Monday, June 11, 2007

Sextuplets -- times two.

More than one baby per pregnancy means increasing the risks -- increased risk of prematurity (we have several sets of twins in our NICU currently), increased risk of complications for mom and babies.

Within the last 24 hours, 2 sets of sextuplets were born. One set has a pretty good chance of having a normal life, the other not so much. Neither set is in the NICU where I work. I've seen many babies at both gestational ages, though.

The Masche sextuplets

Jenny Masche gave birth at 30 weeks, 4 days. There are risks involved in having 6 babies, but the survival statistics for preemies born at 30+ weeks are pretty good. 5 of the six need help from ventilators to breathe. The 6th may yet. Sometimes the little ones tire out and need some help. It's also possible that they will all be breathing on their own within a few days.

If they need a lot of help breathing, they'll get surfactant to help keep their lungs expanded. They may get some high calorie IV feedings before they're ready for oral feedings. Those first feedings will be by a tube placed through the mouth or nose via the esophagus to the stomach.

They will be watched very closely for all the possible problems that go with a pre-term delivery.

Apnea of prematurity
will probably show up by 2 or 3 days of life (or whenever they are off the ventilator). At just over 30 weeks, the probability is very high that the respiratory center in their brains will be immature and they will take breaks from breathing periodically. Their nurses will watch closely to see if they start breathing again spontaneously. If the heartrate drops precipitously, or their oxygen levels fall significantly -- or if they just wait too long to take that breath, someone will gently stimulate them to get them breathing again. If that doesn't work, the nurse will use a bag-valve-mask resuscitation device (self-inflating, or anesthesia-type bag) to breathe for the baby until he or she recovers.

They may stay on the ventilators for a short time or a longer time. Once they're maturing and breathing more on their own, they'll be placed on a CPAP or SiPAP device to help keep their lungs expanded and decrease the work of breathing. This helps decrease the apnea. They may also be given medication to stimulate the respiratory center.

With all that respiratory support, it will be important to keep a close eye on the oxygen saturation levels -- the percent of the hemoglobin that is actually carrying oxygen. Too low and the baby won't do well, but too high and the risk of Retinopathy of Prematurity (ROP) increases born at less than 32 weeks is a risk factor, but oxygen use increases the risk. About half of babies weighing less than 1700 grams will have some degree of ROP.

The babies will have frequent eye exams to watch for early signs of ROP because it can be treated. Laser surgery and cryosurgery are both effective if used before the ROP is too advanced.

There are other possible risks for the Masche babies, but nothing like the risks faced by the other set of sextuplets.

The Morrison sextuplets

Brianna Morrison's babies were born about 8 weeks earlier than the Masche babies. Just over 22 weeks gestation. As far as I know, only one baby has survived at that gestational age. She was a single baby and should have been larger and better nourished than the Morrison babies as a result.

These babies weigh between 11 ounces and 1 lb 3 ounces. They're about 1/3 of the weight of the Masche babies. Their skin is gelatinous with no subcutaneous fat. It is incredibly fragile and great care will have to be taken to simply avoid tearing it. They will lose so much fluid through their skin by evaporation that it will be a huge challenge to keep them hydrated and keep their electrolytes in balance.

The blood vessels in their brains are even more fragile than the 30+ week Masche babies. There is a significant risk of bleeding into the brain.

Their digestive systems are immature and they may not tolerate oral feedings for many weeks. This means they will have to receive IV feedings for longer - and this can be very hard on those tiny livers.

Their risk of ROP is even higher than for more mature babies. The probability of long-term lung problems is very high.

The challenges faced by these babies are huge and I wish them well, but I do not have much hope for their survival.


Anonymous said...

Thank you very much for your comparison of the sextuplet sets. it's caused me to learn a lot about multiple births and the media. In the news the "healthy sextuplets" get all the press, and I've found a lot of websites explaining that God will never abandon the faithful, so carrying six babies at once is a good thing, and should be considered a blessing. But reading about the other case, where the risks to the preemies are so high and if the babies survive quality of life might be pretty low paints a very different picture. Glorifying the premature birth of multiples as a wonderful success seems like a bad thing. I wonder if will encourage expecting parents to take riskier routes when it comes to the health of developing multiple babies, or encourage people to use fertility treatments that can cause multiple births?

Judy said...

It truly amazes me what can sometimes be done with these much higher order multiples (5, 6, sometimes 7). Getting enough calories into the mom is a part of the picture, but it isn't possible to know up front which women can carry to the point of viability and which cannot.

Like both of these moms, I would never be able to have a selective reduction done - not even knowing what I do about the risks of pre-term delivery.

Fertility specialists are trying very hard to avoid this scenario because the risks to mom and baby are very great. In spite of that, there have been 14 sets of sextuplets and there are more on the way.

Anonymous said...

Thank you for writing your realistic picture of the risk that these babies face. I work in one of these two NICU's and while I hope for the best for the babies, I wish that people were better educated about what these kids are in for when they are born premature. These babies have been a news story recently, but I wonder if they will be as cute when they either don't survive, or have long term serious disabilities.

Anonymous said...

Thank you for your comparison. My twins were 29-weekers, and while they are doing well now, they had to get through some rough times in the NICU. I can only imagine how difficult the road must be for both families, especially the Morrisons, with six babies to worry about.

As an infertile, I went through 3 years of treatment before I conceived and carried (almost) to term. Because of my endometriosis, IVF was the best option for us, and we used most of our savings to pay for it.

I think insurance companies should be responsible for covering IVF (even if it's limited to 3 tries). If more couples had access to coverage for IVF, they may be more likely to try IVF and avoid fertility treatments that result in higher order multiples and heart-wrenching decisions around selective reduction.

I only wish the best for these families and their babies, and I think the media should report on the need for insurance companies to be required to cover infertility treatments.