Once tiniest premature babies beat odds, grow up healthy

(CBS/AP) What happened to the tiniest babies ever born? One is a healthy first-grader and the other grew into an honors college student majoring in psychology. Both girls once entered the world weighing less than a pound - and are now thriving, despite long odds.

PICTURES - Tiny preemies beat odds: Rumaisa Rahman and Madeline Mann

But both girls are also the exceptions to the rule and shouldn't raise false hope, according to the doctor who resuscitated the infants at a suburban Chicago hospital.

"These are such extreme cases," said Dr. Jonathan Muraskas of Loyola University Medical Center in Maywood, Ill. They should not be considered "a benchmark" to mean that doctors should try to save all babies so small, he said. Most babies born this small do poorly and many do not survive despite advanced medical care.

The two girls who are featured in the medical report  - which was published in Monday's issue of Pediatrics - are Madeline Mann, born in 1989 weighing 9.9 ounces, then a world record; and 7-year-old Rumaisa Rahman, whose 9.2-ounce birth weight remains the world's tiniest.

Two other babies born since 1989 weighed less than Madeline, and a German girl was born last year at her same birth weight.

The report addresses a question that was hotly debated when Madeline was born 22 years ago, and remains unanswered to this day:  "What is the real age of viability? No one knows," said Dr. Stephen Welty, neonatology chief at Baylor College of Medicine and Texas Children's Hospital in Houston.

Most newborn specialists, including Muraskas, consider babies born after 25 weeks of pregnancy to be viable, or likely to survive. They suggest these babies should receive medical intervention if necessary to breathe. Normal pregnancies last about 40 weeks.

Some U.S. doctors will attempt to save babies at 22 weeks, but that is not done routinely, said Dr. Edward Bell, a professor of pediatrics at the University of Iowa. Bell runs an online registry of the world's tiniest babies, born weighing less than about 14 ounces, or slightly less than 1 pound. Since 1936, 124 have been listed. The registry is compiled from doctors' voluntary reports and so does not represent all survivors.

Bell estimates that about 7,500 U.S. babies are born each year weighing less than 1 pound, and that about 10 percent survive.

Sometimes tiny babies with zero chance of surviving show signs of life at birth, and may be able to breathe for a short time if put in an incubator and hooked up to a breathing machine and intravenous treatments. "But even so, if it's a baby that doesn't have a chance, we don't want to put the baby and the family through the discomfort," Bell said.

Muraskas says his report highlights a sometimes overlooked fact: the fetus' age is even more critical for survival than size.

Rumaisa and Madeline were both palm-sized, weighing less than a can of soda - the average size of an 18-week-old fetus - but they were several weeks older than that. Their gestational ages - almost 26 weeks for Rumaisa and almost 27 weeks for Madeline - meant their lungs and other organs were mature enough to make survival possible. Both still required intensive medical intervention.

Their mothers had developed severe pre-eclampsia - dangerously high blood pressure linked with pregnancy - so they were delivered by cesarean section more than a month early. Both babies needed breathing machines. Madeline had mild brain bleeding, common in tiny preemies, but with no lasting effects. Both girls got treatment for an eye condition common in preemies called retinopathy, which in severe cases can cause blindness.

What are the girls like now?

Madeline has asthma and remains petite - 4 foot 8 and about 65 pounds at age 20, the report showed. Rumaisa at age 5 weighed 33 pounds and was 3 1/2 feet tall - smaller than about 90 percent of kids her age.

Current information was not available in the report. Madeline is now 22 and a senior at Augustana College in Rock Island, Ill.; Rumaisa is 7 and attends first grade in suburban Chicago.

Jim Mann, Madeline's father, said having a baby born so small was "terrifying" at first. But other than asthma, the only lasting effect his daughter has mentioned is having trouble finding age-appropriate clothes because she remains so small, he said. That she has done so well is a source of pride, and wonder, her dad said.

"I don't know why, we were just extraordinarily lucky," Mann said.