Meet the little warrior, born at just 23 weeks and 6 days, weighing only 640g — about the weight of two iPhone 16s. Delivery at 23 weeks is rare; approximately 10 out of 100 babies are born before 37 weeks ( premature), and among these 10 babies who are born premature fewer than 1 in 100 are born at 23 weeks. “Currently, a baby born at this gestation is considered non-viable,” says Dr Sridhar Ramaiah, Consultant Neonatologist at American Hospital Dubai
Against all odds, this baby not only survived but is thriving and went home fully healthy after 111 days in the NICU at American Hospital Dubai.
Here’s why this is such an amazing story of survival
This baby was delivered at the American Hospital Dubai, where the mother was receiving obstetric care. Despite having numerous options, she chose the American Hospital for its world-class and highly specialized neonatal and obstetric care.
At birth, the infant was diagnosed with severe respiratory distress syndrome (RDS) due to underdeveloped lungs, a common condition at this gestational age. His tiny lungs required urgent support; he was promptly intubated (a fine tube was inserted into his windpipe to assist with breathing). He also had a heart condition called PDA (Patent ductus arteriosus), a heart defect that affects blood flow to the lungs. The defect usually closes within the first few days of birth. Sometimes, it may not and requires surgery.
However, in extreme premature babies , the PDA often remains open, leading to chronic lung disease that requires home oxygen, as well as other conditions such as necrotising enterocolitis (NEC),, intraventricular haemorrhage (IVH), and poor growth. Such babies may need prolonged ventilator dependence.
The baby also developed a life-threatening bleed from his lungs, as at this gestation, the lung tissue is not yet fully matured, resulting in pulmonary haemorrhage due to structural immaturity. All complications were directly linked to the baby’s extreme prematurity at 23 weeks.
The baby was quickly transferred to the NICU wrapped in a plastic sheath to maintain his body temperature after showing the baby to his parents.
And then began the baby’s journey of resilience
The baby was managed with Gentle Ventilation protocol and Surfactant Therapy. Gentle Ventilation protocol t aids a baby’s lungs in breathing by applying appropriate yet gentle pressure to ensure adequate gas exchange needed. Routine conventional ventilation protocols, on the other hand, can employ high levels of pressure to push air into underdeveloped lungs, which may cause significant secondary lung damage due to the newborn’s fragile condition. Gentle Ventilation seeks to provide adequate breathing support without leading to adverse effects on lungs or if at all minimizes the lung damage.
Surfactant therapy entails delivering Pulmonary Surfactant into the baby’s lungs. Pulmonary Surfactant (PS) is a complex lipoprotein produced by the body to line the alveoli or air sacs in the lungs. It plays a vital role in respiration. In newborns born extremepremature at birth pulmonary surfactant is almost absent and must be administered externally to support adequatelung function.
“While most infants at this stage later develop severe chronic lung disease and often require oxygen at discharge, we successfully avoided this through specialized ventilation strategies, including subtle ventilation techniques, avoidance of hyperoxia and hypoxia (excessive oxygen and deficient oxygen in the tissues, respectively), and maintenance of appropriate carbon dioxide levels in the baby’s body,” says Dr Ramaiah.
The key to success is knowing when to treat and how to treat
All babies born at this gestation will have PDA, said Dr Osama Consultant Neonatologist at American Hospital Dubai, but effective management at the appropriate time is crucial to prevent complications. “Around 50% of such cases do not respond to medical management and require surgical closure. However, we avoided surgery in this case. It’s about knowing when to treat, how to treat, and for how long to treat,” Dr Osama adds.
“We managed the PDA using medications such as Paracetamol and Ibuprofen and specialized ventilator strategies. We also employed cutting-edge strategies such as High Positive End-Expiratory Pressure (PEEP) and Fine-tuned fluid management. The timing of PDA treatment, choice of medications, and use of subtle ventilation techniques were crucial to ensure successful closure without surgery,” Dr Osama says. “These advanced techniques prevent PDA-related complications and reduce the likelihood of surgery.”
The challenges in treating complex cases involving premature babies
Treating a baby born at 23 weeks presents significant difficulties, says Dr Ramaiah.. “Only 10 per cent survive without immediate disabilities at discharge, and we have worked diligently towards that successful goal. Sixty to seventy per cent of preemies survive the NICU period, and those who do often face oxygen dependency, brain hemorrhages, poor growth, and the need for surgical interventions.”
American Hospital Dubai’s excellence in neonatal and NICU care ensured the baby received gentle yet adequate ventilation to prevent lung damage and reliance on oxygen. Under Dr Ramaiah, Dr Osama and their team’s expert supervision, the baby’s PDA did not progress to a surgical case. The neonatal team maintained strict infection control standards, a critical factor in overall success. Thanks to this rigorous protocol, the chances of infection that are high in underdeveloped babies were eliminated. The baby’s brain scans were normal, he experienced no gastrointestinal complications, and his eye condition (ROP) was treated without surgery.
With top-tier care and 24/7 supervision, the baby came off the ventilator at 28 days and was entirely on breast milk via a special tube by day 11.
At 40 weeks, weighing 3.3 kg, baby was discharged to happy family healthy, strong, and surrounded by love.
