||18 January 2010 05:00
|Show: ||Carte Blanche Medical|
This is Hope Samuels, a tiny girl born prematurely on the 2nd of October 2009. At birth she weighed just 390g, one of the smallest babies ever to survive without any complications.
Annika Larsen (Carte Blanche presenter): 'To appreciate the magnitude of this miracle, consider this: when Hope was born she weighed 390 grams - that's less than this tin of peas.'
Her mother, 21-year-old Robyn Samuels, is a law-enforcement officer in Hermanus. After the 20th week of pregnancy her doctor noticed the foetus wasn't growing and advised her to abort.
Robyn Samuels (Hope's mother): 'I felt my heart was going to break into a million pieces.'
A friend referred her to gynaecologists at the Constantiaberg MediClinic in Cape Town. Dr Monty Brink and Dr Caro Nel took the case.
Dr Caro Nel (Gynaecologist): 'At 27 weeks, we realised that Hope's amniotic fluid was running out dramatically and quickly and that's when we started using the doppler technology to assess the blood flow between Robyn and her placenta and Hope and her mum.'
Annika: 'What was actually going on inside?'
Dr Nel: 'For some reason the placenta doesn't actually attach properly to the uterus so the exchange between mum and the placenta was poor. Because she has been so stressed in the uterus and her growth was so restricted, we realised that she would probably have a much better chance of surviving outside the uterus.'
They performed an emergency Caesarean late on a Friday afternoon. A 27-week-old foetus normally weighs about 1kg. Not only did Hope weigh just 390grams, she was only 26cm long.
Dr Hedi van der Watt (Paediatrician): 'She was a bit stunt when she came out so after the tubing and after giving her some fluids she picked up quite quickly. So we didn't have to do too much to get her going, but it took us probably about two or three minutes before we had a nice strong heartbeat. She was breathing on her own, she was nice and pink, she was moving on her own. The baby tells you very quickly how much will it has to live.'
Dr Hedi van der Watt is the paediatrician who looked after Hope. She was criticised by some colleagues for trying to save such a small baby.
Dr Van der Watt: 'I've cared for a lot of 27-weekers, and even 26-weekers, but it is the gestation that is important. So a 1kg that is a 26-weeker is far more difficult to look after than a 27-weeker that's 390g.'
Annika: 'When you talk about the will to live, what signs do you look for?'
Dr Van der Watt: 'You look at the heartbeat and you look at how much you have to do to support them, and you also look at how much they're moving, how much fight is in them. If it is just a baby that lies there like a rag doll there's no point in trying to make a baby live that is not viable. And Hope from the start showed us that she's got a real fight in her and everything just went smoothly.'
Dr Nel: 'She was very growth restricted, but because of this, she was very stressed. And we know that under these circumstance babies that are very stressed inside the uterus mature a lot quicker than those who are not stressed in the uterus. Hope was born with a maturity far beyond her gestational age, which I think has helped her a lot along the way.'
Hope was moved to an isolation ward in the Neonatal Intensive Care Unit, managed by Sister Mercia Lawrence.
Sister Mercia Lawrence (Manager: Neonatal ICU):'The first day she fitted into my hand like that [shows] curled up in the foetal position. She was about that size.'
Annika: 'Mercia, how do you look after such a tiny baby?'
Mercia: 'The first day we basically ventilated Hope. The next day she came off the ventilator, which was excellent. We put her onto CPAP, which is what this little mask was for; it was all over her face.'
CPAP stands for Continuous Positive Airway Pressure, but the smallest neonatal bonnet meant for prem babies was too big for Hope. They had to pad it with layers of cotton wool to keep it on her head, which measured only 22cm in circumference - the size of a small apple. Her foot was the size of a paperclip.
Annika: 'How did you get a little nappy...?'
Mercia: 'You get special little nappies, but they were way too big for her. So we cut them into four and used masking tape to strap it around because we couldn't find anything that fitted her in the beginning.'
Dr Van der Watt: 'They get fed continuously. You can only use breast milk because they get a lot of complications from not using breast milk. But because they can't tolerate the volumes you start with minute volumes like 0.2ml/hour. We start with intravenous feeds just to keep them maintained because she was born at 390[g], but she dropped down to 310. So they lose a lot of weight initially before they start picking up.'
Annika: 'For babies with extreme low birth weight it is not just about survival, it is also about quality of life. Even for those who do make it there is a large risk they could suffer from brain damage, blindness or cerebral palsy.'
Dr Van der Watt: 'We try to use the minimal handling approach so we left her in an isolated cubicle and only the sister caring for her was allowed to go in and out and obviously myself. Because also to try reduce the amount of infections because the infection are the big problems that these babies pick up.'
Annika: 'How developed was she?'
Dr Van der Watt: 'The organs have developed, but they haven't matured. So we can cause a lot of damage by the intervention... oxygen is a huge toxin so they can get a lot of damage to their eyes, they can bleed into their brains, they can bleed into their lungs, because all the organs are there, but they're not mature. And that is what usually kills the babies.'
The chances of Hope surviving unscathed were very slim.
Dr Van der Watt: 'I think a 27-weeker to survive without any brain damage is about 20%.'
Annika: 'So Hope really is a miracle baby?'
Dr Van der Watt: 'So far it looks like it. Her hearing tests she's passed. She's passed her eye tests. Neuro-developmentally she looks to be on par for her gestation so we'll just keep an eye on her.'
Hope has been in ICU for three months, and has hardly spent any time with her mother. But all that's about to change:
Robyn: 'This is the first time in two weeks so I still have to get to know my baby.'
The nurses have been teaching her how to look after her daughter, but Hope's still so small that even the clothes made for premature babies are too big for her.
Annika: 'Hope is now three months old and weighs 1.94kg. That's almost six times more than what she weighed when she was born. She's still so tiny, but she's going home to bond with her family and lead a normal life.'
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