A promising future for preterm babies

Often fitting in the palm of your hand, premature babies may be tiny but have every chance of going on to achieve far beyond expectations. In marking World Prematurity Day on 17 November, we speak to the parents of premature babies who went on to thrive.

With her first daughter arriving five days late and her second weighing 3.9kg, having premature babies was the furthest thing from Danielle Katzeff’s mind. Yet with her third child, Dovid, and first boy, who was born during the height of the COVID-19 pandemic, Katzeff’s waters broke unexpectedly when she was 28 weeks pregnant. “My doctor at the time however didn’t believe my waters had broken, and the medical staff didn’t swab me,” she says.

She went back to the hospital a few times with what appeared to be complications, but was sent home. It turned out she was experiencing preterm premature rupture of the membranes (PPROM) and had a placental abruption and, as often happens in this situation, went into preterm labour.

The third time she returned to the hospital, she was told she was in labour. It was suggested that she be given medication to keep the baby in, but soon, staff were preparing her for a caesarean. At this point, she was just more than 29 weeks along.

As it was the height of the pandemic, her husband couldn’t be in the delivery room as he was still awaiting COVID-19 test results. “In hindsight, this was a bracha, because to say it was traumatic is an understatement,” Katzeff says. Her paediatrician later told her that no-one in that room thought they were delivering a live baby. The PPROM meant that the baby was no longer surrounded by sufficient amniotic fluid.

Yet, he was born weighing 1.3kg, a promising sign, and was immediately taken to the neonatal intensive care unit (NICU). Here, rigorous safety measures were even stricter due to COVID-19, exacerbating the trauma. “My baby was in NICU, and I was home without him with a breast pump,” says Katzeff.

During her next pregnancy with her son, Zachariah, though they knew there was a preterm delivery risk, neither the Katzeffs nor their medical team expected it to happen again. Yet it did, in much the same way, at 27 weeks. This time, though, with a different doctor, Katzeff was put on bedrest at the hospital, where she was constantly monitored. She made it to just over 30 weeks, when she began bleeding again. And so, Zachariah was delivered.

Both Dovid and Zachariah were ultimately in the NICU for two months. “That time in NICU is a rollercoaster experience where literally anything can happen,” Katzeff says. “Looking back, I’m eternally grateful that we left. Not everyone gets to leave the NICU with a healthy baby.”

Dovid, now four, is smaller than most of his peers, but thriving, with all doctors’ concerns being allayed. While he has gone for speech therapy, these sessions have stopped, and his speech is now only slightly delayed. Zachariah, who is almost three, also goes to speech therapy. Katzeff recently gave birth to a full-term baby girl, an experience she calls a tremendous gift.

More than 41 years ago, Isarae Seeff gave birth to her son, Anthony, now a husband and father, at 32 weeks. “My placenta started calcifying at about 17 weeks, and I started spotting,” she says. Dr Jack Kussel, a renowned, retired paediatrician says it’s usually an issue with the placenta that creates a need for premature delivery.

“We were so sweet and innocent,” Seeff says, speaking of ignorance about the risks of prematurity at the time. Her doctor told her that if she reached 32 weeks, her baby would be ok and in fact, it was at exactly 32 weeks that she began bleeding and the baby was delivered via emergency caesarean. He weighed 1.8kg, and could fit in a shoe box.

“Three weeks later, he came home, breastfed and slept, and was the best baby,” says Seeff. “He caught up on his milestones quickly and grew quickly.” Anthony grew up to be an “A” student with no learning difficulties. “Thank G-d today, he’s over six foot, is doing well, and is an engineer who got a couple of distinctions for matric.”

Kussel says a baby should preferably not be delivered before 32 weeks if at all possible. “The law in South Africa used to be that if you were 28 weeks plus, you were legally alive, and any less was considered a stillbirth,” he says. “It has now moved to 26 weeks, with talk of even making it 24 weeks.

“Yet, there’s no doubt that if a baby is delivered under 28 weeks, there’s a significant chance of it having either major or minor abnormalities,” Kussel says. These can either appear immediately or later on in life and include cognitive, learning, or mid-brain problems. This is why such a child needs to be monitored, especially since they have a higher risk of intracranial haemorrhage. Such brain damage has a greater risk of becoming permanent the earlier it occurs, he says.

“The best person to identify developmental abnormalities is the mother herself,” he says. For example, it’s the mother who will notice that the baby’s eyes don’t follow her when she moves around, or that he or she doesn’t seem to recognise her.

In premature babies, respiratory issues are also common. These include hyaline membrane disease, a breathing disorder in newborns caused by immature lungs. “Today, you use a surface tension lowering factor called surfactant and this has made a big difference to the outcome in premature babies,” Kussel says. In recent years, oscillatory ventilation, a softer mode of ventilation which reduces ventilator-associated lung injury, has improved the prognosis of babies with lung issues.

“We’ve changed the whole outlook for premature delivery,” Kussel says. “You don’t fear a 28-weeker anymore, you set out to save the baby because you know in all likelihood, it will turn out alright.”