Born weighing about as much as 'a large apple,' Saybie is the world's smallest surviving baby

Even before the baby girl was born, doctors knew she was going to be small. She was being delivered by emergency Caesarean section after spending only 23 weeks and three days in gestation because her mother was suffering from preeclampsia, a life-threatening condition that can slow a baby's growth in the womb.

But as Paul Wozniak, a neonatologist at Sharp Mary Birch Hospital for Women & Newborns in San Diego, stood in the delivery room last December looking down at the infant he had just been handed, he was shocked.

"I thought, 'Oh my God, I can't believe how small she is,' " Wozniak told The Washington Post. The doctors had anticipated the baby would be around 400 grams, or slightly less than 1 pound, but she was even tinier. "We weren't expecting anyone this small," he said.

On Wednesday, the hospital announced that the baby, nicknamed "Saybie" by her nurses and doctors, was born weighing 8.6 ounces (245 grams), which means she is now believed to be the world's smallest surviving infant. According to the Tiniest Babies Registry, a database maintained by the University of Iowa, Saybie weighed seven grams less than the title's previous holder, a baby girl born in Germany in 2015.

"For comparison, at birth she was roughly the same weight as a large apple or a child's juice box," Trisha Khaleghi, the hospital's senior vice president and chief executive, said during a news conference.

Despite her small size and the host of health complications that can potentially be deadly for a "micro-preemie," or a premature infant born before 28 weeks, Saybie lived. After nearly five months in the neonatal intensive care unit, Saybie's parents, who wished to remain anonymous, took their "healthy 5-pound infant" home earlier this month, the hospital said.

"I was stunned, frankly," Wozniak said, adding that he spoke with Saybie's mother on Wednesday and she told him her daughter was up to 6 pounds 2 ounces "and doing great."

Saybie's outlook, however, wasn't always so positive.

It all began on that December day when Saybie's mother suddenly didn't feel right.

"It was the scariest day of my life," the mother said in a video released by the hospital on Wednesday. "I just felt very uncomfortable, and I thought maybe this is part of the pregnancy."

Doctors soon informed her that she had preeclampsia, which can cause high blood pressure. If left untreated, preeclampsia can lead to serious, or even fatal, complications for both the mother and baby, according to the Mayo Clinic.

During Wednesday's news conference, Dana Chortkoff, the OB/GYN who delivered Saybie, said the mother had "severely elevated blood pressure" and that if the baby's life were to be saved, she needed to come out.

"I kept telling them she's not going to survive, she's only 23 weeks," the mother said in the video. A typical pregnancy is 40 weeks.

Nationally, the survival rate for babies born around the same time as Saybie is about 20 percent, Wozniak told The Post. Several studies from recent years report equally grim statistics.

When Saybie was born in December, she wasn't breathing, but "had a good heart rate," Wozniak said. He said her parents decided that if she had a heart rate "they wanted everything done."

Wozniak said the hospital has had its fair share of "23-weekers," but Saybie's diminutive size, which was caused in part by the preeclampsia, made her situation all the more challenging. It was difficult to find properly sized equipment, he said, noting that even the NICU resuscitation beds' built-in scales were unable to register her weight because they couldn't go below 300 grams.

The first thing Wozniak and his team had to do was put in a breathing tube. One about the size of a juice-box straw needed to be cut down before it was successfully inserted, he said. Saybie was warmed up, dried off and given medicine to help her breathe, he said.

Then, all they could do was wait.

"We just sat by her bedside the first six hours," Wozniak said. "I thought her chances of making it probably weren't good. I told the folks every hour I would update them, but there's a good chance she's going to die."

The mother said in the video that she recalled doctors telling Saybie's father that he would only have about an hour with the newborn before she passed away.

"But that hour turned into two hours, which turned into a day, which turned into a week," she said.

As nurses and doctors watched Saybie slowly improve and gain weight, they continued to worry about the variety of life-threatening medical challenges "micro-preemies" can face. It is not uncommon for brain bleeds and lung and heart issues to occur, but much to everyone's surprise, Saybie "experienced virtually none" of those complications, the hospital said.

"She's a miracle, that's for sure," Kim Norby, one of the NICU nurses who cared for Saybie, said in the hospital's video.

In the video, colorful signs could be seen plastered on the walls around Saybie's crib. Some kept track of her weight and other milestones. "No more breathing tube," one read. "Tiny But Mighty," another declared.

Saybie kept astounding doctors with her progress even up until the day she was discharged, Wozniak said.

"Many babies like this go home on oxygen, which I thought she probably would, but no, she weaned off of it," he said, adding that she was also breast-feeding well and didn't need a feeding tube. "The fact that she's done so well is just such a reward, and just makes the whole team feel wonderful."

Though Saybie appears to have defied the odds for now, Wozniak said that could change as she gets older. Premature infants, especially those born as early as Saybie, may develop mild vision problems, fine motor issues, language delays or other learning disabilities, which don't always show up until the babies are school age, he said. For the next several years, Wozniak said Saybie will be making regular visits to the hospital's Nemeth NICU Follow-Up Clinic, which is intended to help promote the growth and success of preterm babies.

Still, Saybie's story should inspire hope among parents and medical professionals, Wozniak said.

"It lets everyone know that it is possible," he said.