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Miracle babies

Advances in medicine give premature babies a chance at life

Makale Chartrand spends some quality time with  his mom, Tara Chartrand.
Makale Chartrand spends some quality time with his mom, Tara Chartrand.

BY HOLLI MONCRIEFF
Winnipeg Health Region
Wave, May / June 2015

Twenty years ago, it was thought that a premature baby would need to be at least 25 weeks old and weigh about 500 grams (17 ounces) to have a decent chance at survival.

Today, babies between 22 and 23 weeks' gestation are being delivered at Winnipeg's two maternity hospitals, some weighing just over 400 grams (14 ounces). And their chances of surviving are hovering around 40 to 50 per cent, and improving all the time. Just recently, at St. Boniface Hospital, Mac Gross entered the world at 22 weeks, six days - the youngest baby ever born at St. Boniface Hospital. He weighed 630 grams (21 ounces). Over at Health Sciences Centre Winnipeg, babies are born as young as 23 weeks.

Premature babies generally face a series of challenges upon birth, says Dr. Ruben Alvaro, a neonatologist at St. Boniface Hospital and the person who headed the medical team that delivered little Mac.

For example, premature babies are not as fully developed as those delivered at full term. "Every organ is immature," says Alvaro, including the lungs, kidneys and heart.

They are also more likely to suffer neurological damage from a bleed in the brain. Infections are a problem because premature babies do not have well- developed immune systems.

So why have more premature babies been able to thrive in recent years?

Alvaro says a lot of the change over the last 20 years can be attributed to two major developments. One is the introduction of prenatal steroids in mothers to help boost the development of the fetus, particularly the lungs and the brain. This helps enhance the baby's health, which of course, also helps prevent infection. "The more stable the baby, the less risk of infection," says Alvaro. The other big advance came with the introduction of surfactant, a drug that is used when a baby is born to boost his or her lung capacity and reduce respiratory stress.

Lung and respiratory issues are among the top health challenges facing premature babies at birth, largely because they are born without sufficient levels of surfactant, a naturally occurring substance found in the lungs that enhances breathing, says Alvaro.

"We all have surfactant in our lungs. Premature babies, when they are born, don't have enough. So we actually give surfactant directly into their lungs to keep the lungs open," he says.

Following the approval of surfactant for clinical use in 1991, "the mortality rate from respiratory stress in premature babies significantly decreased," he says.

Interestingly, delivering a premature baby is not all that much different than delivering an infant at full term, says Alvaro. The real work starts after the baby is born, he says.

Of course, the first order of business is to determine, in consultation with parents, whether the premature baby has a real chance of surviving. Once a decision is made, the medical team begins to prepare for delivery. A premature baby delivery team will include as many as two neonatologists, two to three nurses, and two to three respiratory therapists. "It is not a one-person job," says Alvaro. After the delivery, the team gets larger, including dietitians, pharmacists, physiotherapists and a number of specialists. 
A premature baby's chance of survival is heavily influenced by his or her gestational age, the odds improving week by week, even day by day.

For example, Alvaro says a baby born at 25 weeks will have a 75 to 80 per cent chance of survival. At 24 weeks, a baby will have about a 60 per cent chance of survival. Between 22 to 23 weeks, the baby's chance of survival drops to about 40 to 50 per cent.

"A few years ago, we did not even consider going for babies at 23 weeks because the survival rate was less than 20 per cent. But as we started treating these babies at 23 weeks, we are getting better, and the survival rate has increased significantly over the last 10 years."

Alvaro says it is important to remember that the health of the baby at birth is often more important than its gestational age.

"There are babies born at 25 weeks who are extremely sick because of the condition that triggered the premature labour. So, for example, if the mom had a severe infection that triggered the labour, that baby will not be born in good shape. But if the baby was born prematurely because there was a maternal condition - maternal hypertension or something like that - the baby is usually in better shape because there is no infection or anything, and you can prepare for the delivery better."

Generally speaking, St. Boniface will only deliver a few babies a year at 23 weeks, and about four or five at 24 weeks. "It really depends. We don't want to force anything on parents if the prognosis is not that good."

Of course, every premature baby has his or her own story of survival to tell.
In Mac's case, his medical team swung into action the second he was born. Several steps have to be taken immediately when a premature baby is born, so planning is key, says Alvaro. "Everyone needs to know exactly what their job is."

Mac was born stable, so the team was able to delay clamping the cord for about a minute to get more blood pumping from the placenta to the baby. Then, the team placed Mac into a small plastic bag to help keep him warm and to prevent evaporation of moisture. "It's like a greenhouse effect. We put them in a plastic bag and that helps keep the temperature inside the bag and on the baby."

At the same time, the team inserted a device into Mac's nose to provide pressure to his lungs and keep them open so he could breathe. Once that was done, the team placed a sensor on Mac's hand to monitor oxygenation of his blood.

"When the baby is inside the mom, the oxygen level in the blood is low. When the baby takes the first few breaths, the oxygenation level goes up. We monitor oxygenation in the first few minutes of life to see if we need to do any more intervention." 

As it turned out, Mac spent about five weeks on a ventilator and about nine weeks on a continuous positive airway pressure (CPAP) machine.

Today's Mac's condition is much improved. He is stable, breathing on his own, growing and shows no sign of infections. "His prognosis is good," says Alvaro.

Wave: March / April 2015

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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