The chance of survival for a 21-week six-day old fetus is zero. That's something Miami obstetrician Guillermo Lievano thought he knew for sure. Then he delivered Amillia Taylor, who weighed just 10 ounces, and appears to be the youngest premature baby ever to survive, beating the record by more than a week. Lievano wasn't looking to make history when he scrubbed in at Baptist Children's Hospital in Miami last Oct 24. In fact, he says, if he had known the baby's true age he never would have gone the extra mile and scheduled a Caesarean delivery. "My focus would have shifted to simply preserving the mother's health, because I knew babies that small don't survive," he said.
But the language of pregnancy can be confusing. On her first prenatal visit, Lievano said, the mother miscommunicated her dates. As a result, he thought the baby was two weeks older than she actually was. (The family referred all questions to Lievano.) At almost 24 weeks, Amillia would have been right on the "cusp of viability," giving her a small chance of survival. The fact that she came out breathing on her own, and trying to cry, seemed to verify that she was close to that critical age, even though she was much smaller than ultrasounds had indicated. It wasn't until weeks later, when doctors reviewed the in-vitro fertilization records, that they realized the mistake and its implications.
In the 1960s, preemies born around 30 weeks and weighing over three pounds often died because their lungs were too immature to sustain them. Today, thanks to improved treatments, the line of viability hovers around 23 to 24 weeks (and 14 ounces) at hospitals with state-of-the-art intensive care nurseries. But babies younger than that are seen as lost causes. So how did little Amillia do it? That riddle is confounding neonatal experts. Clearly, two things going for her were her race and gender. Neonatalogists know that black baby girls, as a group, mature faster in the womb than other babies, although they still don't know why. (White boys mature slowest.) She was also lucky that doctors were able to stave off delivery for nine days after her mother, Sonja, went into labor.
That gave them time to administer steroids designed to speed up the development of the baby's lungs and, to a lesser extent, other vital organs. (Amillia was delivered after her mother's water broke and she developed an infection.) Babies also tend to mature faster when they're stressed, as Amillia likely was in her mother's dry womb. But even with all that going for the baby, experts like Dr. Rod Phibbs of the University of California San Francisco,say it's still amazing that she made it. "We don't expect any survivors at this gestational age," said Phibbs.
Opponents of abortion rights saw Amillia's survival as proof that second-trimester terminations should no longer be permitted. Meanwhile, doctors said they'd have to review the case as they update their guidelines on premature births. And experts like Phibbs worried that Amillia would raise expectations too high. "What would be worrisome is if this led some doctors to be overly enthusiastic about babies who have no chance of survival," he said. "This is an extremely rare event, any way you look at it."
Currently, there is no way to identify the rare baby that might survive such an early birth. Lievano added that even though Amillia was released from the hospital last week, and doctors are optimistic about her future, (amazingly, so far, she's hitting her developmental milestones on time) it's way too early to know what kind of physical and neurological challenges she may face later on, such as cerebral palsy or learning disabilities. In the meantime, her parents and doctors are trying not to let the mystery overwhelm their appreciation for Amillia's unexpected triumph. "Sometimes you just can't explain these things," Lievano said. "Science only takes us so far. There are a lot of us who think God helped us out here, that this is a miracle. Somehow we were allowed to do something that was bigger than all of us." And so much smaller.
