Modern medicine gives highly premature babies a fighting chance

Four-year old Joshua Rohner of Cape Town a few days after he was born weighing just 500g at Netcare Blaauwberg Hospital. Today he is a energetic little boy and the pride of his doting parents Amanda and Robert Rohner. Photo: Netcare

One in seven SA babies are ‘preemies’ :

Seeing four-year-old Joshua Rohner of Cape Town today, you would never guess that the first weeks of his young life were a desperate struggle for survival. He was born extremely prematurely at just under 24 weeks and weighed just 500g, the weight of a block of butter, spending the first three months of his life in the neonatal intensive care unit at a private Cape Town hospital.

Today Joshua is a healthy little boy who has boundless energy, enjoys karate and is the delight of his doting parents Amanda and Robert Rohner. “He is a wonderful little miracle and such a character,” enthuses Amanda, who was speaking ahead of Pregnancy Awareness Week, 10 to 16 February. “He is obsessed with the music of André Rieu, Abba and Kurt Darren. He is also proving quite the little sportsman, although I don’t know where he gets that from because neither of his parents are sporty.”

A little more than four years ago on 19 November 2011, when Joshua was delivered at Netcare Blaauwberg Hospital in Cape Town, there was a great concern that he might not survive the ordeal of being born so prematurely. Indeed, despite the best efforts of neonatologist, Dr Ricky Dippenaar and his neonatal ICU nursing team at the hospital, Joshua’s twin brother did not survive.

“The whole experience was extremely traumatic and bitter-sweet,” admits Amanda with a deep sadness. “We lost Joshua’s twin brother but we are so grateful that Joshua survived and we are able to have his joyful presence with us today. This is in no small part due the expert care he received from Dr Dippenaar and his team, and we consider ourselves to be exceptionally fortunate to have been referred to him.”

Dr Dippenaar, who made international headlines in 2011 when he headed up the team who saved “ziplock baby” Allegra Lategan, born at just 22 weeks and four days, said that tragically some ‘micro-prem’ babies are just too vulnerable to survive. “However, modern medicine is increasingly giving these babies a fighting chance at survival, and most will eventually go home with their parents and live normal, healthy lives,” he adds.

“We are very fortunate that the technology and know-how to care for these precious micro-prem and other pre-term newborns has developed at a staggering rate, compared to what we had at hand when we treated baby Joshua and baby Allegra in 2011. It is nowadays almost routine practise for specialised units with skilled personnel to not only keep micro-prem infants weighing 500g alive, but also to discharge them home healthy.”

Dr Dippenaar admits that he heaves a deep sigh of relief every time he and the nursing team in the neonatal intensive care unit (NICU) are able to save a premature baby and discharge him or her home. “The team feels compelled to fight for every little life that passes through our hands. We are talking about someone’s precious child and are always going to do everything in our power to send their baby home safely with the anxious parents.”

Amanda says her advice to pregnant mothers is to make sure that they go for regular check-ups and, as far as possible, to have the necessary expertise available close to hand should something go wrong with the pregnancy.

“While we may feel great during pregnancy, there is always the possibility that one could develop some form of complication. I would therefore recommend that moms try to ensure that they carefully choose their obstetrician, as well as the facility where they will give birth. Make sure the hospital has a NICU that is experienced in treating birth complications and premature babies because you never know when it may be needed.”

“I myself was in the care of an excellent fertility specialist when I was pregnant, but was still looking for an obstetrician. I felt healthy during my pregnancy and didn’t expect any problems. Then I had a little bleeding and I was advised to rather play it safe and have it checked out.”

According to the World Health Organization (WHO), an estimated 15 million babies around the world are born prematurely every year, of whom one million die due to complications. In South Africa, an estimated one in seven babies are born prematurely.

“There is an alarming upward trend in the number of preterm births in South Africa,” notes Dr Dippenaar. “There may be a number of reasons why women give birth pre-term, including not receiving antenatal care early enough, or suffering from pre-eclampsia, a pregnancy-related illness associated with high blood pressure, which increases the risk of preterm birth, or as a result of other complications.”

“In private medicine, we are seeing more premature births. This is due to such factors as an increase in the number of older first-time mothers, who tend to have a greater risk of preterm birth. There is also greater use of assisted fertilisation and fertility drugs, which often results in multiple pregnancies. This too carries an increased risk of early birth, as occurred in Mrs Rohner’s case.”

Dr Dippenaar explains that a healthy pregnancy is typically around 280 days or 40 weeks, while a preterm baby is classified as one who is delivered before 37 weeks. A micro-prem baby is one who is born between 22 and 28 weeks.

“It should be remembered that these premature babies are born before they are fully developed inside the womb and physically ready for birth, which leaves them highly vulnerable after birth. Their lungs may be underdeveloped and in need of support, and their skin may be extremely thin, often barely two cell layers thick,” says Dr Dippenaar.

“Modern technology is increasingly adopting principles of bio-mimicry for these infants in an effort to artificially recreate the mother’s womb through the use of state-of-the-art humidifying incubators. Barely visible through the water vapour mist inside the incubator, premature babies are nursed by highly skilled nursing professionals within a low-light, low-sound environment.”

“The umbilical vessels which had previously provided nutrition, blood and growth hormones are reconnected to artificial lines to re-establish nutritional stability. Artificial emollients which mimic natural vernix, the waxy white substance which coats the skin of a baby in the womb, is applied to assist the baby’s skin to mature and adapt to life outside the womb.”

“Life-saving breastmilk from the mother is fed to the baby via a tube as soon as possible after birth. This helps to further establish the child’s immune defences and provides all important growth hormones,” explains Dr Dippenaar.

“The benefits of breastmilk, as well as maternal bonding in the form of kangaroo care, a method of caring for premature babies whereby the infants are held skin-to-skin by a parent, are pivotal to reducing medical conditions such as allergies, childhood obesity and asthma. In addition, they assist with the development of the brain in these extremely fragile infants.”

Sister Chantal Classen, the manager of the neonatal intensive care unit at Netcare Blaauwberg Hospital, says that having an extremely preterm baby is, understandably, highly stressful for most parents.

“We try to reassure parents such as the Rohners, that the staff and doctors at our unit have many years of experience with premature babies. We encourage the moms to rest and to bond with their babies as much as possible during this time. We also emphasise that their breastmilk will help their baby to grow as it provides all the nutrients needed.

Amanda says that her son had a number of problems with his health during the first two years of his life but has now outgrown these and is now energetic and healthy little boy. “He has had some speech development problems, but this may have been due to ongoing ear infection problems, and we have noted an improvement since he had a grommet procedure recently.”

Dr Dippenaar points out that, with the necessary intensive care in the first weeks or months of their lives, extremely premature children can be stabilised and their continued development can be facilitated. For this reason, it is important that parents explore their options and identify facilities that specialise in the care of preterm infants.

“Fortunately, we are seeing hospital groups such as Netcare placing increasing emphasis on this all-important aspect of medicine, and are equipping specialised NICUs at their hospitals with state-of-the-art incubators and other life-saving technology which enables medical practitioners and nursing teams to provide the required care,” he concludes.

Four-year-old Joshua Rohner plays at his home in Cape Town. Neonatologist Dr Ricky Dippenaar, who practises at Netcare Blaauwberg Hospital, says that modern medicine is increasingly giving extremely premature babies a fighting chance at survival, and developing into healthy children. Photo: Netcare

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