The smallest ever surviving baby in the UK

Both Ramiah and Romeo were born at Royal Oldham Hospital (ROH), one of three specialist neonatal centres in Greater Manchester providing the highest level of intensive care to the smallest and most vulnerable babies. ROH is also the birthplace of the world’s first IVF (in vitro fertilisation)/test tube baby, born in 1978.

The miracle birth was attended by the wonderful neonatology team at ROH, who are well qualified to deal with extreme prematurity and fully trained in advanced neonatal life support. Ramiah cried as her head was delivered; she was intubated and given one dose of surfactant in the delivery room before she was transferred to the state-of-the-art neonatal intensive care unit at ROH.

Ramiah experienced many medical challenges typically associated with extremely premature babies, including surfactant deficiency lung disease, necrotising enterocolitis, patent ductus arteriosus, metabolic bone disease, broncho-pulmonary dysplasia, and neonatal sepsis. However, Ramiah proved she was strong. Having undergone intensive care with respiratory support, parenteral nutrition and multiple blood transfusions, she was stable enough to take her full nutritional requirement of milk via nasogastric tube at the age of 17 days and was discharged home at the age of five months in early June 2020 on home oxygen with routine follow up of neurodevelopmental assessment.

We believe that Ramiah received the best family-integrated neonatal care from our extraordinary neonatal team at ROH and that this contributed to her survival. Although such extremely premature babies may face a higher risk of death, learning disability or developmental delay, some may grow up with no long-term effects of premature birth; no significant physical or cognitive disabilities.

Ramiah’s story demonstrates how, with excellent neonatal care, babies at the extremes of viability can survive and thrive. It also throws light onto the complexity of decision making for resuscitation and intensive care of these tiny babies based on birth weight or gestational age-based guidelines.

The authors received permission from Ramiah’s parents to include this article in Infant.