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In this issue: SUMMER 2010

Welcome letter
Big dreams for tiny babies
The thrill of discovery
A joint effort
Born too soon
The nature of nurture
Steeplechase benefits Children's Hospital
Friends and fashion

 

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Big dreams for tiny babies

By Jessica Ennis / June 2010

Becca Hill, 2, flashes a bright smile during a recent visit to the Nashville Zoo. Photo by Daniel Dubois.Becca Hill, 2, flashes a bright smile during a recent visit to the Nashville Zoo. Photo by Daniel Dubois.Wearing clothing made to fit a 6- to 9-month-old baby, Becca Hill’s tiny size is deceptive of her real age.

The bubbly 2-year-old smiles and laughs as she poses for a photograph. Becca was born nearly three months early with the astoundingly low birth weight of 13 ounces (slightly heavier than a can of soda) and measuring just 9 ½ inches – so small she easily fit into her father’s hand. At the time of her birth on June 21, 2008, Becca was documented to be the smallest surviving baby ever to be born in Tennessee and one of the smallest in the world.

Nancy Hill was just 15 weeks pregnant and living in Louisville, Ky., when she first learned that something might be wrong with her baby.

She was startled to learn her baby was at increased risk of developing spina bifida. Then two weeks later, Nancy found out that her baby’s measurements were very small.

“They told us to be prepared to lose the baby,” Nancy recalls.

In mid-June, Nancy and her husband, John, both pastors, moved to Bethpage, Tenn.

Soon after the move, Nancy developed a life-threatening obstetric condition called HELLP Syndrome, treatable only by the prompt delivery of the baby. Delivering nearly three months early would be extremely risky as Becca’s weight wasn’t even in the viable range, but there were no other options. She was 370 grams, and viability is considered 500 grams.

“We asked them to be as aggressive as possible and do everything they could,” Nancy said. “When she came out, she couldn’t cry, but she was trying. She was tiny, but she was strong. They put a preemie-sized hat on her and it was huge. All I could see was her tiny face peeking out when they took her away.”

Nancy was then taken to recovery and had to wait to see her daughter.
“The first time I saw her 26 hours later, I thought, ‘she’s going to make it.’”

Above: A quick first family portrait of Becca, John and Nancy Hill. Becca was about 2 months old here and weighed a little over 2 pounds. Below: One of the first photos of Becca, on the day she was born. She weighed a mere 13 ounces. Photos courtesy of the Hill family.Above: A quick first family portrait of Becca, John and Nancy Hill. Becca was about 2 months old here and weighed a little over 2 pounds. Below: One of the first photos of Becca, on the day she was born. She weighed a mere 13 ounces. Photos courtesy of the Hill family.Becca continued to make small gains, but her outcome was still unknown. The family knew at any time, things could go downhill.

“The first few weeks we were thrilled,” Nancy recalls. “Any time with her was special and more than we thought we were going to have.”

Becca spent 123 days in the NICU. During that time there were many ups and downs. She was discharged five weeks past her due date.

The challenges didn’t stop once Becca was home. The family was basically on “house arrest” from fall to spring, and wasn’t allowed to have visitors because Becca might get sick.

She returned to Vanderbilt to have surgery to repair a hernia and doctors placed tubes in her ears to help remove fluid buildup which was causing her to have hearing problems.

It was discovered that Becca is missing her septum pellucidum, a thin, triangular, vertical membrane separating the lateral ventricles of the brain. Often, this can cause visual impairment. She was diagnosed with Sensory Processing Disorder, which is common in preemies. Fortunately, her vision has checked out OK, but Becca still isn’t walking on her own. She attends physical therapy to help with her gross motor skills and occupational and feeding therapies for her oral aversion and other sensory issues.

Becca is full of personality and seems to have a constant smile on her face. She’s learning to say a few words and uses sign language as she is developing her verbal skills.

“She’s very social,” Nancy said. “We expect her to grow out of her delays, but she’s going to be a high risk for medical issues,” including diabetes and, ironically, obesity due to her extremely low birth weight.

But the Hills agree that any challenges they face with Becca are more than worth it.

All the advances that occurred in neonatal medicine over the years have helped give the smallest and the sickest premature babies the best chance at survival, even when the odds are stacked against them. Up until about a half century ago, doctors were often helpless when they tried to save premature babies. A baby Becca’s size wouldn’t have stood a chance.

“You’d sit and look at babies and watch them gasp and die,” recalled Mildred Stahlman, M.D., professor of Pediatrics at Vanderbilt University and a pioneer in the research of premature lung diseases.

Mildred Stahlman, M.D., rocking Cole Petty, started the first modern NICU in 1961 after creating a ventilator to help premature babies breathe. Photo by Joe Howell.Mildred Stahlman, M.D., rocking Cole Petty, started the first modern NICU in 1961 after creating a ventilator to help premature babies breathe. Photo by Joe Howell.Their tiny lungs typically weren’t developed enough to sustain life, and successful medical interventions had not yet been discovered, much to the frustration of the doctors frantically trying to care for them.

Stahlman devoted all her energies into making a key finding that in 1961 began to offer hope for premature babies who previously died within a few days of birth.

She adapted an iron lung typically used for polio patients to create a ventilator to help the babies breathe, allowing their lungs time to mature. Stahlman’s interventions saved the first baby at Vanderbilt in 1961, and by the end of the year, she had created what is considered the first modern Neonatal Intensive Care Unit in the world.

After that, Vanderbilt’s NICU was doing an excellent job saving babies born at the hospital, but babies born elsewhere and transferred to Vanderbilt weren’t making it in time.

“One day, three babies came in dead on arrival,” Stahlman recalled. “This was intolerable.”

She lobbied to establish a regional transport system so babies born at other hospitals could be transported by a neonatal ambulance to Vanderbilt. The ambulance was a converted bread truck, outfitted under the direction of one of Stahlman’s fellows, Angela Skelton, M.D., and named “ANGEL” in her honor. The first year, nearly 300 patients were transported to Vanderbilt on the ANGEL ambulance.

Soon, Vanderbilt was considered a regional hub for excellence in neonatal care and services began to grow. The 78-bed NICU at Vanderbilt now admits about 1,200 critically ill newborns each year, approximately half of which are transported from other hospitals in the state and region.
 


 

 

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