The world's tiniest baby - meet the 10oz bundle of defiance

Actually it’s not rare at all for a baby to be born at this tiny size. It’s just very rare for one to survive — so rare that unless there is some unusually positive sign (e.g. in this case perhaps later gestational age than usual for this size, and lung function closer to what would be expected for the later gestational age than for the size), it’s extremely rare for any attempt to be made to save a baby who’s 10 ounces at birth. If you didn’t see many this size in the NICU, it’s not because there weren’t many born alive at this size, but because they were too small and hopeless to be considered candidates for NICU and were just allowed to die peacefully in their parents’ arms.

A typical micropreemie parents blog re twins both born at around twice the size of the girl in the article, shows both still subject to frequent hospitalizations. At over 3 years of age, one still can’t sit unaided. And from the next to most recent hospitalization (most recent was just 3 months later) comes this sad quote from the mother:

“Today we put Eden on a nasal cannula for oxygen. She screamed and fought and tried repeatedly to pull it out. I had to hold her down. I am SO TIRED of holding my kids down so people can hurt them.” http://micropreemietwins.blogspot.com/

Yes, these two look like they have some good times too, but if they’d been born at 3/4ths the size they were (never mind 1/2 the size), there would be almost no chance of that — but definitely lots more of people holding them down to hurt them, assuming they’d even survived.

Her most recent post links to a blog about a pair of twins born slightly larger, and in much worse shape:

“Over the last 5 weeks my little Lena has had four brain surgeries. One to externalize her shunt, one to replace a shunt that had been in too long, one to flush out an infected cyst and install another drain in to cyst and one to reinternalize her shunt. She came into the hospital very sick, got better, got very sick again, had seizures, countless IV pokes, countless blood tests, several CT scans, two EEGs and probably more traumatizing events that I can’t even remember.” http://www.bitsandpiecesofme.typepad.com/

It’s usually a tough call whether it makes any ethical sense to try to save the tiniest ones, even just considering that one child’s interests. It gets even tougher when you consider the reality that for the money/resources spent trying (often unsuccessfully) to keep one of these kids alive and even marginally functional, at least 1000 deaths of young children in the third world could be prevented, or dozens of cases of horrific child abuse here could be prevented or stopped much earlier. I think it’s important to consider the downside in that big picture, when deciding where to draw the line with heroic measures for babies so small that, at best, they’ll grow up with serious physical disabilities.

It’s usually a tough call whether it makes any ethical sense to try to save the tiniest ones,

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I agree with you completely. Yes, you are right about babies being born at this German baby’s weight that never make it to the NICU. One of the major reasons for studies of the progress of micropremies is to find some bright lines defining when it is not in the best interest of baby or family to use extraordinary measures to keep them alive.

Much data has been collected over the past 25 years, and I believe many of the tiniest are not treated as aggressively as they would have been at one time.

But of course there’s a happier flip-side, in that both improvements in knowledge and technology have meant real success for some babies who would previously have been too small to save at all or to save with above-zero quality of life. That’s the best argument for attempts to save the borderline cases (but not the really hopeless cases) — that even if it is unsuccessful, the suffering of that child and family may make a real contribution to future successes. The lousy part of the ethical equation is that there’s no way to ask the micropreemie how much suffering s/he is willing to endure for the sake of others not yet born.

Perhaps since you have a good deal of experience in this area, you could answer a technical question. There are a lot of features of growing in mom’s uterus that obviously can’t be replicated outside of it. But I’ve often wondered why, with the extremely fragile skin that these micropreemies have, why it wouldn’t be beneficial/feasible to keep them in a warm electrolyte solution, matching amniotic fluid as closely as possible, instead of in a dry (though presumably humidified) incubator. With all the things tethered to them as it is, it doesn’t seem like it would be too difficult to find a way to harness them so as to keep their heads above water to breathe air. On-going filtration and the content of the solution should be able prevent infection from this arrangement. And a little creativity should be able to manage the catheters, etc.

I would think there would be some physiological benefit to the skin, and thus indirectly to other parts of the body. In addition, I would think there would be a psychological benefit to remaining in the warm wet embrace that they’re really designed to be in at that stage. As this article mentioned, they can’t really be handled/cuddled, so often have to settle for very light stroking with a finger or two. I would think this lack of normal sensation of constant, all-embracing skin contact would cause them significant stress, which God knows these fragile little creatures aren’t in good position to handle. Seems to me that the more nature can be mimicked, the better off they’d be. For example, after decades of keeping the poor little things under bright lights, for the convenience of medical staff, the damage that does was discovered, and the practice changed. Do you think one day we’ll see them maturing in tanks of liquid?

Nothing is impossible, but I cannot visualize treating a baby inside a fluid environment. As you said there are too many tubes and attachments. But innovations are happening constantly - many by nurses who have convinced doctors to listen, I may add.

It took a long time to convince doctors that we could nurse them in covered incubators, instead of under bright lights, and in nestled positions instead of lying flat out on a hard mattress.

Regarding that light stroking - a no no, because the nerve endings are so close to the surface. the baby feels a sensation like a feather on the soles of our feet, for example. Not pleasant. A gentle pressure that would mimic the pressure of the walls of the uterus is much preferred by the baby, who feels security in that kind of touch. The voices of the mother and the father are also very soothing.

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