baby in cot 311.
(photo credit: Illustrative photo)
MAYWOOD, Il. -- In 1989, Madeline Mann became the world's smallest surviving
baby after she was born at Loyola University Medical Center. She weighed 280 g.
(9.9 oz.) -- about the size of an iPhone.
In 2004, Rumaisa Rahman set a
Guinness World Record after she was born at Loyola, weighing 260 g. (9.2
Remarkably, Madeline and Rumaisa both have normal motor and
language development, Loyola physicians wrote in a case report in Pediatrics,
the official journal of the American Academy of Pediatrics. The article was
published online Dec. 12.
Rumaisa remains the world's smallest surviving
baby, and Madeline now is the world's fourth smallest surviving baby, according
to a registry kept by the University of Iowa Children's Hospital. Rumaisa and
Madeline are the smallest and second smallest surviving babies born in the
United States. And Rumaisa and her twin sister, Hiba, are the world's smallest
surviving twins. (Hiba weighed 1 pound, 5 oz. at birth).
Of the 85
smallest surviving babies in the United States, three were born at Loyola and
five others were cared for by physicians trained at Loyola.
Jonathan Muraskas, MD, and colleagues caution that successful outcomes such as
Madeline and Rumaisa are not necessarily typical. Many extremely
low-birth-weight preemies either do not survive or grow up with severe, lifelong
disabilities such as cerebral palsy, mental retardation and
Comparing other micropreemies with Madeline and Rumaisa could
"propagate false expectations for families, caregivers and the medico-legal
community alike," Muraskas and colleagues wrote.
Madeline and Rumaisa had
several advantages. Female preemies tend to do better than males. They had
relatively long gestational ages for their birthweights. And their mothers were
given steroids before birth, which helped their lungs and brains mature more
During their pregnancies, Madeline's and Rumaisa's mothers
experienced preeclampsia (pregnancy-induced high blood pressure). There was
decreased blood flow through the placenta, which restricted the babies' growth.
Madeline was born at 26 weeks, six days, and Rumaisa was born at 25 weeks, six
days. Under normal conditions, it would take a fetus just 18 weeks to reach
Madeline spent 122 days in Loyola's neonatal
intensive care unit, and Rumaisa spent 142 days. They each have met
developmental milestones at appropriate ages. Rumaisa, 7, is a first grader and
Madeline, 22, is an honor student at Augustana College in Rock Island, Il. But
they both remain small for their ages.
Advances in neonatal care have
allowed the resuscitation and survival of smaller and smaller newborns, Muraskas
and colleagues wrote. They suggest that at the threshold of viability, three
critical factors should be considered: gestational age, steroid treatment before
birth and female gender.
"With Japan lowering its limit of viability to
22 weeks and public fascination with micropreemies, how small is too small? The
medical, ethical and economic issues will continue to be vigorously debated."
Muraskas is co-medical director of Loyola's neonatal ICU, and a professor in the
Departments of Pediatrics and Obstetrics & Gynecology, Divisions of
Neonatology and Maternal/Fetal Medicine, of Loyola University Chicago Stritch
School of Medicine.
Co-authors are Brian J. Rau, MD, Patricia Rae
Castillo, MD, John Gianopoulos, MD, and Lauren Boyd, MD.
This article was first published at www.newswise.com