A LITTLE MIRACLE CALLED MADELINE

From: Dr. Jai Maharaj (usenet_at_mantra.com)
Date: 08/30/04 

Date: Mon, 30 Aug 2004 21:31:12 GMT

Screenplay material for an independent, non-profit film:

A little miracle called Madeline

The Hindu
Thursday, August 26, 2004

Gestational age and the sex, more than weight at birth,
are the critical factors deciding the chances of survival
of a pre-term infant.
 
[Caption] Madeline Mann was born at 27 weeks gestation in
1989 and her weight of 280 g was equal to infants born at
16 or 17 weeks gestation. - AP

View picture here:
http://www.hindu.com/seta/2004/08/26/images/2004082600411401.jpg

THE SMALLEST-EVER pre-term infant known in medical
history - all of 280 g weight and a length of 25 cm, has
survived past infancy and turned 15 years old. Madeline
Mann was born pre-term as her mother suffered from a
pregnancy disorder called preeclampsia, which starved her
of essential nutrients.

What is indeed remarkable is that Mann born at a
gestational age of nearly 27 weeks (26 weeks and 6 days
to be precise) has none of the physical or neurological
problems that often afflict such pre-term children as
they grow up.

Though Mann was born only 13 weeks premature in 1989, her
weight was equal to those infants born at 16 or 17 weeks
gestation. Her weight of 280 g is about a third of the
weight of babies of a similar age and only a fraction of
the three kilograms that newborns normally weigh after a
full 40-week pregnancy.

Normal development

Babies born with such drastically low birth-weights tend
to suffer severe disabilities such as cerebral palsy,
blindness or learning problems. Yet, in the end
everything seems fine and Mann seems to suffer from none
of the problems other pre-term infants suffer from.
Though small for her age at only 136 cm and weighing only
25.4 kg, she has no psychosocial maladaptations.

"The normal cognitive development of our patient is more
remarkable than her survival," Dr. Jonathan Muraskas of
Loyola University Medical Center, Illinois, U.S., who
treated Mann as a newborn, wrote in the New England
Journal of Medicine. A significant number of newborns
with an extremely low birth weight (1 kg) have shown sub-
optimal neurodevelopment outcomes and cognitive function
when followed up to school age.

Gestational age

Dr. Muraskas should know best. According to him, the
neonatal survival rate improves dramatically from 5
percent at a gestational age of 23 weeks to 90 percent at
a gestational age of 27 weeks. Thus Mann born at nearly
27 weeks of gestation had a good survival chance.

According to him, gestational age, more than weight at
birth, is a very critical factor deciding the chances of
survival. "Prospective studies have demonstrated that
newborns delivered before 24 weeks of gestation have been
completed are less likely to survive and to survive
without deficits than are those delivered after a longer
gestation," Dr. Muraskas wrote in the journal.

Gender saved Mann

One more factor, which turned in Mann's favour was her
sex. Apart from gestational age at the time of birth, the
female sex is a very critical characteristic in newborns
at the threshold of viability. "Girls generally have a
better prognosis than boys," according to Dr. Muraskas.

The reason is not known however. Fifty-two newborns with
at average gestational age of 25 weeks and six days with
a birth weight of less than 400 g have been described in
the literature. And the number of girls is an astonishing
83 per cent. The University of Iowa Registry for the
tiniest babies shows an overwhelming number of infants
being females.

Trying to beat the odds are a handful of key medical
advances that have happened in the last 30 years that
help premature babies survive the traumatic birth. But
for these advances, many pre-term babies would have
surely died. Pregnant mothers going into premature labour
are now routinely given steroids to accelerate the
development of the infant's lungs. Also, drugs called
surfactants are given to infants, which help open up the
lungs.

Despite these developments, babies born at 23 weeks are
on the threshold of survival. This is particularly so
because the infant's brains, guts and lungs are too
immature to cope.

Not surprising then that only less than 40 per cent of
infants survive, and the vast majority of those that do
survive go on to develop major disabilities.

In contrast, by 27-weeks of age, the infant's organs are
matured enough and over 90 per cent survive and only a
small fraction suffers severe handicaps.

Doctors' concern

Dr. Muraskas and other doctors are concerned however.
They fear that Mann's survival and well-being will send a
wrong message that no matter what the weight or time of
birth at gestation, pre-term babies can survive.
"Extremely low-birth-weight, "miracle" newborns can
propagate false expectations for families, caregivers,
and the medico-legal community alike.

Gestational age and female sex are critical
characteristics in newborns at the threshold of
viability," reiterated Dr. Muraskas in his article.

R. Prasad
In Chennai

More at:
http://www.hindu.com/seta/2004/08/26/stories/2004082600411400.htm

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