Medical advances saving babies

NICK EICHER, HOST: Good Stanley Cup Championship Thursday morning from St. Louis.

It’s the 13th of June, 2019. I still can’t believe the Blues won the Cup last night.

So I thought I’d break out the team’s victory tune here. The Blues play this old Laura Branigan song every time they win, and last night was the biggest one in the history of the franchise. First Cup in 50-plus years!

So a very good morning to you. I’m Nick Eicher.

REICHARD: And I’m Mary Reichard. Congratulations!

Yeah, I think we heard you cheering all the way down here in Springfield. But the Reichard household was pretty happy, too. My husband Joe is a St. Louis boy, so he’s with ya, Nick.

EICHER: So let me make an appropriate transition here: We’ll move from miracle seasons to miracle babies. The tiniest of tiny babies.

Going back to December of last year, doctors in San Diego delivered a baby girl who weighed about what an apple weighs. In this case, just 8.6 ounces. They told her dad he would probably only have an hour with her.

REICHARD: Right, but that hour turned into two and then a full day. That day stretched into a week. Five months later, baby “Saybie,” as the nurses called her, went home with a world record. She is the smallest surviving baby ever born.  

Joining us now to talk about this miraculous case and others like it is Kimberly Costello. She’s a neonatologist in Pennsylvania. Thanks for joining us today!

KIMBERLY COSTELLO, GUEST: Thank you so much for inviting me.

REICHARD: The baby in this story was born at 23 weeks and 3 days. How rare is it for a baby to survive at that early stage?

COSTELLO: So, typically we do have babies now surviving fairly regularly as low as 23 and 0/7ths weeks and now even into the 22 week range. So the other thing to really think about is not just survival but intact survival. And what intact survival means is how the babies are doing. Do they have adequate brain development? Are their eyes developed? And things like that. Lungs, especially. So, in general right now, there is about a 25 percent survival rate as far as actually surviving the NICU experience. But then intact survival is a little bit lower than that. But, again, that is improving.

REICHARD: What are some of the medical advances that are allowing babies like this to live?

COSTELLO: One of the biggest advances that we had actually happened back in the 80s and that is the advancement of surfactants. Surfactant is a medication that we use that helps babies’ lungs mature faster so that they can get off the ventilators and they can breathe better. After that advancement, really what we have done is made advances in neonatal neurodevelopmental care. And what that means is we have been able to learn that we really need to allow the babies time to rest. And what that means is we try to do less. Because one of the biggest things that affects a baby’s survival is intraventricular hemorrhage. And so that’s when there’s bleeding in the brain. And although we don’t fully understand how this happens, we do know it’s because babies are immature. And there are specific neurodevelopmental guidelines that we follow in order to lessen the rate of the brain bleeding or IVH. Because that oftentimes leads to things such as cerebral palsy. And so over time, as we have helped these babies survive, we have allowed them to survive intact, which is really, really exciting and something that a lot of people don’t even know is possible.

REICHARD: How do doctors decide when these treatments will work? Is there a point at which babies are just too young to survive? And how do doctors know when that is?

COSTELLO: Right. So, nobody really knows. What we like to do is we like to have a prenatal consult with the family. Legally, we don’t have to resuscitate these babies because they are at the edge of viability. But when families understand that we can make a difference, oftentimes they do choose to allow us to step in and see what we can do. A baby will clearly declare themselves if they are going to survive or if they’re not going to survive. But if we don’t give them a chance at the beginning, then we just never know. It’s never easy. It’s not a smooth road at all. But with continued conversations with the families, oftentimes we can help these children survive.

REICHARD: Do cases like that little baby in San Diego help change the perception in the medical community about what’s possible?

COSTELLO: I absolutely think that it does change how people perceive micro-preemies. Now, every baby that is born at the edge of viability, which is the 22, 23, 24-week mark, every baby is different in that realm. And there is different scenarios as to why that baby’s born so early. But, again, with all the advances we have had, we certainly can give those babies a chance. And I think it’s a very hopeful story, but there has to be that conversation with the family so they understand we will certainly do absolutely everything we can to help them, but every outcome is different.

REICHARD: What about the abortion debate? Do you think cases like this one help change the narrative there?

COSTELLO: I do think it will help change the narrative. And I do think that something we often don’t talk about in the medical community that I think we need to talk about more is the option of adoption. You know maybe that will make people think and perhaps adoption is the road that would be better for them. We certainly don’t want to force someone to be a parent if they’re not ready for that. But we want to make sure that all avenues are certainly explored.

REICHARD: Kimberly Costello is a neonatologist in Pennsylvania. Thanks for joining us today!

COSTELLO: Thank you!

(Photo/Sharp HealthCare) The baby, whom nurses at a San Diego hospital called “Saybie,” is believed to be the world’s tiniest surviving newborn.

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