Grace Punke arrived in the world on July 22, 2009, after only 24 weeks gestation.
She was about as undeveloped as a baby can be and still survive.
From left: Grace, Kristine,
Nathan and Taylor Punke, Marathon County In spite of major health challenges, she not only survived but thrived.
She had plenty of support from her parents, Kristine and Nathan Punke, and the
staff at the Neonatal Intensive Care Unit (NICU) at Ministry Saint Joseph's
Children's Hospital in Marshfield.
"At 24 weeks, we consider the margin of viability to be about 60
percent," said Marshfield Clinic Neonatologist Audra Winder, M.D. "At 23 weeks,
only about one-third will survive."
A normal term for a pregnancy is 40 weeks. Only about four to eight babies born at
less than 26 weeks are admitted per year to the Saint Joseph's NICU.
Like almost all babies born so early, Grace was on a ventilator. She could not
breathe adequately on her own because her lungs were not fully developed.
She also had problems with her heart that needed surgical correction, as well as a
number of other conditions including a vision problem that required laser surgery.
No parent can be ready for the appearance of a baby born at 24 weeks of gestation.
"I don't know if there are words to describe it," said Kristine Punke,
who at age 35 had given birth to a full-term daughter one year earlier. "You just
don't know how to react and you wonder if you did the right thing and if they are
in pain."
Nathan Punke said when he first saw his daughter, "It was a little shocking
with all the things attached to her. You feel helpless."
The neonatologists hear that often. People expect to see a full-term, chubby
baby.
Instead the Punkes saw a baby weighing about a pound and a half and just 11.5
inches in length, or about the length of a sheet of copy paper.
The baby had immature skin that was red and shiny. And, of course, the parents
couldn't see or hold Grace for at least an hour because the doctors and staff were
working hard to keep her alive.
Kristine Punke was partly sedated after having an emergency Caesarian section.
Through a small door window, Nathan watched the staff working. When he saw the
nurses flash the thumbs-up sign, he felt better about her chances.
First 24 hours
The couple had been warned the first 24 hours were critical.
Before Grace even arrived, the Punkes faced a major decision because they live in a
rural area between Wausau and Merrill.
Kristine was a 10-year patient of Thomas P. Connolly, D.O., who delivers at
Ministry Saint Clare's Hospital in Weston.
When Kristine started bleeding and having contractions, Dr. Connolly asked her to
come to Saint Clare's for observation.
It soon became obvious that the baby was going to be born via C-section and that
she would need a NICU.
When Kristine was told that the Level IIIA NICU at the hospital in Wausau can only
care for babies over 28 weeks gestation or 2.1 pounds, the Punkes decided to go to
Marshfield's Level IIIB unit.
They didn't regret it.
"We had some friends who had triplets born the previous December in
Marshfield," she said. "I followed their progress all the way through and I
was thinking of them. Knowing they had been in Marshfield too, we knew we were in good
hands."
Kristine was concerned that her baby would have been transferred from the Wausau
hospital all the way to Madison had complications developed.
Grace did, in fact, require considerable specialty care.
She had a number of heart problems, including an open vessel that had to be closed
by Pediatric Surgeon
Charles W. McGill, M.D.
She also had bleeding into her brain, which required monitoring by a pediatric
neurologist.
She had retinopathy, which required laser eye surgery.
She also was jaundiced because of her immature liver and had apnea and anemia, both
related to her preterm birth.
All of these conditions are fairly common in babies as premature as Grace.
"It's really good for these babies to be here where everyone knows them and
has access to their medical records," said Dr. Winder. "The electronic
medical record is a huge asset for a child with needs as complex as
Grace's."
Grace stayed on the ventilator for about three months, a typical course for her
age. She continued to need oxygen after the ventilator was discontinued.
She was eventually discharged and went home on November 9, a day after her original
due date. The emotional rollercoaster was not over for the Punkes, however.
In early February, Grace apparently picked up a virus that made breathing even more
difficult. "I didn't know what was going on so I took her into the emergency
department at the Wausau hospital," Kristine Punke said. Grace remained
hospitalized there for 10 days.
Other hurdles
Kristine and Nathan Punke know they will probably face other hurdles with
Grace.
Lung issues may be a lifelong concern.
Grace will also be at slightly greater risk for cerebral palsy and has up to a 50
percent chance of having learning challenges because of her prematurity.
"How will they be affected as they reach their 50s or 60s?" asked Jody Gross, M.D., a neonatologist who
has been at the Marshfield NICU for 26 years. "We don't know yet."
The Saint Joseph's Children's Hospital NICU dates back 41 years, when
it was started by James Opitz, M.D., who still practices there part-time.
Dr. Gross said some of her patients have gone on to have normal lives, with babies
of their own. The 24-bed unit typically has 16 to 18 babies.
Of the 1,200 deliveries at Saint Joseph's Hospital annually, about one-third
are admitted to the NICU for at least some period. About 2 percent of premature babies
are born at less than 32 weeks gestation.
At the NICU, the smallest and most vulnerable high-risk babies receive the highest
level of critical care available anywhere.
Both neonatologists said practicing in a NICU can be intense.
But Dr. Winder said she thoroughly enjoys helping young parents learn how to care
for their children, and seeing them through various milestones.
"It can be exhausting, yes," said Dr. Gross. "But it has kept me
interested for 26 years here, and I couldn't imagine doing anything
else."
Grace, for her part, observed her first birthday in July and is doing remarkably
well.
"She is meeting most of her age-appropriate milestones and most of her health
concerns are improving," Kristine Punke said. "For a baby born as early as
she was, she has come a long way."
