Sierra, Centre Hall (2005)

Sierra may not have realized it at the time, but her first New Year's Eve celebration also was a celebration of her health and homecoming.

Sierra was born on October 2, 2002, nearly four months before she was expected to arrive. Her mom, Danielle, hadn't thought much about the contractions when they started; it was, after all, only 23 weeks into her pregnancy. She even went to work the morning after her water broke. But after talking with her doctor by phone, she understood that if her contractions weren't stopped, her baby's health was in jeopardy.

She went to Lewistown Hospital, where she was prepared for Life Flight® transport to Geisinger Medical Center in Danville.

When she arrived at Geisinger, doctors tried to stop her contractions and delay the birth to give her baby more time to grow. At this stage in the pregnancy, even a week can mean an entirely different outcome, according to James Cook, MD, director of neonatology at Geisinger's Janet Weis Children's Hospital.

"At 23 weeks, neonatal survival rate is only ten percent. At 24 to 25 weeks, it jumps to 50 percent. Just one week can make a huge difference," Dr. Cook says.

Within hours, however, Danielle felt her baby drop. She hadn't begun to dilate when she arrived at Geisinger, but now she was fully dilated.

"I was supposed to lie there for about a month, but the next morning [after arriving at Geisinger], there she was," Danielle says of her daughter. "I delivered naturally in one push -- that was it."

Because Sierra was born 17 weeks early and weighed only one pound, seven ounces, she immediately was admitted to the Neonatal Intensive Care Unit (NICU) at Geisinger's Janet Weis Children's Hospital, located on the other side of a pass-through window from the labor and delivery area.

Premature babies need to be stabilized quickly, Dr. Cook says. They often need a ventilator to help them breathe and their body temperatures drop very quickly. The pass-through window helps babies receive the care they need without the risks involved with transferring them to another area of the hospital.

Danielle's dad, Tom, remembers the uncertainty when he saw Sierra for the first time, roughly two hours after she was born. "She was nothing but skin and bones, and was very red. I really didn't think she was going to make it," he says.

"Her ears weren't even completely formed yet," Danielle adds.

Sierra would face a number of problems typical for premature babies, including respiratory distress syndrome, which required use of a ventilator. Overall, however, her problems were not as severe as expected, Dr. Cook says. "Her breathing was our number one concern, and growth was number two. She had no problems with her eyes, which is very unusual, and no feeding problems, which also is unusual for babies as premature as she was."

Danielle says she worried constantly during Sierra's stay in the NICU, especially because her condition could change so quickly. One night, Danielle recalls, she said good-night to a relatively healthy Sierra and went home. By the time she returned the next day, "she looked like she was on her last leg." Sierra had developed an infection sometime during the night.

Though Danielle never knew what would be waiting for her on each trip to Danville, she made the trip every day -- even after she went back to work -- to be with her daughter, always with the hope for progress.

"They tell you not to ask her weight every day, but you just have to know. You can't wait," Danielle says. Although parents may want them to, "babies don't grow every day," Dr. Cook smiles.

By Christmas, Sierra was growing and breathing well. Danielle was cautious not to be too optimistic, but when doctors moved Sierra from the NICU to the special-care unit, she knew it likely was only a matter of time before her daughter would be able to go home.

On New Year's Eve 2002, still nearly three weeks before Danielle's due date, Sierra came home to Centre Hall. She weighed just four pounds, 10 ounces, but she went home with only an apnea monitor -- a routine process to monitor breathing.

Now two years old, Sierra is healthy and active and shows no signs of any ongoing medical or developmental problems. Danielle says she thinks of everything Sierra has been through often, and is thankful for the care she received from the doctors and nurses who helped make it possible.

"The odds were stacked against her," Dr. Cook says. "Of the ten percent that survive at 23 weeks, more than 90 percent have significant problems. No one would have expected Sierra to do this well. She's a miracle."

Thinking about it now, "you just look back with a smile and move forward with courage," Danielle says.