Weighting Game : 18 1/2 Ounces at Birth, She’ll Be Going Home Soon

At her smallest, Dana Kathleen Knowles weighed less than Dr. Spock’s baby book.

“We figure that she was the smallest viable human being in the world that day,” UCI Medical Center neonatal nurse Susana Tristan-Trudell said of the tiny infant, who tipped the scales at 12 1/2 ounces when she was 10 days old.

“I don’t think they come any smaller than that and live,” said Dana’s neonatologist, Dr. Jack Sills.

But on Thursday, weighing four times as much as she did on that day last September, Dana left the medical center. She was not quite big enough to go home, but she was healthy enough to head back to Hoag Memorial Hospital Presbyterian in Newport Beach, where she and her twin sister were born nearly 17 weeks prematurely on Sept. 20.

The twin, named Deana Kay, survived about five hours. Dana, weighing 1 pound, 2 1/2 ounces at birth--about 1 1/2 ounces more than her sister--was immediately rushed to UCI Medical Center’s “infant special care unit,” staffed and equipped to care for the smallest and sickest babies.

On Thursday, Dana weighed 3 pounds, 14 1/2 ounces and was deemed stable enough to go back to Hoag’s neonatal intensive care unit, where she will be closer to her parents, Jerry and Cathy Knowles of Costa Mesa. When she weighs in at 4 pounds, 5 ounces, Dana will go home.

“I’m real excited. After this, she’s going to be coming home in three or four weeks,” said Cathy Knowles.

Dr. Sills said Dana’s life was saved by the “close relationship” fostered by Hoag and UCI. Hoag neonatologist Dr. Lawrence Wickham notified UCI when the birth of the twins was imminent, and an ambulance with UCI’s special neonatal equipment and staff rushed, sirens screaming, to the Newport Beach hospital.

“It’s real nice when things fall into place,” said Tristan-Trudell. “She was lucky she was born in the right place at the right time.”

The twin babies were born so prematurely, Jerry Knowles said as he cradled his yawning daughter, because “this little critter had her feet in my wife’s birth canal.” Doctors tried but could not stop the premature labor. The twins were delivered vaginally.

The new mother was released from the hospital the next day, and every day since then the Knowleses have spent at least a couple of hours at UCI Medical Center, caring and praying for their critically ill daughter.

Jerry Knowles said he knew within five days of her birth that Dana would make it. The doctors and nurses were less sure. A single baby born after a 23-week pregnancy has a 10% to 20% chance of survival, said Sills, an assistant professor of pediatrics. The odds for a twin born that prematurely are a little longer, he said.

Dana’s first 24 hours were extremely unstable, Sills said. The baby was immediately placed on a ventilator to help her breathe and underwent surgery to correct a valve that regulates the amount of blood that feeds into the lungs, he said.

She reacted so well that within a week she was taken off the ventilator, but only briefly. Infection set in, and Dana was placed back on the breathing machine, Sills said. She was on the ventilator 76 days.

Dana’s weight was expected to drop after birth, Sills said. When a baby is born after a 23-week pregnancy, up to 80% of the birth weight is water, and frequently a preemie will lose 20% of its birth weight, he said. Dana, however, lost an alarming 30%. It was not until her 31st day that Dana weighed as much as when she was born.

As she got bigger, she was weaned off the intravenous feeding, but only after recurrent bouts of “feeding intolerance,” in which her immature intestines could not tolerate formula, Sills said.

Eight weeks passed before doctors and nurses believed Dana was out of danger. Sills said there is no evidence today that her lungs were scarred by the extensive time on the ventilator. The baby’s eyesight and hearing appear normal, she feeds well and there is no evidence at this time of brain or neurological damage, which often occurs with premature infants. Dana will be periodically checked over the next five years by UCI doctors to monitor her development, he said.

Cathy Knowles, 25, who works for a computer firm, said the most painful thing she had to bear during her daughter’s struggle for life was “the ups and downs. Her condition could change within hours, from one extreme to the other. You get your hopes up, and then the next day they get shot down.”

For Jerry Knowles, 25, a construction worker with the Irvine Ranch Water District, the hardest point came one day when nurses rolled the tiny Dana in her incubator past larger infants in the special care unit. Nurse Tristan-Trudell said the parents of the other babies asked, in disbelief, “Is that a baby?”

Wearing a pink cap and pink and white socks Thursday, Dana still looked small, but healthy and content to rest in her father’s arms. She was not always so docile.

In Dana’s first weeks after birth, “she was ornery; she was mean,” Tristan-Trudell said. “Now she’s an angel, definitely a good baby.”

“Thank God she inherited my aggressiveness,” Jerry Knowles said, gazing at his daughter. “She doesn’t give up.”