Cape Town - Born at 24 weeks gestation and weighing a mere 300 grams, baby Hope Daniels - who is thought to be one of the smallest micro-premature babies in terms of weight to have ever survived in South Africa - was discharged home from hospital today in time to be with her parents for the festive season.
Born by emergency caesarean section Netcare Kuils River Hospital in Cape Town on 19 March, baby Hope has had to spend more than nine months in the hospital’s neonatal intensive care unit before doctors deemed her strong enough to be discharged home with her parents, Dorianne and Lesley Daniels.
During her time at Netcare Kuils River Hospital, tenacious little Hope not only beat the odds against her surviving being born at just over half of the normal pregnancy term, but won the hearts of the doctors, management, nurses and other staff members at the hospital. Many of them turned out to bid Hope and her family a fond farewell.
“We have been most satisfied with Hope’s neurological, visual and hearing developmental progress. Now weighing 5.44kg, she is growing strong and already has such a strong personality,” reports Dr Zaheera Kajee, a neonatologist who practises at Netcare Kuils River Hospital, and has been part of the team responsible for the baby girl’s care.
“As she was born so prematurely, however, Hope will still require special care and feeding at home, and we will have to keep a close eye on her development and health as she grows,” she adds.
Hope’s mother, Dorianne Daniels, describes her little girl, as “my miracle baby”. Astonished by Hope’s tenacious will to survive - which was evident from the time of her birth when she was delivered kicking, crying and with her eyes wide open - her doctors feel inclined to agree.
Hope weighed exactly 300 grams, less than a standard can of soft drink, at the time of her birth. Dr Kajee affirms that, although not the youngest, Hope has some claim to be considered the smallest micro-premature baby to have survived in South Africa.
A week after her birth, Hope’s weight had, much to everyone’s concern, fallen to just 285g and this included the weight of her continuous positive airway pressure (CPAP) and other lines. To put this into context, Hope’s weight was then close to that one of the smallest babies to have ever survived in the world, who was reportedly born at 243,8g in Chicago in 2004, when her mother was 25 weeks pregnant.
Dr Kajee admits that she feared for Hope after she was born, as the little girl was significantly premature and her organ systems were very underdeveloped. Dr Kajee had to warn Dorianne and Lesley Daniels that there was a high risk that Hope may not survive and, if she did, she was likely to face numerous challenges to her health and development.
Hope had her own ideas, however, and slowly but surely continued to grow.
“My husband, Lesley, and I have been trying to have a baby for the past 10 years, so we have been praying hard for Hope ever since her birth,” says Mrs Daniels. “The 275 days that Hope has spent in hospital have been exceptionally hard and something of an emotional roller coaster, but we are deeply grateful to have reached a point where she is now ready to come home with us.”
Dr Kajee explains that while Hope now has a good appetite for solids, it has been a challenge to get her onto full oral feeds, as she has had a reluctance to take her feeds via a bottle or breast. Hope will consequently still require feeding via a special pump at home, which her parents have been trained to use, until she can independently feed larger volumes of milk on her own. Although she is still not taking a bottle mom is still expressing and Hope is obtaining her milk via a tube feed.
“The team at the hospital have been amazed by Hope’s dogged determination to not only survive, but also to thrive. I think that we all steeled ourselves for the worst but, to our astonishment she not only firmly announced her presence after she was born, but also went on to overcome most obstacles that such micro-premature babies usually face,” adds Dr Kajee.
“Hope has shown herself to be a little fighter and became a firm favourite of everyone at Netcare Kuils River Hospital who have worked hard to care for her and provide support to her parents. The manager of the neonatal and paediatric intensive care unit, Sr Claire Pitt, and her nursing staff have been incredibly passionate about Hope’s care. We owe them our heartfelt thanks for so often going well beyond the call of duty to look after Hope and support her parents.”
According to Dr Paul Keating, a paediatrician who practises at the hospital and who has also been involved in Hope’s care, one of the major problems after birth was that it is not possible to ventilate such a tiny baby. “We provided Hope with all of the supportive care we could but with such underdeveloped lungs, she had to breathe on her own. I am delighted to say that Hope did this from the start with great aplomb,” he relates.
Dr Keating says that, as quite commonly occurs in premature babies, Hope went on to develop a spontaneous bowel rupture, but this was successfully repaired in August.
Despite fertility treatments, Mrs Daniels struggled for a decade to conceive as a result of a chronic illness. She says that she had reached a point at which, “I had almost given up on believing I could have a baby - it seemed like it would take a miracle."
Towards the end of 2017, Mrs Daniels became ill with Bell’s palsy. Her doctor warned her that the medication she had to take for this condition could result in her falling pregnant. “I laughed because after many rounds of fertility treatment over the years, I still hadn’t fallen pregnant and I certainly did not expect to then. And well, I am delighted to say, the doctor was right!”
Due to Mrs Daniels health, the pregnancy was not going to be straightforward, and at around 21 weeks she developed pre-eclampsia, a condition in pregnancy associated with high blood pressure, which can affect the placenta and cause the foetus to stop growing.
“As the pregnancy was threatening my own health, my concerned doctors advised me that that it was no longer possible to wait longer to deliver Hope. There were also deep concerns regarding her survival, as she was so premature,” she relates.
After discussions among the obstetricians and the neonatologists, it was decided that Mrs Daniels should be admitted to the antenatal unit at the hospital for close observation and monitoring, and to enable her baby to grow as much as possible prior to delivery, as this would improve the infant’s chances of surviving. With Mrs Daniel’s blood pressure soaring and growing apprehension about the risk to her health, however, doctors were left with no choice but to deliver Hope at just 24 weeks and three days.
Sr Pitt says that Hope, who now weighs 5kg, already has an immense personality: “She loves cuddles with her mom and dad, and loved it when the nurses sang rhymes to her. And, when it came to her milk, we could not be late!
“From a personal point of view, I was extremely concerned about Hope after she was born, as there were just so many ‘what ifs’ about her survival and development. We consequently celebrated all of Hope’s development milestones, such as when she hit the 1kg mark on 16 June. She is still very small, has some catching up to do and
will need close follow up for some time to come. The team is, however, relieved and overjoyed that she has progressed so well.
Adds Mrs Daniels: “There were many people who had supported Hope and myself over this time including the wonderful doctors and nursing staff at Netcare Kuils River Hospital, as well as the members of our church and my family. My husband has also been a rock and the members of my church have been praying for us throughout. I am so grateful to them all."
“Everyone at the hospital has become attached to Hope, who is such a lovely little soul, and we are celebrating the wonderful progress she has made while in our care, and that the family are now able to spend their first festive season together. We wish baby Hope and the Daniels family all the best, as we bid them farewell today,” concludes Nolan Daniels, general manager of Netcare Kuils River Hospital.