Singapore’s smallest premature baby, weighing 345g, beats all odds of survival; parents ‘in debt’ to the medical team

SINGAPORE: Two hours: that was the time that Ms. Rohani Mustani and her husband had to decide whether to deliver their baby or terminate the pregnancy.

Mdm Rohani was 23 weeks pregnant when her blood pressure rose sharply due to severe pre-eclampsia. Doctors told them the boy’s survival rate was about 20 percent.

It was devastating news for the couple, who had already chosen a name, Zaiya, when they learned that they were having a girl.

Despite their chances, the husband and wife decided that Mdm Rohani would deliver the baby by emergency cesarean section.

Zaiya was born on March 27, after just 23 weeks and six days. Weighing 345g, it was the size of an adult’s hand. His arms and legs were as thin as fingers, doctors said.

He is possibly one of the smallest babies in Singapore to survive and be discharged.

Speaking to reporters at the National University Hospital (NUH) on Monday (October 26), Mdm Rohani recalled thinking that the abdominal pains he felt were regular gastric pains, but after arriving at the emergency department, he was shocked at the hear that he was showing symptoms of severe pre-eclampsia.

“I had to give birth the next day. We did a scan and the baby was very, very small. Doctors predicted that the survival rate was very low, only about 20 percent. But we were hopeful, and I gave birth as usual through the emergency c-sect, ”she added.

The 37-year-old mother of four said she felt “very, very sad” when she found out she had to give birth so prematurely, but a NUH pediatric doctor reassured her and told her to give birth first. give birth to the baby “and then we’ll see what we can do.”

A full-term pregnancy is considered to be at least 37 weeks.

Babies born before 24 weeks’ gestation are not considered “viable” because their chances of survival are low, explained the lead consultant for the neonatology department, Dr. Krishnamoorthy Niduvaje.

“Twenty percent is still hope, rather than no hope. So I decided to follow him. Whatever happens after that, I leave it to fate. I’m glad for my part that I delivered, rather than finished, ”said Mdm Rohani.

FOUR MONTHS IN NEONATAL ICU

But Zaiya’s birth was only the beginning. Born almost four months early, she was immediately taken to the neonatal intensive care unit (NICU), where she remained for the next four months.

When Mdm Rohani and Mr. Saufi finally saw baby Zaiya correctly, she was lying in an incubator surrounded by tubes and connected to a ventilator. They did not get to touch her until three months later, mainly for fear of infection.

“It was in an incubator, we could only see it through the transparent glass. We are not allowed to feel it. Do you know how painful it is for a mother? Mdm Rohani said.

“I couldn’t even hold her, touch her fingers. I could only see her. The only time I could see her skin to skin was when they changed her diaper, when they lifted the glass of the incubator, so I could see her face to face. “

Two months after giving birth, Mdm Rohani returned to work. Parents visited Zaiya in the hospital every day, taking turns staying next to her incubator in the NICU due to COVID-19 restrictions.

For little Zaiya, almost everything was too big for her, recalled clinical nurse Wang Xia. The nurses had to carefully insert direct lines into his arm, the size of an adult’s finger, to give him infusions and extra nutrition for the first few weeks.

This is because they were unable to feed her additional volumes of milk, Ms. Wang said. “When they are premature, they have a lot of difficulty digesting milk. So we provide additional nutrition through our own line. ”

Since preterm diapers cost three to five times more than normal diapers, the nurses decided to stick to normal ones to help the family cut costs. Baby Zaiya was so small that a regular-size diaper covered her up to the breast, Wang said.

Since Zaiya’s skin was so thin, “almost transparent,” her diaper had to be changed at least six to eight times a day to avoid irritation and breakage of the skin, which could lead to infections, he added.

For the ventilator, the nurses had to use a smaller-than-usual breathing tube about 2mm in diameter, which also made it difficult to feed the Zaiya drug through the tube, Ms Wang said. A normal ventilation tube it is usually 2.5 mm or more in diameter.

For extremely premature babies, their immediate survival depends on lung expansion, Dr. Krishnamoorthy said. “If your lungs don’t expand, they can’t. So to improve the lungs, we apply this drug to help them expand. ”

Even with medications, many extremely premature babies may need respiratory support for weeks and months. And this could cause some chronic changes in your lungs, which may have future implications, he added.

One of Zaiya’s main obstacles in the NICU was weight gain, Mdm Rohani said. She expected to hear from the nurses every day about whether her daughter had lost or gained weight, and even a 100g or 200g weight gain was good news for her, she added.

Since she was born extremely premature, the blood vessels in Zaiya’s eyes did not fully develop “in an organized fashion,” which could have resulted in blindness if not treated properly, said Dr. Krishnamoorthy.

Besides all this, Zaiya also had a small hole in her heart, which was “a very temporary one”. In most full-term newborn babies, this hole is expected to close naturally after birth in two to three days, he added.

“But in premature babies, it takes much longer to close. And if it doesn’t close, sometimes more blood gets to the lungs and that causes problems in the lungs, and that also needs treatment. ”

‘IN DEBT’ OF NUH DOCTORS AND NURSES

Six months after his birth, Zaiya now weighs 4.27 kg.

Noting that tracking milestones in the development of a premature baby is “very important,” Dr. Krishnamoorthy said that Zaiya has met the required milestones at the two-month mark. You can respond by smiling, lifting your head, and grabbing objects.

After the medication, the hole in Zaiya’s heart was closed, without the need for surgery. She was discharged in August and then returned for laser eye surgery, which was successful.

After more than four months in the NICU, Zaiya was finally able to meet her three brothers and grandparents.

His hospital stay and treatment cost the family around S $ 50,000 after the subsidies, Saufi said, adding that without them it would have been about S $ 200,000.

The youngest in the family was born on the same day as her third child, who is four years old this year, and the occasion was “quite sad”, as they were supposed to be celebrating her birthday on the day Mdm Rohani gave birth.

Her other three children were expecting them to return from the hospital with Zaiya a few days later, and the first response when she did not return home with them was, “Is it because of COVID-19?” She recalled laughing.

Adding that the family is “in debt” to the NUH team for taking care of Zaiya, Mdm Rohani said: “We had several blood transfusions, laser for his eye because he had ROP (retinopathy of prematurity), and then he had a small hole in your heart.

“One after another, we managed to overcome obstacles along the way. The doctor even said that he is very very strong for his age, he kept fighting. ”