Coming into the world at one pound, one and a half ounces, baby Carl Burton is proving to be a formidable fighter. Kicking and cooing, bright eyed with a tuft of bushy hair baby Carl celebrated his first birthday last Wednesday. Really he should be only seven months, but his mother Nicole Todd said he's alert and almost on track as a one-year-old.

Carl was born five months premature at King Edward VII Memorial Hospital and although her doctor told him his chances of surviving were slim, mother Nicole said she always knew he would make it.

“I can remember my doctor telling me he might not make it, that it's a 50-50 chance. That he's just so tiny. That they are not used to dealing with babies like this and that if he doesn't make the air ambulance then that's it,” she said.

“But I just knew he was going to make it. Nothing in my mind believed otherwise.”

Ms Todd said the pregnancy had been difficult from the outset. She had been so ill that she could not hold a job. While there was nothing medically wrong with her, she suffered terrible dehydration. Vomiting everything she ate, even water, she said she went through an incredible amount of trash bags. And, she dropped 20 pounds.

“I was in and out of the hospital constantly to get hydrated. I was a pregnant woman losing weight. I couldn't keep anything down. Nothing worked to make me feel better ... not even Gravol tablets. Nothing,” she said.

Then five months into the pregnancy she was coughing in the bathroom when blood came out of her mouth.

“I could feel the pressure of him dropping and dropping. I walked into the hospital and felt fine but when I got there he just came. They didn't even have time to give me the steroid injection to help,” she said.

Carl was born at 7.09 p.m. and airlifted to IWK Hospital in Halifax, Canada around 8 a.m. the next day. His father accompanied him as his mother had delivered by caesarian and needed to remain hospitalised to heal.

“He squeezed my finger before he left,” she said. This small act filled her with the faith that her son, who comfortably fit in his father's palm, would make it.

Strong enough to make the journey to be with Carl she set out wheelchair bound for Halifax. The trip was an ordeal.

“My plane got delayed. It was awful. I thought after having him everything would go back to normal but it was awful. Just getting out there to him was a challenge. I went to Toronto airport and as far as they were concerned you were on your own. I said I don't know anyone out here. I had to sleep for one night in the airport.”

In the end she flew from Toronto to St. John, St. John to Moncton and then took a cab for two hours to the hospital in Halifax.

“It took me two days longer than expected to get there and it was tough in a wheelchair,” she said. “But wherever I went I bumped into good people who, helped me through whatever difficulty I was facing.”

At the hospital in Halifax Ms Todd was told that Carl could die at any time.

“Every day it was touch and go. He didn't stabilise where we felt he was out of the woods until four to five months later,” she said.

“It was a lot of major issues that he had to overcome just to get to a regular level so that he could start growing. For the first two months he was under a pound. He struggled. He was one pound one and a half when he was born and his weight went down. He would put weight on and then we would discover that it was just liquid - it wasn't the weight we needed him to have so they would take that weight off. It was a bumpy ride with all the medications and procedures,” she said.

Medications and procedures that totalled in the hundreds of thousands. “There is just no way we could have managed without health insurance. The cost of the air ambulance alone was about $80,000,” she said.

Baby Carl spent eight months in IWK Hospital where he saw several specialists and had dozens of operations. He had four main nurses, three cuddlers who worked with him three times a week, a phsical therapist who met him twice a week and a social worker.

“He had everything you can think of,' his mother said. “He had complications with his eyes. They were going to do the laser surgery on him when it just corrected itself. They (the doctors) were amazed. He had lung problems. He still has a hole in his heart. He's had two hernias but no diseases. He had viruses but that is normal for premature babies.”

And it wasn't only operations baby Carl faced.

“Every day he was attached to a lot of wires. He had a ventilator and tubes in his head, tubes for feeding and in his nose for breathing support.” In fact Carl was not able to breast feed because it got in the way of his breathing apparatus.

Moved to Bermuda in February baby Carl is getting stronger. He was suffering from acid reflux, which caused his trachea to be inflamed. To help the trachea to heal and to prevent possible damage to his voice box, doctors inserted a feeding tube directly into his bowel. When this was mistakenly pulled out, another tube feeding directly into his stomach was inserted.

Doctors recently gave the all clear on his trachea and he is starting to take food orally - although the feeding tube remains attached as a precaution. His mother is his primary care giver dispensing all his medication and attending to his needs.

“You have to pay attention constantly and there is so much to remember,' she said. “You have to be so careful that's why I write everything down.” Carl only recently ended a regimen of twice daily medication. When that was on his mother explained the sort of detail that was important. “I had to remember several things; to flush the line, to give water during the day three times, to make sure no milk was left in there (the feeding tube) - it's been hard.”

An attentive mother she said she knows his needs by his cry. There's a cry when he has gas, when he wants to pooh and now for teething,” she said. She's also very organised and has kept a detailed scrapbook and log of his development. She has labelled all his supplies in case someone else needs to step in and care for him.

“Right now he's fine everything is pretty much stabilised where we are working on getting his immune system strengthened,' she said. “He's almost there. The lung tissue takes eight years to finish healing, but all his major organs are fine. Ears are fine, eyesight is fine.”

She is meticulous not only about his physical environment but also his mental one. She said she asked that a nurse in Canada be changed from his roster because her tone was too harsh for him.

“I want him to be a calm free spirited baby,” she said. “You can see he is very happy. He has been through so much and I don't want him to have to go through any suffering. He gets love everyday. First thing he sees every morning is a smile. I smile and am upbeat whenever I speak to him.”