ROBERT SIEGEL, host:
This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.
MELISSA BLOCK, host:
And I'm Melissa Block. A baby girl believed to be the most premature baby ever to survive, should be going home from the hospital this week. Look at photos of Amillia Taylor soon after she was born. She was a little longer than a ballpoint pen, nine-and-a-half inches. She weighed just under 10 ounces at birth. She was delivered in October by C-section, after 21 weeks and 6 days of gestation. Full-term pregnancies last between 37 and 40 weeks.
Dr. Paul Fassbach is one of the neonatologists who've been treating Amillia Taylor at Baptist Children's Hospital of Miami. He recalls his first reaction, when he was called soon after her birth.
Dr. PAUL FASSBACH (Neonatologist, Baptist Children's Hospital): I absolutely did not think she was going to make it.
BLOCK: And why is that?
Dr. FASSBACH: We base everything on statistics, and statistically, babies of this size are not good at all, probably less than one percent. I started taking care of her the second day of life, and she truly was, for her size and where we were at early on, she was relatively stable.
BLOCK: It's interesting, because if you didn't think that she was viable, it would seem there would be a whole chain of decisions that would be made at that moment, in terms of whether to treat, whether to take extreme measures.
Dr. FASSBACH: Absolutely, and generally we do - we intervene as we can, as much as possible. We talk to the parents and let them know that things may be taking a turn for the worse. But as each hour passed, she continued to be stable, and we just intervened when necessary - gave her the IV fluids and antibiotics and kept her on the mechanical ventilator. She responded to all those measures. She was able to be weaned off the ventilator, and we introduced some oral feedings, and day by day came and passed, and she just continued to do well.
BLOCK: Was there disagreement among hospital staff about whether it was the right decision to use resources, expensive resources, to keep a baby alive who at least at the beginning you thought really had a very poor prognosis?
Dr. FASSBACH: Absolutely. There's always a question of are we doing the right thing. By us evaluating hour-to-hour, minute-to-minute even, it helps us in that decision-making. Unfortunately, we don't know which baby is going to do well. In this case, we had a good outcome.
BLOCK: You obviously feel like she's doing well enough to be allowed to go home. Would you, though, be concerned about problems that you may not see right now, but that could well develop down the road?
Dr. FASSBACH: Sure. The architecture of the brain is ongoing, and there could be issues with her long-term development of her brain. Her current neurological exam leads us to believe that she'll have a good prognosis. So that's really all we can say right now.
BLOCK: And with baby Amillia set to go home, is she breathing on her own now? What sort of system does she have around her?
Dr. FASSBACH: She is currently really like any - close to any term baby at this point. She is on some supplemental oxygen. That will hopefully come off with time. Most of these babies come off in one year, and most of that group come off within a few months after going home.
BLOCK: You know, I've looked at the photographs that were taken soon after she was born, and it's really virtually impossible to imagine that something so tiny could four months later be about to go home from the hospital. I wonder if that sort of shakes your medical world in some way.
Dr. FASSBACH: I believe that a lot of people are going to be looking at this, and we don't think this should be the norm. We do believe everything should be individualized, but it's a burden on parents, it's a burden on the NICU staff that has to deal with, in some cases, these babies that pass. The American Academy of Pediatrics - it's not recommended by them to intervene in babies of this size, usually. But again, like I said, this isn't really - shouldn't be the norm. There was a lot of things in play for her to get where she is, but the outcome is a lot of times a lot different than Amillia's outcome.
BLOCK: Is that a worry for you, that other parents with extremely premature babies might look at this case and say wow, you know, she made it. Why can't we do the same thing for my baby?
Dr. FASSBACH: It is an absolute worry. People will hear of this story and be in the same situation and be expecting the same outcome, but every case is different. So I'm sure this is not going to be the last, and we don't really know where our edge is going to be. I mean, we believe we know - we're at the edge of viability, but then all of sudden, we have a case like this where we have a baby that does well, and people may look at it and rethink things and stuff like that, but we're pretty much at our limits right now.
BLOCK: Limits of viability.
Dr. FASSBACH: Limits of viability.
BLOCK: Dr. Fassbach, thanks very much for talking with us.
Dr. FASSBACH: No problem. Thank you very much.
BLOCK: Dr. Paul Fassbach is a neonatologist at Baptist Children's Hospital in Miami. You can see a photo of the 10-ounce Amillia Taylor soon after her birth and at four pounds now with her mom at our Web site, npr.org.
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