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Article in “Pediatrics” Details Outcomes for Very Premature Babies

by | Dec 13, 2011

By Dave Andrusko

Madeline Mann, shortly after birth (left) in June 1989, and in an undated photo at 22 years of age. (Credit: AP)

Every time an encouraging report comes out about the outcomes for very premature babies, the responses of reporters and headline writers runs the gamut. Here are three examples based on a just-published study in Pediatrics:

“Care For Earliest Preemies Improves, But Low Birth Weight Remains Risky” (National Public Radio); “Born smaller than soda cans, tiniest babies are growing up healthy; docs say most not so lucky” (an Associated Press story tha ran in the Washington Post); and “Once tiniest premature babies beat odds, grow up healthy” (CBS News online).

So what is the news? At one end you have the unqualified good news in the first paragraph and then discounted throughout virtually the rest of the story. From Nancy Shute’s NPR, referring to Madeline Mann,

“It’s the kind of news that parents of a premature baby would grasp at: One of the world’s smallest preemies, born weighing a mere 9.8 ounces, is now a 22-year-old college student who’s living a normal life.”

Then immediately how this is not only atypical but almost dangerously misleading, etc., etc. “It’s very dangerous to make this out to be a wonderful success,” says Phyllis Dennery, chief of neonatology and newborn services at the University of Pennsylvania and Children’s Hospital of Philadelphia. The reality is often quite different.”

Okay, enough of the glass is one/70th filled perspective. Here’s Lindsay Tanner’s lead: “What happened to the tiniest babies ever born? One is a healthy first-grader [Mann] and the other [Rumaisa Rahman] grew into an honors college student majoring in psychology. Both girls once entered the world weighing less than a pound – and are now thriving, despite long odds.”

Tanner takes the middle ground in her next sentence: “A medical report from the doctor who resuscitated the infants at a suburban Chicago hospital is both a success story and a cautionary tale.”

Who are these girls? At the time of her birth in 1989. Mann was the smallest ever: 9.9 ounces. Rusmaisa’s  9.2 ounce birth weight remains the tiniest. Tanner tells us that since 1989 two babies have weighed less than Madeline and in 2010 a German girl was born at the same 9.9 ounce figure.

The reminder of Tanner’s story and that of CBS News’s Monica DyBuncio explores the fierce debate about what to do and when based on a concept that remains murky: “viability” (likely to survive). What hospitals do varies across the country and different nations have different standards, according to the stories. For example, “In Japan, doctors have lowered that threshold — the gestational age — to 22 weeks,” Tanner writes. “Normal pregnancies last about 40 weeks.”

In addition,

“Some U.S. doctors will attempt to save babies at 22 weeks, but that is not done routinely, said Dr. Edward Bell, a University of Iowa pediatrics professor.

“Bell runs an online registry of the world’s tiniest babies, born weighing less than about 14 ounces, or slightly less than 1 pound. Since 1936, 124 have been listed. The registry is compiled from doctors’ voluntary reports and so does not represent all survivors.

“Bell estimates that about 7,500 U.S. babies are born each year weighing less than 1 pound, and that about 10 percent survive.”

But Madeline’s story remains filled with optimism. According to Tanner, Madeline is petite but “other than asthma, the only lasting effect his daughter has mentioned is having trouble finding age-appropriate clothes because she remains so small, he said.

“That she has done so well is a source of pride, and wonder, her dad said.”

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