Alicia, the smallest baby ever to survive in Iowa, weighed only 12 ounces, about as much as a can of pop.

Her parents, Lu Ann Paul and Harry Allen of Marion, could hold her in the palm of one hand. Her diapers, which were the size of a folded Kleenex, came up to her armpits. A wedding ring could be slipped over her thigh.

"Her legs were even smaller than my pinky finger," Lu Ann said.

"I was there when she came out and I just couldn't believe how small she was," Harry said. "I couldn't imagine something that small surviving."

Today, Alicia is scheduled to leave University Hospitals and go home to the nursery Lu Ann and Harry have prepared for her. She weighs 5 pounds, 5 ounces - seven times her birth weight.

Alicia will have to breathe oxygen for six months to a year, drink a special, high-calorie formula and avoid respiratory infections, which can be deadly to premature babies. But her main job is to grow.

Alicia weighed 349 grams when she was born, 10 grams less than Rebecca Schultz, who was born Jan. 1, 1994. Today, Rebecca lives with her parents, Dann and Sylvia Schultz, in Cedar Falls and is a healthy 3 1/2-year-old.

"She's doing wonderfully," Sylvia Schultz reported. "She's attending preschool and day care and interacting wonderfully with the other children. Her speech is coming along beautifully."

She said Rebecca weighs only 23 pounds, "but what she lacks in size, she makes up in personality."

Rebecca, the previous record-holder, blazed a trail for Alicia, for which the Allens are grateful.

"It kind of put us at ease a little bit to know another baby went through it," Lu Ann Paul said. "It helped a lot."

Dr. Edward Bell, director of neonatology at University Hospitals, said it is "very, very uncommon" for babies weighing only 12 ounces to survive.

Bell said the world's smallest surviving baby weighed 10 ounces at birth. He doesn't know where Alicia and Rebecca rank because "nobody keeps statistics...But I think it's pretty unusual.

"We're delighted that both of these babies have done as well as they have," he said. "They're both miracles."

"Old" For Their Size
Alicia and Rebecca were helped by the fact that they were "old" for their size. Alicia had been in the womb for 24 weeks. Two out of three premature babies with a gestational age of 24 weeks survive now. Of course a 24-week baby should weigh 24 ounces, and Alicia weighed half that. She was closer in size to a baby with a gestational age of 20 weeks, and babies that young typically do not survive.

Alicia's four extra weeks in the womb allowed her organs to mature.

"The reason she could survive and most babies this size can't is because she was far enough along in her development," Bell said. "Every few years, the frontier pushes back a little bit more."

Recent medical advances have made it possible to save babies who even five years ago were considered too small to survive.

"There are many small pieces in the big puzzle of intensive care that go together to make these things possible," Bell said. "One of the important ones is just the realization that things like this can happen."

Treatment Getting Better
Bell said doctors and nurses have learned how to care for extremely premature babies. "As we gain more experience with caring for tiny babies, we get smarter about how to do it and get better at it," he said.

Obstetricians have a new drug that speeds up the development of fetuses that are in danger of being born prematurely, Bell said. An injection of betamethasone causes a fetus to develop the equivalent of a week in the uterus in only 24 hours.

Once a premature baby is born, Bell said, surfactant can be administered directly into the lungs to counteract breathing problems. The lung cells normally produce surfactant, but those cells are not working yet in the lungs of very premature babies. The chemical keeps the air sacs in the lung from collapsing when a premature baby exhales.

Breathing is a real problem for premature babies, and the breaths produced by normal ventilators are too large and too slow for tiny lungs. So artificial breathing machines have been scaled down and speeded up. Instead of 40 to 60 breaths a minute, these high-frequency ventilators deliver 600 to 900 tiny puffs of air a minute.

"That enables us to get oxygen in and carbon dioxide out without stretching the fragile lung tissues so much and causing damage," Bell said.

Alicia was on a high-frequency ventilator until April 25.

"You could rest your hand on her chest and you could just feel it vibrating," her mother reported. "It was kind of a weird sensation."

Bell said manufacturers also have created smaller equipment and supplies to meet the needs of premature babies. "Ten years ago, the tubes and things that we had would have been too big to care for a baby this small."

Never Any Doubts
Lu Ann and Harry Allen, who have suffered through the heartbreak of two stillbirths, said they never had any doubts about trying to save Alicia.

"We were just very hopeful from the beginning that everything was going to be OK," Lu Ann said. "I don't think we ever had a negative thought. We always thought positively."

The Allens said they believe their upbeat attitude helped Alicia.

"We tried to always be happy around her," Lu Ann said. "Every time we come and visit her, we tell jokes and we laugh."

It hasn't all been smooth sailing, though. Alicia was 31/2 weeks old before her parents could hold her. She had to receive nourishment through a feeding tube instead of a bottle. Alicia was so tiny that when blood was drawn for tests, she had to have a transfusion.

As a result, the Allens don't plan to have another child.

"I'm not sure if I'd really like to put another baby through this," Lu Ann explained. "She really went through a lot."

But Alicia never gave up fighting. "Her will to survive is amazing," her father said.

Despite Alicia's struggles, her parents said they don't have any second thoughts.

"It's all been worth it," her mother said. "She's just so happy and she's such a good baby."