When Kyla Cruceta gave birth to her son Exzavier Genty at 22 weeks and 4 days into her pregnancy, he weighed only 1 pound and 3 ounces. While in labor, other hospitals told her the baby would not survive, but a doctor at Tufts Medicine gave her hope.
"He was smaller than the palm of my hand," said Kyla. "He was very critical."
Several Boston hospitals were called in an effort to transfer her somewhere better equipped to care for a newborn as premature as her son, but most requests were denied until a call was placed to Tufts Medical Center.
"We didn't have the whole picture," said Ashley Peterson, MD, director of Obstetric Quality and Safety, director of Perinatal Diagnostic Center and a Maternal Fetal Medicine Physician. Among other things, Dr. Peterson specializes in preterm birth.
"I needed more clinical data," she said. "I felt the best thing for the patient was to see her. Doors were closing for her elsewhere without seeing the whole clinical picture and myself and another colleague agreed that we might say the same thing, but we needed to have all the pieces to the picture. That made all the difference."
When she met Kyla, Dr. Peterson said there was hope, but she was also realistic. To her surprise, the baby was bigger than anticipated and was doing better than expected after birth while in the delivery room.
"Dr. Peterson made the delivery smoother," said Kyla. "She was reassuring, she made me feel comfortable. She made me feel like a human being and not just another patient. At first, I didn't think we had options, but she turned my whole experience around. I'll never forget her name."
Survival at 22 weeks gestational age is still uncommon, she said, but Exzavier is a little fighter. From his parents being incredible advocates for his success and the expertise of the Tufts Medical Center Neonatal Intensive Care Unit (NICU), he had a strong team behind him.
Exzavier spent five months in the NICU receiving around the clock care. Among other treatments, Exzavier needed 3 bowel surgeries due to early complications with spontaneous rupture of the bowel, a common finding in extremely preterm infants, as well as eye injections to treat retinal disease and help to preserve the development of his vision.
"Exzavier had an expectedly complicated stay but it's truly remarkable that he went home without any oxygen support or feeding support," said NICU director Jaclyn Boulais, MD. "His stay has highlighted the exemplary multidisciplinary effort that goes into caring for extremely preterm infants and his parents have been an important part of that team. He is truly amazing."
The chance of a baby like Exzavier surviving to discharge is about 18 percent among babies who receive maximal medical treatment, said Dr. Boulais. Many high level NICUs are now taking care of more babies at 22 weeks gestation, but the outcomes are still challenging enough where parents and the team may not pursue active resuscitation. Each case is unique and these extremely difficult decisions take into account many factors including the pregnancy, the information known about the fetus, parental beliefs and values, and the experience of the team at the hospital caring for mom and baby. Currently, the lowest gestation age that's offered medical intervention at most institutions is 22 weeks and many of those babies may still not survive or have complications that lead to substantial disability even under the best circumstances and care.
"I would say the fact the Exzavier left our NICU without any medical equipment or significant neurologic concerns is quite rare. Coming from a starting point of needing aggressive medical support for nearly every organ system to function to leaving breathing all on his own, taking bottles without difficulty, and interacting with his caregivers at the beside, he's just a wonderful example of what's possible even with extreme prematurity," said Dr. Boulais.
Slowly, Exzavier gained weight and strength until he was discharged in April at 6 pounds. Today, he is healthy and thriving, gaining weight and meeting many of his milestones.
"He's here now, he's strong and he's a fighter," said Kyla.
Exzavier continues to receive follow up care at Tufts Medical Center, including seeing an eye specialist, cardiologist and gastrointestinal care specialist.
"At Tufts Medicine, we like to provide a personal service both to the patients and to our colleagues at other hospitals," said Dr. Peterson. "We have personal relationships with physicians at the hospital we got the transfer from that go back decades. It speaks to the kindness and the teamwork that we like to model every day for our learners. I think it's really the Tufts Medicine way. It's a special place. When other hospitals call, we answer. It's personal."
