Born at 21 Weeks & Thriving

Every day, preterm babies fight and survive despite the odds stacked against them. However the earlier a preterm baby is born, the more challenges he or she will face — with most experts agreeing that 22 weeks is the earliest babies can survive outside the womb. But a now 3-year-old girl, born at just 21 weeks, four days, gestation is pushing those limits.

Courtney Stensrud and her husband welcomed their daughter (they asked to withhold her name for privacy reasons; she’s also not depicted in the photo above, which is a stock image) back in 2014. Born at just 15-ounces, she had to stay in the neonatal intensive care unit (NICU) for 126 days — over four months — before she could go home.

“She may be the most premature known survivor to date,” wrote the authors of a case report about the little girl’s birth, published this year in the journal Pediatrics.

Stensrud went into labor early due to chorioamnionitis and preterm premature rupture of membranes (PPROM). At the time of birth, she asked her doctor — neonatologist and author of the Pediatrics study, Kaashif Ahmad, M.D. — to do everything he could to resuscitate her baby. He agreed.

“We immediately placed a breathing tube in her airway. We started giving her oxygen, and really pretty quickly, her heart rate began to rise. She very slowly changed colors from blue to pink, and she actually began to move and began to start breathing within a few minutes,” said Ahmad.

Just after Stensrud gave birth, Ahmad counseled her on the low odds of her baby’s survival.

“Although I was listening to him, I just felt something inside of me say, ‘Just hope and have faith,'” Stensrud said. “Three years later, we have our little miracle baby.”

For the first two or so years of life — until they “catch up” with their full-term peers — preterm babies’ development is measured on a different scale (their corrected age) to account for the extra time they would have otherwise spent in the womb. At 2 years old, Stensrud’s daughter’s child development test scores were typical for 20-month-old kids — right in line with expected development, given she was born 4 months early.

In addition, preterm babies are at greater risk of a number of health disorders, including auditory or visual impairments and cerebral palsy — although the Stensrud’s daughter hasn’t been diagnosed with any of these conditions.

“If you didn’t know that she was so preemie, you would think she’s a normal 3-year-old,” Stensrud says. “In her school, she is keeping up with all the other 3-year-olds.”

Experts, however, stress that we’re still a far ways away from more preemie babies surviving and thriving under such extreme odds.

“We have to be very cautious about generalizing one good outcome to a larger population. It is very possible that there have been many 21-week babies resuscitated in other places that did not have positive outcomes, and for that reason, we haven’t heard about them,” said Ahmad. “We reported this case because after this resuscitation she did well, but it may be possible that this is just an extraordinary case and that we shouldn’t expect the same from other babies. We have to learn more before we can make any conclusions.”

Other experts also note that because gestational age is a guess, at best, and ultrasounds are accurate within about a week, Stensrud could have been further along than her estimated due date suggested.

“Unfortunately, the majority of infants born this early do not survive,” Noelle Younge, M.D., assistant professor of pediatrics at Duke University School of Medicine, told CNN.

About one in 10 babies in the U.S. is born prematurely. A March of Dimes report released in early November found that there were 8,000 more preterm births in 2016 than 2015. 

New technology has greatly improved the survival rates for the littlest babies while reducing the risk of complications. A 2017 study published in The New England Journal of Medicine found that the number of American babies born at 22 to 24 weeks gestation who survived increased from 30 percent in 2000 to 36 percent in 2011. They also found that the percent of babies without neurodevelopmental problems increased from 16 percent to 20 percent.

However, rates of poor outcomes among extremely preterm infants remain high, said Younge, adding that continued research is critical. “We need to continue to develop ways to improve outcomes for infants born extremely preterm,” she said.


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