Park Won-soon
Professor in Department of Pediatrics, Sunyunkwan University School of Medicine
Park Won-soon is one of the most renowned neonatologists in Korea. Among his high-profile patients are Lee Eun-hye, one of the world’s three most premature babies (born at 21 weeks and five days of gestation) to survive, and Im Yoon-ji, the country’s lightest baby (born at 350 grams) to survive.
The 58-year-old has spent most of the past 30 years at neonatal intensive care units (NICU), trying to save the lives of preemies — babies who are born before they are physically ready to leave the womb. Some of these babies are so small that they fit in an adult’s hand and weigh less than 1 kilogram. Their skin is hypersensitive and their underdeveloped organs could collapse anytime. “We just try our best and hope that God will take care of the rest,” Park said in an interview. “Some cases are extremely difficult or just beyond treatment.” Breathing difficulties are common among preemies due to immature lungs. To help them get extra oxygen, a 2-millimeter breathing tube may need to be inserted. If the baby is too tiny for the tube, another option is a special respiratory machine that applies mild air pressure 900 times per minute to keep a patient’s airways continuously open. Another problem such babies face is the high risk of infection, for which they may be too small to take the necessary medications.
For example, a baby who weighs 500 grams cannot handle more than 30-40 cubic centimeters of antibiotics and food a day because the baby has underdeveloped kidneys and insufficient blood (just 50 cubic centimeters), Park said. “So we try to find the best balance of everything within the possible amount,” he said. “Such baby is also at high risk of water loss through the skin because the baby’s vulnerable skin is like that of a burn patient. To minimize the loss of water and other fluids injected into the body, we keep the humidity very high in the incubator.” Even minor changes in their bodies could bring about major health consequences, such as cerebral palsy, deafness, mental retardation and even death. So NICU doctors and nurses always stay vigilant. The World Health Organization (WHO) defines preterm birth as that of a baby before the 37th week of the mother’s pregnancy.
Based on the gestational age, premature babies can be divided into three categories: “moderate to late preterm” for those between 32 and 37 weeks of gestation, “very preterm” for those between 28 and 32 weeks of gestation and “extremely preterm” for those under 28 weeks. Normally, babies are born after 40 weeks of gestation and weigh around 3.5 kilograms. The gestational age is considered a more critical survival factor than weight because it is more related to the maturity of organs. The WHO considers 24 weeks as the limit of viability, which refers to the minimum age at which a baby can survive outside the womb. But some younger preemies have survived. Park is one of the most renowned neonatologists in Korea. Among his high-profile patients are Lee Eun-hye, one of the world’s three most premature babies (born at 21 weeks and five days of gestation) to survive, and Im Yoon-ji, the nation’s lightest baby (born at 350 grams) to survive. “Until the late 1980s, few babies lighter than 1 kilogram could survive in Korea,” Park said. “Thanks to advancements in technology, research and know-how, today we can save more of them.” According to SMC, it has one of the world’s highest average survival rates of preemies between 23 to 24 weeks of gestation at 70 percent, higher than the United States’ 60 percent. In 2013, Park established the Korean Neonatal Network to share SMC’s expertise in treating preemies with other hospitals. The organization now has 64 member hospitals. “The main purpose of the network is to save more preemies by working together to improve our systems. The members accumulate and share data about preemies’ mortality, cause of death and course of treatment without revealing their personal information,” he said. It used to be thought that every premature baby needs surfactant and other mechanical aids. But Park believes “kangaroo care,” wherein the preterm baby has skin-to-skin contact with the mother or father, is a more effective method of care. “The motto of our team is ‘maximum observation with minimal intervention.’ We try to be as minimally invasive as possible, and this change in philosophy of treatment has so far produced better outcomes,” he said. “Years ago, all preemies were immediately put in incubators and maternal contact was very limited due to preemies’ unstable conditions. But today mothers are encouraged to hold or sometimes breastfeed them for an hour or so a day.”
Babies need your help
The field of neonatology has developed rapidly over the past half century. It was only 1963 when Patrick Bouvier Kennedy, the son of former U.S. President John F. Kennedy, died two days after being born five-and-a-half weeks prematurely. Today babies like Patrick in Korea have much greater chances of survival, but many still do not survive because of the high costs of saving them. “It is possible to save 2,000 to 3,000 more preemies every year, if the government provides proper financial support,” Park said. “The country now has people and technology that can help them but they don’t. This is so wrong.” About 28,000 premature babies, representing 6 percent of the total, are born in the country every year. The rate of preterm birth tends to be higher in developed countries. The figure is 14 percent in the United States and 12 percent in Japan. Older mothers have a higher risk of pregnancy-related complications such as preterm birth. As more Korean women delay marriage and childbirth, the rate is expected to increase to the levels of other developed countries, Park noted. “Our children are our future,” he said. “This is an important issue that politicians have to pay more attention to. The issue is also related to the nation’s problem of low birthrates. Parents want to know whether the government truly cares about the babies who need help.”
Stem cell transplant for treating preemies’ lung, brain disorders
Park is working to develop treatment for bronchopulmonary dysplasia, a chronic lung disorder, and intraventricular hemorrhage, a bleeding into the brain’s ventricular system — disorders that are common among preemies. The treatment he is developing uses cord blood, which is known to be rich in hematopoietic stem cells that can be used to treat blood and immune system diseases. “They are the two biggest killers of preemies,” Park said. “The first and second phases of clinical research for bronchopulmonary dysplasia have been completed. We expect to see the final results soon.” The first phase of clinical trials for intraventricular hemorrhage has also been completed, he said. “The results of experiments on animals are very good, but the problem is that drug firms are reluctant to making an investment, saying that the treatment’s commercial viability for the rare disorders is uncertain.”