Premature baby in California third smallest in world to survive

Melinda Star Guido, now 14 weeks old, with her mother, Haydee Ibarra, at the Los Angeles medical centre on 14 December. Photograph: Jae C. Hong/AP

At birth, Melinda Star Guido was so tiny she could fit into the palm of her doctor's hand. Weighing just 9.5 ounces (269gm) she was among the smallest babies ever born in the world. Most infants her size do not survive. But doctors are now preparing to send Melinda home.

The child was born premature, at 24 weeks, last August and spent her early months cocooned in an incubator in a neonatal intensive care unit.

Almost every day, her mother, Haydee Ibarra, 22, sits at her bedside and stays overnight whenever she can.

Newborn Melinda in the neonatal intensive care unit at the Los Angeles County-USC Medical Centre. Photograph: Haydee Ibarra/AP

Melinda is believed to be the second smallest baby to survive in the US and third in the world.

During her pregnancy Ibarra suffered from high blood pressure. She was transferred from a hospital near her home to Los Angeles' flagship hospital, which is better equipped to handle high-risk pregnancies.

There was a problem with the placenta and the foetus was not getting adequate nutrition and oxygen. Doctors knew Melinda would weigh less than a pound at birth, but they were surprised at how small and fragile she was.

"The first few weeks, it was touch and go. None of us thought the baby was going to make it," said Rangasamy Ramanathan, a doctor who oversees premature infants at Los Angeles County-USC Medical Centre, where Melinda has been treated.

Doctors told Ibarra and her husband, Yovani Guido, that even if Melinda survived, children born that premature could have developmental delays and impairments such as blindness, deafness or cerebral palsy.

Ibarra told doctors to do whatever was necessary to help her baby. Ramanathan recalled: "They said, 'we'll take the chance, please try'. So we said, 'OK we'll try'."

Almost ready to go home, Melinda is now thriving. Photograph: Jae C Hong/AP

Melinda was delivered by caesarean section and transferred to an intensive care unit where a team of doctors and nurses kept watch round the clock. She was kept in an incubator, with breathing equipment and a feeding tube. Her mother said her skin felt like plastic because it was so thin.

"It takes a lot of good care and a lot of good luck. Most them don't survive," said Edward Bell, a paediatrician at the University of Iowa, who keeps an online database of the world's smallest surviving babies born weighing less than a pound (453gm).The list contains 126 babies dating back to 1936. Since submission is voluntary, it does not represent all survivors.

Ten babies weighing less than a pound were born last year and survived. Melinda joins three other tiny survivors delivered this year – in Berkeley, Iowa City, and Seoul, South Korea. All were bigger than Melinda, who is not eligible to be listed until her discharge from hospital.

Most tiny babies who survive are female. Girls mature faster than males of the same gestational age, and having more developed lungs and other vital organs, have an increased chance of survival.

Bell published a study last year, however, which reported that many survivors were struggling with health and learning problems. According to available growth data, many of the children are short and underweight for their age.

But the smallest surviving baby born – weighing 9.2 ounces – is now a healthy seven-year-old, and another, who was 9.9 ounces at birth, is an honours college student studying psychology.

Their progress was described in a study by doctors at Loyola University Medical Centre, in Illinois, and published this week in the journal Pediatrics.

In the past three years, the Los Angeles medical centre has treated two other babies with extremely low birth weight who survived, but Melinda holds the record at the hospital.

A month after she was born she was treated for an eye disorder that is common in premature babies. She faced her biggest test last month when she had surgery to close an artery that usually seals after birth.

Ibarra held Melinda for the first time after the surgery. Before that, she had been able only to touch her through the incubator. The next challenge for Melinda is learning to bottle feed.

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