Born weighing 470 grams

At twenty weeks, Kiera went in for a routine ultrasound and appointment. Having so far had a healthy and routine pregnancy, she wasn’t at all concerned. As part of the exam, they did some bloodwork on Kiera, and noticed some irregularities. She was immediately referred to Mount Sinai Hospital’s Special Pregnancy Unit and saw Dr. Kingdom. She learned that her baby had stopped growing properly, and there were concerns about the likelihood of viability.

Kiera had to go to routine appointments, sometimes daily, to be monitored and have her baby’s progress closely tracked. Just before her pregnancy hit 27 weeks, her doctors sat Kiera and her husband down and said that their baby – a baby girl – was not going to make it. The doctors were worried about her size – she was measuring at less than 500g, which is less than one pound – and that she wasn’t developing and meeting developmental milestones. The team referred Kiera and her husband to grievance counseling.

Stunned, Kiera and Daniel went home to try and process everything they had been told. Daniel began to research how small the smallest viable babies are. He found some articles about babies who had been born and survived, despite weighing roughly what their baby weighed. He and Kiera decided to fight for their baby girl. They went back to the doctors and said they knew she was small, but they wanted to do anything they could to give her a chance at survival. The doctors said because of the baby’s failure to grow as normal, they didn’t know exactly where she was from a development perspective. If she was born and survived, she might face a future of severe developmental delays, potentially both physical and mental. Kiera and Daniel knew the risks, but also knew that their daughter was worth the gamble. They said they wanted to try and continue with the pregnancy and delivery, to see if their baby girl might beat the odds and survive.

That same day Kiera was referred to the Mount Sinai Hospital birthing unit. Her baby’s heart rate was dropping, the numbers weren’t looking good, and so they told her she was going to have an emergency caesarean-section that day. Within an hour after sitting down to say they wanted to advocate for their daughter’s chance to thrive, Kiera was giving birth.

Arabella was born weighing 470 grams, which is roughly one pound. She was whisked to the NICU right away – Kiera didn’t even see her until the next day. The doctors discovered that she had osteopenia, which is a condition some premature babies have wherein their bones are so fragile they fracture easily. Arabella needed surgery to repair some of her fractures, so she was transferred to SickKids, where they performed the surgery. She spent the next six months travelling back and forth between the Mount Sinai Hospital and SickKids NICUs. At Mount Sinai she developed a sepsis infection which nearly killed her, but thanks to the care provided by the NICU staff, she fought the infection and won.

“I remember every single nurse, doctor, staff member we spoke to in the NICU, none of them ever said, ‘she’s too small, she won’t make it’ or anything like that. They gave her a shot at life and supported her through every moment of those first few months. We are so incredibly grateful,” recalls Kiera.

Arabella dealt with additional surgeries, being on a CPAP machine – a standard device to help premature babies with breathing – and also on a ventilator. She fought a lot of battles during her first few months, and Kiera and Daniel were scared. “She was our first and only child. It was really a lot to go from being told she wouldn’t survive, to having her born alive, to seeing her have to fight so hard and overcome so many odds. We never gave up on her, but neither did the team at Mount Sinai,” Kiera recalls. “The nurses in particular were just amazing. It’s hard to be at the NICU so often and feel helpless, but Mount Sinai doesn’t let you just sit there. As parents, you’re active care team members. They showed us how to change her diaper around all the tubes and machines and monitors, how to check her temperature, how to give her a sponge bath. When they did the rounds we were encouraged to be there and participate, not just listen. It was really an amazing experience,” says Kiera.

Following Kiera’s delivery, the team at Mount Sinai had done some tests of her placenta, to see if they could determine what had happened and why Arabella was so small. It turned out that Kiera had an extremely rare placental disease. The majority of women who develop this condition see their baby’s growth stop at roughly 20 weeks, and typically the baby passes away shortly thereafter. Arabella had somehow avoided this fate and had made it to 27 weeks – defying the odds from day one.

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Today, Arabella is a healthy, normal, and active six-year-old. She started grade one in September 2023. She’s tall for her age, though still thin. Kiera and Daniel sometimes can’t quite believe how far she’s come. “Every single clinic that we graduated from, it was like another reassurance that she was going to be a fighter and keep going. We’ve graduated from the bone clinic, the heart clinic, the lung clinic, the NICU follow up clinic, the developmental clinic, each one has been such a milestone for us. I’m so proud of her and continue to be so grateful to everyone at Mount Sinai who helped us give our baby girl a fighting chance.”