weighing just 9.2oz - the equivalent size of an 18-week old foetus.

The tiniest baby ever to survive premature birth, Rumaisa now goes to school in Chicago and is expected to develop normally.

Twenty-two-year-old Madeline Mann, below, was born in 1989 weighing 9.9oz, then the world record.

She suffered bleeding on the brain shortly after her birth, but suffered no other long-term problems and is now an honours student studying psychology in Rock Island.

Both were born at Loyola University Medical Center and were resuscitated by Dr Jonathan Muraskas.

Their progress was detailed in a study published this week in the journal Pediatrics.

[Mama Mia]

It states right in the article that the reason the baby was so small at 24 weeks is because there were placental problems, so wasn't getting enough nutrients.

Also, the survival rate at 24 weeks is between 35 -60 % depending on which study you look at - so this baby being one of the smallest to ever survive obviously means that they were very low weight for their gestational age.

[Rachel333]

So you "googled".

Could you kindly direct us to the medical journals?

You could also google it yourself since you were the one who expressed doubts. It's really easy to find a few examples from reputable sources, as others have shown.

[YPestis]

The case of these "micropreemies" is an ethical quandary doctors grapple with since technology made their survival possible. Most doctors I've met have actually felt strongly against using heroic measures. Most say they feel the need to take extreme medical interventions due to fear of lawsuits.

The reasons are mostly related to the low success rate and the immense suffering it brings to patients, as well as the extraordinary costs associated with heroic measures. At least a few doctors told me the reason we spend more money than any other developed country per patient with such dismal results is because most of that money goes to cases such as micropreemie and end of life care. Most say they would rather see more money spent on preventive care and on increasing access to health care to the rest of the populace.

I've even had a self-described libertarian (and die-hard republican according to other residents) who believed money should be better spent on vaccinations and prenatal care for low income women than on old men who are at death's door. He does make a strong point. How many more babies could we save if we let nature take its course for one child so that we could vaccinate millions? How many more micropreemies could we prevent if we used that money, instead, to increase access to prenatal care for poor women? Health care money is finite. We should be good stewards and use it efficiently so to maximize the saving of lives. There gets to a point where we are throwing good money away to fend off death, not save a life.

[meow139]

At any rate, glad the sweet girls oaks.

[Deleted07]

as for the questions:

will people start demanding that neonatologists perform similar miracles on all babies thrust out of the womb so early?

I think some people can be mistaken to believe that these days preemies are common and that our resources and progress in the area mean that its an 'easy fix' with excellent outcomes. And that is true to some small extent. But luckily most people realise that anything before at least the last trimester is very dangerous and comes with no guarantees of long-term health or even survival.

Will parents who decide to let nature take its course and not prolong the child's life face legal consequences, essentially being stigmatized as murderers?

I don't believe anyone would be stigmatized as murderers, I think most people would do as this couple did and ask the doctors to do everything they can, even if there is a chance of cerebral palsy or other conditions is there. But yeah as Ypestis said, this is where it gets ethical... But then I'm reminded of Siamese Twins... No one is considered a murderer when conjoined twins are decided to be separated, and one happens to die.

I think its just down to personal choice. If it were your baby, you would probably want everything done possible to save it. Whatever you feel, premature birth is scary and I couldn't imagine what an emotional roller coaster it would be for such a long period of time with so much uncertainty.

[Mama Mia]

I really dislike the "it costs sooo much money" argument. We spend billions and billions to blow people up in ridiculous wars, we spend billions and billions to keep non-violent offenders incarcerated, or to fight the losing war on drugs. Or untold billions to bail out the banks.

But we can't afford both extremely expensive medical care AND preventive care - we have to choose ? Does that mean if someone is independently wealthy they can choose to save their elderly relative or very premature infant and everyone else is disposable ? WTH

[valsa]

But we can't afford both extremely expensive medical care AND preventive care - we have to choose ?

Yes, of course. Resources are finite and we will always have to choose. There is some extremely expensive medical care that provides good return on the investment and some that does not. Heroic measures for the extremely young (micropreemies) and extremely old do not fit that description.

While I am loathe to spend billions of dollars on pointless wars, even if we didn't spend our finite money on that, we could still find better uses for it than keeping alive children with an over 50% chance of death or severe disability, or 90 year old vegetables.

[NurseNell]

I have conflicted opinions on this issue as a nurse who spent 20 years caring for those premiees and micropreemies who had long term health effects. When you see the lives many of these children have you have to wonder, are we doing them any favors? Children who will never be developmentally older than an infant, never able to interact with others. The majority of the children I worked with had IQs under 40. And there were the kids with rare, orphan diseases, many of them really horrible diseases. But then I remember if I were a parent to such a child wouldn't I too want to do everything? I don't believe those of us who've never been in that situation can answer that. And there are some children who progress to an older developmental age, still very delayed but able to interact as a 2 or 3 y.o. would. Yet our local Children's Hospital has an ad on TV showing micropreemies specifically who have gone on to college. I think one is even in medical school now. So there is hope. And when you've just given birth most parents choose to dwell in possibility.

The smallest baby I ever personally cared for was a little over 1 lb at a Naval Hospital pre NICUs. Her mother had tried to induce an abortion by taking a bunch of different over the counter meds and the baby was born alive. She was being fed with a NG tube as gastrostomies on tiny babies weren't yet being done. She was about a month old when I cared for her and she fit in the palm of my hand. I don't know if she had been intubated and on a ventilator earlier. I would think so but then I don't even think we had ventilators with the settings you'd need for a baby of any size. I wish I knew what became of her. She was obviously a very resilient baby. I only took care of her a few days as I had been pulled there from my regular assignment.

edited because I do know how to spell preemies

[kb2]

I don't think this is really a new thing, just a rare thing that the hospital thought could make a good press release.

There have always been babies who "beat the odds," which makes the decision of whether to do anything so gut-wrenching. But it doesn't mean the odds have changed--just people's vicarious experiences via news story. If you don't know anyone personally who had a micropreemie, the only stories you hear are the success ones, but really for every one good story there's ten bad.

Also, in this case it wasn't an early labor that caused the delivery--the baby was delivered on purpose for bad placenta reasons. The delivery itself was an intervention, and letting nature take its course would have meant possibly acquiring more brain damage from poor oxygenation while hooked up to a bad placenta. It's hard to say what would have been less expensive in the long run--if the baby had a better chance of being alive and nondisabled by being delivered that early, then "letting nature take its course" might have also ended in a child who needed expensive interventions to stay alive no matter the gestational age.

[pixydust]

When you see the lives many of these children have you have to wonder, are we doing them any favors?

This. I don't know what I would do if I had a micro preemie, when I lost my mucous plug and went into labor with my daughter the first time, I was 22 weeks along, and they estimated that she was about 1#. All that I could think was that I wanted someone to stop the labor and make everything better NOW. Thankfully they were ble to stop the labor (and twice more) and she stayed put until 35 weeks and only had minor issues and is now a very tall, smart 6 year old. Actually, I do know what I would have done with my daughter if she had been born then, I would have had them do anything resonable to keep her alive...but under 1#, I'm not sure.

[Beeks]

Yes, of course. Resources are finite and we will always have to choose. There is some extremely expensive medical care that provides good return on the investment and some that does not. Heroic measures for the extremely young (micropreemies) and extremely old do not fit that description.

While I am loathe to spend billions of dollars on pointless wars, even if we didn't spend our finite money on that, we could still find better uses for it than keeping alive children with an over 50% chance of death or severe disability, or 90 year old vegetables.

The problem is who makes these decisions? Who is going to tell a parent - well yes, there is a 50% chance that your child could survive and lead a normal happy life but sorry, it's not worth the money?

[FakePigtails]

The documentary Little Man deals with this issue: http://www.rottentomatoes.com/m/10006189-little_man/ and http://www.littlemanthemovie.com/blog/?page_id=33 . It's such a complicated topic :(

[ilovetchotchkes]

This. I don't know what I would do if I had a micro preemie, when I lost my mucous plug and went into labor with my daughter the first time, I was 22 weeks along, and they estimated that she was about 1#. All that I could think was that I wanted someone to stop the labor and make everything better NOW. Thankfully they were ble to stop the labor (and twice more) and she stayed put until 35 weeks and only had minor issues and is now a very tall, smart 6 year old. Actually, I do know what I would have done with my daughter if she had been born then, I would have had them do anything resonable to keep her alive...but under 1#, I'm not sure.

Family friends of ours, mom lost 6 boys all at about 20 weeks. After 6 boys lost, she conceived a girl, drs put a cerclage in, and she went OVER and had to be induced. Then, she found herself pregnant again about 4 years later. Found out it was a boy,then about a week later, went into labor at like 22-23 weeks. They held it off for another week or two. Somehow the kid survived. After so many losses, they decided to try anything they could to keep the baby alive. He's now about 5. Very VERY small for his age and about a year behind academically but he's a sweet sweet kid.

I honestly don't know what I would do in that situation. I really really really don't. Especially if I had other kids to take care of.

[Mama Mia]

It really would be so hard to decide how far to go with extreme measures. I was just googling around on this topic after reading the article .. and just the statistics for survival and survival without severe disability varied greatly - partially because the technological advances in care seem to be making a big difference.

And you never know with the disabilities how likely each one is, and how extreme it will be. With one of my children ( born full term ) there was a cord prolapse and he suffered lack of oxygen for a period of time -- the Doctors said how he might have suffered 'brain damage' -- well he has really severe ADHD and academics were never his strong point- but he is also very bright and creative and a wonderful artist and a hard worker and an all around great young man (at least according to his mom lol ) -- When they said "brain damage" how would I know if they meant ADHD or living like a vegetable for his entire life ? If he had been a micro-preemie and I had to decide how much intervention to give when hearing terms like 'brain damage' .. yikes. So complicated.

[ilovetchotchkes]

It really would be so hard to decide how far to go with extreme measures. I was just googling around on this topic after reading the article .. and just the statistics for survival and survival without severe disability varied greatly - partially because the technological advances in care seem to be making a big difference.

And you never know with the disabilities how likely each one is, and how extreme it will be. With one of my children ( born full term ) there was a cord prolapse and he suffered lack of oxygen for a period of time -- the Doctors said how he might have suffered 'brain damage' -- well he has really severe ADHD and academics were never his strong point- but he is also very bright and creative and a wonderful artist and a hard worker and an all around great young man (at least according to his mom lol ) -- When they said "brain damage" how would I know if they meant ADHD or living like a vegetable for his entire life ? If he had been a micro-preemie and I had to decide how much intervention to give when hearing terms like 'brain damage' .. yikes. So complicated.

Exactly, if it was a case like my friend and the kid was just a bit slow? Or yours w/ the ADHD (hell I have adhd myself!) i'd say "yes, keep him alive". But I read about a case where the kid was 9, and still in diapers and not walking. That.... thats a big difference. I don't think I could do it. But then again, you won't know until the kid gets older yanno? there's no way to tell.

[VeraAnne]

My water broke at just over 22 weeks. I was given the option to either try to delay labor or have a c-section since my son was transverse. We decided to try to stop labor, and were successful for 7 weeks. My son was very, very small for gestational age, and required growth hormones to catch up. He has sensory issues and Aspergers, but he has no cognitive delays.

With micro preemies you prepare for the worst, but are sometimes amazed.

[SunnyAndrsn]

I spent an hour on Friday night working with our code team trying to resuscitate a 6 month old. Likely a SIDS death. You do try and do everything, you just do.

[keen23]

My babysitter had a baby just yesterday morning. He's still alive, born at just about 26 weeks, weighing in at 1 lb, 5 oz, roughly the size of a 20 oz soda bottle (if like me, you need "real world" comparisons to get the size). His foot is the size of his Mom's fingertip.