By Dave Andrusko
Kudos to CNN’s Jacqueline Howard for her story about the daughter of Courtney Stensrud and her husband, now three-years-old, who was born at just 21 weeks, four days.
A report published last week in the journal Pediatrics says, “She may be the most premature known survivor to date.” (The parents requested that the girl’s name and current photo not be given out.)
Indeed, the lead author of the Pediatrics article, Dr. Kaashif Ahmad, a neonatologist at Methodist Children’s Hospital in San Antonio, Texas where the girl was born, “counseled her about the baby’s extremely low chances of survival and initially counseled against resuscitating the baby,” according to Howard.
How did Mrs. Stensrud respond?
“Although I was listening to him, I just felt something inside of me say, ‘Just have hope and have faith.’ It didn’t matter to me that she was 21 weeks and 4 days. I didn’t care,” Stensrud said.
“As he was talking to me, I just said, ‘Will you try?’ And he said he would, and three years later, we have our little miracle baby,” Stensrud said.
“I don’t tell her story a lot, but when I do, people are amazed,” she said. “If there’s another woman in antepartum that is searching Google, they can find this story and they can find a little bit of hope and a little bit of faith.”
The bulk of the first half of the story was to tell the reader that Mrs. Stensrud’s child was an outlier–that newborns that premature rarely survive–and how great are the costs associated with caring for them. Not the most uplifting reading.
It became a more balanced story later when Howard talked about how survival rates have improved but managed to miss how often whether a child born very prematurely survives depends on whether the hospital “actively” treats him or her.
Why did she go into early labor? According to the Pediatrics report it was “due to a premature rupture of membranes and a common infection of the placental membrane called chorioamnionitis.”
Ahmad told Howard that when he and his colleague entered Stensrud’s labor and delivery room, they were “not expecting to resuscitate the preterm baby.”
“But when the mother asked that we do everything for her daughter, despite having no reason to believe the baby would survive, I just made the decision to proceed with a vigorous resuscitation,” Ahmad said.
“So we placed her under an overhead warmer, we listened, and we heard her heart rate, which we were not necessarily expecting,” he said. “We immediately placed a breathing tube in her airway. We started giving her oxygen, and really pretty quickly, her heart rate began to rise. She very slowly changed colors from blue to pink, and she actually began to move and began to start breathing within a few minutes.”
Three years later, her development is remarkably normal;
“If you didn’t know that she was so preemie, you would think she’s a normal 3-year-old,” Stensrud said. “In her school, she is keeping up with all the other 3-year-olds. She loves playing with other kids. She loves everything I think a normal 3-year-old likes. She loves her baby dolls, she loves books, and she loves make-believe. She loves anything and everything her (older) brother is doing.”
When so much emphasis in making treatment decisions is placed on whether a baby is 21 or 22 or 23 weeks gestational age, it was very helpful that Dr. Noelle Younge, an assistant professor of pediatrics at Duke University School of Medicine, who was not involved in the case report, pointed out the obvious:
“Except in the case of assisted reproductive technology, there is always uncertainty about gestational age dating,” Younge said.
“First-trimester ultrasounds are generally thought to be accurate within five to seven days, so it is possible the infant may have been 22 weeks of gestation at birth,” she said. “As neonatal and obstetric care improve over time and a greater number of infants are actively treated at 22 weeks of gestation, there are likely to be more cases of infants who survive with favorable outcomes, but unfortunately, the majority of infants born this early do not survive.”
It was doubly important because Dr. Younge led a recent study on preterm babies that appeared February in the New England Journal of Medicine, showing an increased survival rate. Howard wrote of that study
The percentage of infants born at 22 to 24 weeks’ gestation who survived climbed from 30% around 2000 to 36% around 2011 across the United States. …
The researchers found not only that survival rates increased between 2000 and 2011 but that the percentage of infants who survived without neurodevelopmental problems increased from 16% to 20%.
A very encouraging story which ends marvelously. Mrs. Stensrud told Howard
She didn’t agree to tell her family’s story for herself or her daughter, she said, but “for those other parents out there.”
“From the moment she entered this world, she’s just always wanted to live,” Stensrud said of her daughter. “Now, she lives life.”