The Age Old Question

Yesterday we learned something new. Dr. Balsan took some time to talk to me about this last weekend and Maria's setbacks. He basically said that her setbacks confirmed what he had suspected all along: Maria is younger than we think. Here's how it works:

Because her birth mom didn't know she was pregnant, she was given a sonogram and made a best guess at her last period. The sonogram and her best guess both put Maria at 26 weeks gestation. After the C-section, Maria was given a Gestational Age Assessment. This assessment scores various movements and reflexes and the gestational age is assigned based upon the final score. After the physical assessment, Maria's score put her at 28 weeks. So the NICU kept the 28 week number as their starting point. This calculation would make her 35 weeks and 1 day today.

We may have told some of you that Maria is small for 35 weeks - she's in the 10th percentile for height, weight and head circumference. Well, if you score her as a 33-week baby, she's in the 50th percentile. Here's an example of how Maria's symptoms have confirmed her younger age.

Keeping with the 28 week delivery age, Maria was first taken off her caffeine at 32 weeks and did not tolerate it. That intolerance is a bit odd, as its reasonable for a 32 weeker to be weened off caffeine. But, if you think of Maria as being born at 26 weeks, she would've been taken off caffeine at 30 weeks, and her response would be completely expected and normal for a 30 weeker...they still need caffeine.

So what about the initial Gestational Age Assessment, then? Why did she score like a 28 weeker? Well, of course there's a margin for error, which is two weeks. We're now thinking that she was just very active and spunky for her 26 week age, and that the sonogram was probably more accurate in assigning her age. For the sake of simplicity, Dr. Balsan is keeping her initial age as the official one - she is still talked about as being 35 weeks gestation, and born at 28, but everyone's is just lowering their expectations for her. If we see her as being somewhat immature for her age, then all of her symptoms and setbacks make perfect sense.

Sorry if that was confusing. Maria is an immature 35 week baby, and therefore will probably require more time in the hospital (at least 4 more weeks, depending on how she does).