NUH's smallest baby to survive birth discharged after 13 months in intensive care

7/8/2021 3:49:00 PM

NUH's smallest baby to survive birth discharged after 13 months in intensive care

NUH's smallest baby to survive birth discharged after 13 months in intensive care

Born almost four months premature at 212g, Kwek Yu Xuan was about half the expected weight of babies born at her age. Here's how she beat the odds stacked against her.

A baby like Yu Xuan born at 24 weeks and 6 days would be considered an “extremely preterm” baby, said Dr Ng. Between 2001 to 2020, the hospital saw 34 babies delivered at around 24 weeks, of which 24 survived.This is because this period is critical for the development of the baby, especially its lungs, which are still maturing, said Assoc Prof Zubair.

Kwek Yu Xuan with her father at National University Hospital. (Photo: NUH)Because Yu Xuan was so small, it was difficult to find space to attach all the necessary equipment or probes to monitor her health, said Ms Zhang.Regular diapers were also “huge” on Yu Xuan, so their team had to source for smaller diapers or improvise, said Ms Zhang.

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Stay strong little angel ❤️ 💪🏻😍 🥰

World’s smallest baby, born at 212 grams at NUH, now doing well at 14 months oldSINGAPORE — On June 8 last year, after feeling excruciating abdominal pain for about two hours, Mrs Kwek Mei Ling, who was about 24 weeks pregnant, rushed to the National University of Hospital’s (NUH) Accident & Emergency (A&E) unit in an ambulance. 🙏🙏🙏 🙏🙏🙏❤️ Thank you, Yu Xuan, for fighting a tough and difficult battle . I believe your parents are really proud of you. Be happy and healthy always!

World’s smallest baby, born at 212 grams at NUH, now doing well at 14 months oldSINGAPORE — On June 8 last year, after feeling excruciating abdominal pain for about two hours, Mrs Kwek Mei Ling, who was about 24 weeks pregnant, rushed to the National University of Hospital’s (NUH) Accident & Emergency (A&E) unit in an ambulance. 🙏🙏🙏 🙏🙏🙏❤️ Thank you, Yu Xuan, for fighting a tough and difficult battle . I believe your parents are really proud of you. Be happy and healthy always!

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Men on pregnancy and infant loss: Anger, crying in private and being expected to ‘man up’ DELIVERING PREMATURELY Babies born before 37 weeks of pregnancy are considered premature, and they make up about one in 10 births, said Dr Ng....

Singapore sees about 3,500 premature births every year. A baby like Yu Xuan born at 24 weeks and 6 days would be considered an “extremely preterm” baby, said Dr Ng. Between 2001 to 2020, the hospital saw 34 babies delivered at around 24 weeks, of which 24 survived. The borderline of viability is between 22 weeks and 25 weeks, said Associate Professor Zubair Amin, head and senior consultant of the same department at NUH. Babies born in this window are “not 100 per cent viable”, and doctors cannot say with confidence that they will survive past birth, he added.

This is because this period is critical for the development of the baby, especially its lungs, which are still maturing, said Assoc Prof Zubair. “We look at the gestational weight, and also the baby’s age. In Yu Xuan’s case, she was so small that we don’t have any norms to say (what) her chances of survival (were),” he added. After she was born, Yu Xuan was on a ventilator with a breathing tube for seven weeks to support her breathing. She also had to be fed through a tube, as it was impossible to feed her while she was intubated, said Dr Ng.

Kwek Yu Xuan with her father at National University Hospital. (Photo: NUH) The initial part of her stay in the NICU presented the team with some challenges, as it was their first time taking care of such a small premature baby, said Dr Ng. “We need to look after Yu Xuan very carefully. Because she is so delicate, so small, her skin is so thin, she easily loses water and her skin can be easily broken,” said Ms Zhang Suhe, advanced practice nurse and nurse clinician. Because Yu Xuan was so small, it was difficult to find space to attach all the necessary equipment or probes to monitor her health, said Ms Zhang.

“Literally, her whole body, we put our measuring devices on her. The skincare is very, very crucial because broken skin means there’s chances of infection,” she added, noting that fortunately, Yu Xuan did not suffer from any infections throughout. In selecting a breathing tube, even a 2mm difference in size was a big difference because her trachea was so small, and using the wrong tube could cause breathing problems. Regular diapers were also “huge” on Yu Xuan, so their team had to source for smaller diapers or improvise, said Ms Zhang. “We do face a lot of challenges in terms of medical care, nursing care.

Fortunately, we actually overcome them one by one with all the brainstorming, daily thinking about what is best for Yu Xuan.” Kwek Yu Xuan discharged well and at home with her parents. (Photo: NUH) When she was about 1.9kg, the doctors removed the tube and instead used nose prongs with the ventilator. By then, she was breathing on her own, and the ventilator was providing additional oxygen support.

In the later months of her stay, she developed more like a regular preterm baby, and the team could offer her routine care, said Ms Zhang. WHAT’S NEXT FOR YU XUAN Yu Xuan’s 13-month stay in the NICU also makes her the longest staying baby in NUH’s unit, said the hospital. Despite the odds stacked against her with health complications from birth, she was active, cheerful and responsive while she was in the hospital, the team said. Before premature babies are discharged, doctors will make sure that they are stable enough to go home, and that the family is comfortable with taking care of them, said Dr Zubair. Parents also need to be trained on how to use the equipment and how to respond in different situations, he added.

Kwek Yu Xuan discharged well and at home with her parents. (Photo: NUH) “The discharge was really huge, huge work put in by every one of us. Her parents are very ‘on’; they are very willing to learn whatever we have identified for them” said Ms Zhang. The doctors and nurses took charge of training her parents in different aspects of her care, in preparation for her discharge. “We put together rehearsals.

We even rehearsed how to transport (Yu Xuan), because we anticipated she needs to come back to the hospital with all the equipment,” she added. The Give.asia campaign started by Yu Xuan's mother raised S$366,884 for her hospital and treatment fees. The total cost of Yu Xuan’s stay was about S$200,000, said Mrs Kwek. A Give.

asia crowdfunding campaign that she launched last year raised S$366,884 for her baby’s case. On top of the S$200,000 used for Yu Xuan’s stay in the NICU, the couple kept another S$50,000 to fund the rest of Yu Xuan’s treatment and recovery. They donated the remaining S$56,000 to Give.asia to help other families in need. “On the discharge day, the whole team of residents and doctors, we were all very, very happy for her, happy for the family,” said Ms Zhang, adding that even some members of the team who were not on duty came to take photos and see her off.

Yu Xuan currently needs to return to the hospital for follow-up check ups once a month. She has chronic lung disease and pulmonary hypertension - two conditions commonly associated with extreme prematurity - but is expected to get better with time, said her doctors. Premature babies past 36 weeks who still need a ventilator are ascribed to have chronic lung disease, said Dr Ng. Aside from the oxygen support from the ventilator, Yu Xuan also takes medicine for her chronic lung disease, as well as diuretics to help her urinate more. “A lot of 24-weekers have come through our department, and they generally have the same types of long-term conditions that she has,” said Dr Ng.

“We have many with chronic lung disease, many who had ROP (retinopathy of prematurity) treatment, and we’re all hopeful that they will eventually outgrow these problems and grow up to be healthy children.” Source: CNA/hw(rw) .