A PREMATURE newborn declared dead at birth was found alive this week after spending 12 hours in the refrigerated room of an Argentine morgue.
Her parents had returned to the hospital the evening after her birth to take a picture of their baby for the funeral. Instead of the lifeless body they were expecting, Analia Bouter and Fabian Veron found their daughter alive and crying in her coffin. Bouter calls it a miracle. A week after the ordeal, the baby is in a critical but stable condition.
So what happened? It鈥檚 not so much a miracle as a misdiagnosis, says , a stillbirth researcher and obstetrician at Harvard Vanguard Medical Associates in Wellesley, Massachusetts.
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Bouter was 26-weeks pregnant when she gave birth and was sedated during labour. The anaesthesia would have affected her child, says Fretts, and may have contributed to the misdiagnosis. But an experienced clinician should have been able to spot this.
鈥淭hey could hear the heartbeat with a paediatric stethoscope. But the baby wouldn鈥檛 have made much effort to breathe,鈥� says Fretts, referring to respiratory distress which results in reduced lung function in many premature babies.
However, medics at Perrando de Resistencia Hospital in Chaco, Argentina couldn鈥檛 find a pulse in Luz Milagros, and she was declared stillborn.
鈥淎 trained person should know the difference between a sedated baby and a dead baby,鈥� Fretts says. But any effort to resuscitate a stillborn baby will be based on the viability of the infant鈥檚 survival. In many developing countries, the rates of stillbirth are so high that a baby born three months prematurely might be considered an inevitable loss and 鈥渢he signs of life could be overlooked,鈥� she says.
鈥淚n the periviable period (a narrow window between 22 and 26 weeks of gestation that almost universally results in stillbirth or neo-natal death) there can be a fair bit of misclassification,鈥� says Fretts. 鈥淚n a setting where the chances of survival are low, they鈥檙e probably not looking very hard for a baby with a heartbeat because they know what the outcome is going to be.鈥�
It鈥檚 even more confounding, then, that this happened in a country where the rate of stillbirth is fairly low, with babies being stillborn, a rate that has dropped by over 60 per cent since 1995 (The Lancet, vol 377 p 1319).
Fretts says that babies who are small for their gestational age produce stress hormones that help them adapt to life outside the womb. This survival mechanism could have kicked in for Bouter鈥檚 child, especially if she was underweight as well as premature.
鈥淚f the baby was crying 12 hours later, my guess would be that it was further along in gestation than they thought, and the expectation that the baby wouldn鈥檛 live coloured their view, so they didn鈥檛 look too carefully.鈥�
The hospital鈥檚 director, Jose Luis Meirino, said that all the staff present at the birth concluded that Luz was stillborn.
Meirino says hypothermia may have disguised her vital signs, but said in a statement: 鈥淎t the moment we have no explanation.鈥�
The medical staff involved, including an obstetrician, a gynaecologist and a neonatologist have been suspended while authorities investigate.
Bouter says she plans to sue the hospital for malpractice.
