SINGAPORE: Two hours - that was how much time Madam Rohani Mustani and her husband had to decide whether to deliver her baby or terminate the pregnancy.
Mdm Rohani was 23 weeks pregnant when her blood pressure rose sharply due to severe preeclampsia. Doctors told them that the child's survival rate was about 20 per cent.
It was devastating news for the couple, who had already picked out a name - Zaiya - when they found out they were having a girl.
Despite their chances, the husband and wife decided that Mdm Rohani would deliver the baby by an emergency caesarean section.
Zaiya was born on Mar 27, after just 23 weeks and six days. Weighing 345g, she was the size of an adult’s hand. Her arms and legs were as thin as fingers, doctors said.
She is possibly one of Singapore's smallest babies to survive and be discharged.
Speaking to reporters at the National University Hospital (NUH) on Monday (Oct 26), Mdm Rohani recalled thinking that the abdominal pains she felt were regular gastric pains, but after arriving at the emergency department, she was shocked to hear that she was showing symptoms of severe preeclampsia.
“I had to deliver her the very next day. We did a scan, and the baby was very very small. Doctors predicted that the survival rate was very very low, only about 20 per cent. But we just had the hope, and I delivered as per normal via emergency c-sect,” she added.
The 37-year-old mother of four said she felt “very very sad" when she found out she had to deliver so prematurely, but she was reassured by a doctor in NUH’s paediatrics department who told her to deliver the baby first “and then we’ll see what we can do”.
A full-term pregnancy is considered to be at least 37 weeks.
Infants born before 24 weeks of gestation are not considered to be “viable” as their chances of surviving are low, explained senior consultant at the department of neonatology Dr Krishnamoorthy Niduvaje.
“Twenty per cent is still hope, rather than no hope. So I decided just to go with it. Whatever happens after that, I just leave it to fate. I’m just glad on my part that I delivered, rather than terminate,” said Mdm Rohani.
FOUR MONTHS IN NEONATAL ICU
But Zaiya’s birth was only the beginning. Born almost four months premature, she was immediately whisked to the neonatal intensive care unit (NICU), where she stayed for the next four months.
When Mdm Rohani and Mr Saufi finally saw baby Zaiya properly, she was lying in an incubator surrounded by tubes and hooked up to a ventilator. They did not get to touch her until three months later, mostly for fear of infection.
“She was in an incubator, we only managed to see her through the clear glass. We are not allowed to feel her. Do you know how painful it is for a mother?” said Mdm Rohani.
“I could not even hug her, touch her fingers. I could only see her. The only time when I could see her skin to skin was when they changed her diaper, when they lifted up the incubator glass then I actually could see her face to face.”
Two months after giving birth, Mdm Rohani returned to work. The parents visited Zaiya in the hospital every day, taking turns to stay by her incubator in the NICU due to COVID-19 restrictions.
For tiny Zaiya, almost everything was too big for her, nurse clinician Wang Xia recalled. The nurses had to carefully insert direct lines into her arm - the size of an adult’s finger - to give infusions and extra nutrition for the first few weeks.
This is because they could not feed her extra volumes of milk, said Ms Wang. “When they’re premature, they have a lot of difficulty in digesting the milk. So we give extra nutrition through the line itself.”
Since diapers for premature babies cost three to five times more than regular ones, the nurses decided to stick to normal ones to help the family reduce costs. Baby Zaiya was so small that a regular-sized diaper covered her up to her chest, Ms Wang said.
Since Zaiya’s skin was so thin, “almost transparent”, her diaper had to be changed at least six to eight times a day to avoid irritation and skin breakage, which could lead to infections, she added.
For the ventilator, nurses had to use a smaller than usual breathing tube of about 2mm in diameter, which also made it more difficult to feed Zaiya medication through the tube, said Ms Wang. A regular ventilator tube usually has a diameter of 2.5mm and above.
For extremely premature babies, their immediate survival depends on lung expansion, said Dr Krishnamoorthy. “If their lungs don’t expand they cannot make it. So to make the lungs better we put this medicine to help them expand.”
Even with medicine, many extremely premature babies may need ventilator support for weeks and months. And this could cause some chronic changes in their lungs, which may have future implications, he added.
One of Zaiya’s main hurdles in the NICU was gaining weight, said Mdm Rohani. She looked forward to hearing from the nurses each day about whether her daughter had lost or gained weight, and even a 100g or 200g weight gain was good news to her, she added.
Since she was born extremely premature, the blood vessels in Zaiya’s eyes were not fully developed “in an organised fashion”, which could have resulted in blindness if not properly treated, said Dr Krishnamoorthy.
On top of all this, Zaiya also had a small hole in her heart, which was “a very temporary one”. In most full-term newborn babies, this hole is expected to close naturally after birth in two to three days, he added.
“But in premature babies, it takes much longer to close. And if it doesn’t close sometimes more blood goes to the lungs and that causes problems in the lungs, and that also needs treatment.”
'INDEBTED' TO NUH DOCTORS AND NURSES
Six months after she was born, Zaiya now weighs a healthy 4.27kg.
Noting that tracking the developmental milestones of a premature baby is “very important”, Dr Krishnamoorthy said that Zaiya has met the milestones required at the two-month mark. She can respond by smiling, lift her head and grasp objects.
After medication, the hole in Zaiya’s heart closed, with no need for surgery. She was discharged in August and later returned for a laser surgery on her eyes, which was successful.
After more than four months in the NICU, Zaiya could finally meet her three siblings and grandparents.
Her hospital stay and treatment cost the family about S$50,000 after subsidies, said Mr Saufi, adding that it would have been about S$200,000 without them.
The youngest of the family was born on the same day as their third child, who is four this year, and the occasion was “quite sad” as they were meant to be celebrating her birthday on the day Mdm Rohani gave birth.
Their three other children had expected them to return from the hospital with Zaiya a few days later, and the first response when she did not come home with them was: “Is it because of COVID-19?”, she recalled with a laugh.
Adding that the family is “indebted” to the NUH team for taking care of Zaiya, Mdm Rohani said: “We had several blood transfusions, laser for her eye because she had ROP (retinopathy of prematurity), and then she had a small hole in her heart.
“One after another, we managed to overcome the hurdles along the way. The doctor even said that she’s very very strong for her age, she kept fighting.”