CHARLOTTE, N.C. -- In the neonatal intensive care unit at Presbyterian Hospital, some of the nurses carry photocopies of footprints of the tiniest baby they’ve ever cared for, one of the smallest in the world.
It’s their way of showing support for Kenna Claire Moore, born Jan. 9, weighing only 9.6 ounces.
“She weighed less than a can of Coke,” said her mother, Nicki Moore, 39.
Today, the baby that doctors gave little chance of survival, weighs almost 4 pounds. She’s been in the NICU for 139 days, and she’s expected to go home with her parents to south Charlotte in the next few weeks.
“We knew she had a 10 percent chance under the best of circumstances,” Moore said. “All I heard was that she had a chance.
“Now we’re making plans for her to come home. They’ve stopped questioning her survival.”
Kenna may be the fourth smallest surviving baby in the world, based on an online registry of “The Tiniest Babies” compiled by a pediatrics professor at University of Iowa.
Dr. Ed Bell began keeping the list of so-called micropreemies – born weighing less than a pound – after the 1994 birth of a baby weighing only 400 grams at his Iowa hospital.
Kenna was born at Presbyterian at 272 grams. “We’d never had one under 500 grams,” Bell said.
“And when it looked like this baby might have a chance, that’s when I started looking around.”
Six years, 138 babies
Over the next six years, he collected details of the world’s smallest babies who survived premature birth.
He published the registry in 2000. It now includes 138 babies, compiled from doctors’ voluntary reports and Bell’s own research.
“It’s not complete, but it’s the best we have,” Bell said.
The smallest so far is Rumaisa Rahman, born at Loyola University Medical Center in Illinois in 2004, weighing 260 grams, or 9.2 ounces. Today she has normal motor and language development, according to an article in Pediatrics.
Kenna is not on the registry; Bell doesn’t list babies until after they have gone home.
Since the 1980s, advances in neonatal care have allowed the resuscitation and survival of smaller and smaller newborns.
Still, many extremely low-birthweight babies either do not survive or grow up with severe lifelong disabilities, such as cerebral palsy, mental retardation and blindness, according to Dr. Jonathan Muraskas, an expert in neonatal medicine at Loyola and lead author of the Pediatrics journal article.
Females fare better
Of three Loyola preemies on the registry, all were females, who tend to do better than males, Muraskas wrote. They also had relatively long gestational age – time in the womb – for their birthweights. Two of the mothers received steroids before giving birth, which helped the fetuses’ lungs mature more quickly.
Kenna, too, was small for the time she’d spent in her mother’s uterus. Normally, it would take a fetus only 18 weeks to reach Kenna’s birthweight. But because she had been developing for 24 weeks and because her mother also received steroids, her chances improved.
“You can’t predict these things. I’ve been humbled more than once,” said Dr. Larry Brady, medical director of the Presbyterian NICU.
“It’s a long process, with lots of ups and downs for the parents and the care team. Mom is there every day. She’s participated in the care.
Kenna “does have risks for issues later on related to vision and neurodevelopment and hearing, but we’ve followed all those things as she’s progressed,” Brady said. “She is thriving nicely.”
Problems early in utero
Problems developed when Moore was 20 weeks pregnant and diagnosed with pre-eclampsia, or pregnancy-induced high blood pressure.
Then at 22 weeks, an ultrasound test showed her fetus had not been growing since the previous ultrasound four weeks earlier. “The placenta didn’t work well,” Brady said. “They knew she was going to come early or die in utero.”
So, three days before Christmas, doctors ordered Moore to stay in bed. They hoped to give her baby a better chance of survival by keeping her in utero for at least 24 weeks. A normal pregnancy lasts 40 weeks.
In early January, Moore received two injections of a steroid to help mature the baby’s lungs.
But time was running out. Moore’s own health was an issue, too. “They were concerned about me having a stroke or seizures,” she said.
On Jan. 9, when Moore had been pregnant 24 weeks and three days, doctors delivered the baby by C-section, 16 weeks early.
Kenna was whisked to a warm stabilization room, where doctors inserted the smallest tube they have into her trachea to help her breathe.
As with many preemies, nurses wrapped Kenna in plastic to keep her warm. Most preemies can shed the wrapping after a few hours, but Kenna needed the plastic protection for a week, while also lying on a warming mattress in an incubator kept at 98 degrees and 90 percent humidity.
When Moore got the first glimpse of her baby, all she could see was a tiny foot kicking at the plastic.
“You know what?” Moore thought. “This kid’s gonna make it.”
Close calls, caring nurses
As Kenna fought for her life over the past four months, Moore and her husband, Sam, faced some scary moments.
One day in March, a nurse called them to say Kenna “isn’t acting right.” Nicki Moore rushed to the hospital, where doctors later diagnosed the baby with necrotizing entercolitis, the death of intestinal tissue, a common condition in premature babies.
Kenna was treated with medicine. “She really could have died,” her mother said.
Another night, when Nicki Moore called the NICU before going to bed, she spoke to a nurse whose report on Kenna was less than reassuring. “I burst into tears, and Sam said, ‘You want to see her now?’ ”
Again they rushed to the hospital, where Nicki Moore was concerned that the nurse on duty might be unfamiliar with Kenna’s condition.
In response, the nurse quietly flipped her name tag to display a paper heart with Kenna’s tiny footprints on it.
Meredith Minor, one of Kenna’s primary nurses, said they wore the footprints on their badges as “a reminder that babies can overcome some pretty incredible obstacles. … (Kenna) has, at every step of the way, surprised all of us.”
“The mom has been Kenna’s biggest cheerleader,” Minor said. “Even in the darkest hour, she would find a way to be positive. That’s one of the reasons Kenna has done so well.”
Recently, a speech therapist has worked with Kenna to improve her tongue movement and sucking response. As a result, the baby has progressed from tube feedings to bottle- and breast-feeding.
Occupational and physical therapists exercise her body, which is stiff because there was too little amniotic fluid to allow her to stretch normally. One arm was “squished in utero,” Moore said.
Last Thursday, Kenna had eye surgery to prevent blindness from a condition called retinopathy of prematurity.
Hoping to go home
When Kenna goes home, she’ll be welcomed by a 17-year-old half-sister and a 14-year-old half-brother, who were also born prematurely. They were four weeks early and 10 weeks early, respectively.
“I think we’ve kind of hit the jackpot here” with Kenna, Nicki Moore said.
The parents won’t have to worry about day care because Nicki works at home doing bookkeeping for her husband’s remodeling business.
“Kenna was a fighter. She clearly wanted to be here,” Nicki Moore said.
But she also gives lots of credit to the team of doctors and nurses at Presbyterian.
“They’re all friends now. They’re family,” Moore said. “It could have been the worst experience of our lives.
“But it’s been the worst and best because of the love and the care.”