Tiny Heeran entered the world at just 22 weeks, more than four months before his due date. Though he weighed less than a pound at birth and faced significant challenges, he's now home and thriving thanks to the support of a multidisciplinary team of experts and his loving parents.

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On Christmas Eve 2022, Sharni Saravanan was rushed to Mayo Clinic Health System in Red Wing. She was pregnant and bleeding, a terrifying combination. But doctors assured Sharni and her husband, Karthik Viswanathan, that she and their baby were fine.

This year, Christmas Eve looked much different for Sharni and Karthik. There were no trips to the hospital, no worries about anyone's health.

And there was someone new joining the celebration: their son, Heeran, who was born at just 22 weeks.

His survival is a testament to his strength, his parents' love, medical advances, and the efforts of a devoted care team at Mayo Clinic in Rochester.

"Fifty years ago, premature babies born at 35 weeks might not have lived past a few days," says Christopher Colby, M.D., a neonatologist at Mayo Clinic Children's Center in Rochester.  "Now, thanks to new technology and scientific discoveries, even the smallest babies, born as early as 22 weeks, have a chance of surviving with an optimistic prognosis for their developmental outcomes."

From routine to high-risk

At a routine checkup in early January 2023, shortly after the Christmas Eve scare, an ultrasound revealed that Sharni's cervix was shortening, increasing the risk of preterm labor. She had a procedure called a cerclage, in which stitches close the cervix to prevent premature birth.

The procedure gave Sharni and Karthik's unborn child a chance to grow.

"Despite a 20% chance of survival, our baby exhibited strength and resilience with no signs of distress," Karthik says, noting that Heeran appeared "content inside his mother's womb."

While Heeran appeared content, Sharni was transferred to Mayo Clinic in Rochester, where a specialized team could monitor her now high-risk pregnancy.

Three weeks after the cerclage procedure, Sharni experienced premature rupture of the membrane — her water broke prior to 37 weeks gestation. She was given steroids to help her unborn baby's lungs develop more quickly, a treatment that improves survival and long-term outcomes in premature babies.

Three days later, Sharni went into labor and delivered her son. Heeran Karsha arrived on Feb. 2, 2023, weighing less than a pound. He was just 10.8 inches long.

"Infants like Heeran require intensive care from a large multidisciplinary team to provide lifesaving interventions," says Ray Stetson, M.D., a pediatrician and neonatologist who helped care for Heeran in the Neonatal Intensive Care Unit.

For Heeran, those interventions included treating conditions common in premature infants: patent ductus arteriosus, an opening between the two major blood vessels leading from the heart; periventricular leukomalacia, a type of brain damage; and retinopathy of prematurity, a condition in which blood vessels grow abnormally in the retina. He also had surgery to fix a hernia in his lower abdominal wall.

But Heeran (and his parents) received much more than that from his care team.

Caring for tiny patients — and their parents

In addition to expert medical care, Dr. Stetson says he and his colleagues provide "empathy, compassion, transparency and support for the infant's parents during hospitalizations that can last for many months."

That encouragement meant a great deal to Sharni and Karthik.

"Everyone was so caring and supportive," Sharni says of the NICU team. "A few of the nurses would check up on Heeran during the night shifts even if they weren't assigned to him. They also shared a lot of tips during the care time which gave both of us a lot of confidence."

And when Heeran marked a major milestone — finishing his first bottle — "the whole unit was so happy that they took turns visiting him to tell him how proud they were," Sharni says.

Ellen Bendel-Stenzel, M.D., was among the staff cheering Heeran on.

"It's impossible not to form a strong bond with our NICU parents as we celebrate every victory and mourn every setback with them during a prolonged hospitalization," says Dr. Bendel-Stenzel, a neonatologist. "Heeran was a rockstar preemie, beating the odds and rising in the face of adversity with his loving and supportive parents."

That love and support is critical to tiny patients, Dr. Bendel-Stenzel says.

"Over the years, we've learned that having parents actively involved and present in the care of their preterm infant improves both outcomes and the care we provide," she says. "Heeran's parents were an integral part of his growing and healing. They embraced their parental role in this process and were a joy to have on Heeran's healthcare team."

After 110 days in the NICU, Heeran was able to go to his new home in Rochester, where his parents moved to be closer to his care team. While he still receives some oxygen support, he's meeting developmental milestones — and delighting his parents.

"Heeran turns 1 in February, for which we are very grateful and proud," Sharni says. "He likes being held and to sit and listen to different sounds. He is very curious about new things and people."

Updates like that are gifts to the people who care for premature infants and their families.

"The milestones met by Heeran and other children like him have positively impacted how I counsel expectant parents facing the potential of extremely preterm birth," says Jane Brumbaugh, M.D., a neonatologist. "Children born at extremely early gestations have the potential to thrive. The strength and resiliency demonstrated by these young infants bring me hope."