Local hospital's tiniest surviving baby defies odds

Though she weighs less than one pound, local doctors optimistic of her chances

By Stephanie Rice, Columbian Vancouver city government reporter

Published:

Updated: December 24, 2012, 8:46 PM

 

She was supposed to arrive closer to St. Patrick's Day.

But Harley Daylee Gulliksen was born prematurely on Dec. 20, via emergency Caesarean section at Legacy Salmon Creek Medical Center.

Delivered about 13 weeks early because her mother's health was at risk, Harley was 10 inches long and weighed 15 ounces at birth — there are 16 ounces in one pound — making her the smallest surviving baby ever to be delivered at Legacy.

Prior to Harley, the smallest surviving baby born at Legacy, which opened in 2005, was a boy who weighed 1 pound, 7 ounces.

Harley's parents, Tiffany Burril and Mitchall Gulliksen, both 22, are calling their daughter a Christmas miracle.

Dr. Bret Freitag, medical director of Legacy Salmon Creek's neonatal intensive care unit, said Harley's doing remarkably well.

"There are challenges, but she's off to a really great start," Freitag said Monday, adding he's optimistic Harley will survive.

Harley's in an incubator, which provides heat to keep her temperature stable, and she has a feeding tube through which she's receiving breast milk pumped by her mother. She has an IV in her belly button, a substitute umbilical cord supplying her with nutrients like the ones she'd ideally still be receiving from her mother. She's also on caffeine to stimulate her breathing, Freitag said, and insulin to help her tolerate sugar. She sleeps most of the time but has opened her eyes, and can grasp a pinky finger extended by her mother or father.

One of Harley's arms, by the way, measures shorter than an adult's pinky.

On Monday, Harley was one of 14 babies in the NICU; the largest baby weighed 6 pounds, 10 ounces. Legacy Salmon Creek's NICU typically takes babies born as early as 26 weeks. Babies born earlier than that typically need surgical intervention and are transferred to Randall Children's Hospital at Legacy Emanuel in Portland.

Harley's small for her age, Freitag said.

Burril was 271/2 weeks along, with a due date of March 20, when it was decided last week that Harley needed to be delivered. An average fetus at 27 weeks' gestation would weigh approximately 2 pounds, 8 ounces, Freitag said. Harley's size was closer to a fetus at 22 or 23 weeks.

Harley was delivered by Dr. John G. Buckmaster, a perinatologist who works out of Legacy Medical Group's Maternal-Fetal Medicine Clinic, said Brian Willoughby, spokesman for Legacy Salmon Creek.

Difficult pregnancy

Burril said her pregnancy wasn't planned, but at the same time she and Gulliksen, who live with his parents in Vancouver, hadn't been actively trying to prevent a pregnancy. She said she was incredibly ill during her pregnancy, vomiting frequently, and didn't consistently gain weight. If anything, she said, she weighs about five pounds less now than she did before she was pregnant. She didn't see a physician right away — "I was scared of doctors, I guess" — she said, but said she was taking prenatal vitamins.

Eventually she went to a doctor because she was vomiting blood, and she was prescribed pills to help with her nausea. She estimated she was about three months along when she first saw a doctor. In addition to not being able to keep food down, she said she got dizzy and would have to lie down if she tried to do chores around the house. An ultrasound showed that Harley's bones weren't growing as they should, and Burril said she was ordered on bed rest. Her doctor was concerned with her low levels of amniotic fluid.

Burril was admitted to Legacy on Dec. 17 after a test showed protein in her urine, a warning sign of pre-eclampsia. She didn't get better, and after tests showed her with a low platelet count and elevated liver enzymes, the decision was made on Dec. 20 to rush her into surgery.

Gulliksen said he wasn't allowed to watch the surgery, and had to wait about 30 minutes before he was allowed to see Harley.

"I was really just happy to see her," Gulliksen said Monday. "I'm still very emotional. I get all happy, and then I get very sad."

Burril was discharged from Legacy on Sunday, and returned to the NICU on Monday to spend time with her daughter. She said she was the last family member to meet Harley on the day she was born, as she was groggy after the surgery.

"It was very touching," she said upon seeing her fragile daughter for the first time. "But I was just really upset. I kept wanting her back in me."

Freitag said Burril had HELLP syndrome. The "H" stands for hemolysis, or a breakdown of red blood cells, the "EL" stands for "elevated liver" enzymes and the "LP" stands for "low platelet" count. There's no known cause, he said. Left untreated it can be fatal.

Harley may well be the smallest surviving baby ever cared for in Clark County, Willoughby said, as such high-risk preemies born at PeaceHealth Southwest Medical Center are typically transferred to Randall Children's Hospital, OHSU Hospital or Providence St. Vincent Medical Center.

Freitag said the cause of Harley's intrauterine growth restriction — defined as developing babies who weigh less than 90 percent of other babies at the same gestational age — was unknown and wasn't necessarily caused by Burril's condition. The biggest challenge Harley faces, he said, will be tolerating food as her intestines, as well as her other organs, are underdeveloped. All of her vital body functions are working, though.

The next four weeks will be critical, he said.

Freitag said Harley will likely have to grow to 4 pounds before she can leave the incubator, and probably won't be ready to go home until late March, close to her mother's original due date. She's at increased risk for developmental problems.

For now, mother and father are taking it one day at a time.

Gulliksen, who works as a caregiver for his mother, said Burril has medical insurance because she's a member of The Confederated Tribe of Grand Ronde. The couple will see how many medical expenses her insurance will cover, then figure out how to pay the balance, Gulliksen said.

Today, they planned on spending part of Christmas with their families but also plan to be at Legacy Salmon Creek, where tiny Harley, like other babies in the NICU, has a private room.

"We plan on spending a lot of time with Harley," Gulliksen said. "That way she has somebody with her."

Stephanie Rice: 360-735-4508 or stephanie.rice@columbian.com.