Byler Babies arrive

Karoline Byler, of Wesley Chapel, Florida, can finally take a deep breath. Her babies were delivered Saturday, September 1, between 9:00 and 9:03 pm at Bayfront Medical Center in St. Petersburg, Florida. They were taken through the connecting tunnel to adjacent All Children's Hospital. The 2 hospitals have been planning for months and there's a video linked from the All Children's web site that describes the plans. The hospitals have managed many sets of multiples - including quintuplets, so they are understandably confident of their ability to manage the Byler babies.

From the All Children's Web site:

Names and birth weights for the five boys and one girl are as follows:

Brady Christopher - 2 lbs., 8 oz.
Eli Benjamin - 3 lbs
Ryan Patrick - 3 lbs
Jackson Robert - 2 lbs., 10 oz.
Charlie Craig - 2 lbs., 5 oz.
Mackenzie Margaret - 2 lbs., 9 oz.

They describe the babies condition as stable, except for Ryan Patrick who is "receiving airway support" and in serious condition. To me, that means something short of a ventilator because that would generally be described as critical condition. The babies were born at 29 weeks, 4 days gestation. There are certainly risks for these babies, but at 29+ weeks and having come through delivery with apparently no major complications, statistics are in their favor.

The family, with an eye to supporting these 6 additions to their family, has signed an exclusivity contract with Inside Edition reportedly worth $12,000, so you'll have to watch their broadcast if you want to see pictures of the babies today. As the reporters in the video I linked above said, that will buy a lot of diapers.

Update:

I should have anticipated this. 2 of the Byler babies are now in critical condition and 2 others in serious condition. It's quite common for 29 week preemies to have some respiratory issues and I hope that's all that's going on here.

We call that initial period when the baby does so well the "honeymoon" and it last about 24 hours. The babies start running into problems with inadequate surfactant production after that.

If that's the issue, the 2 who are in critical condition probably had to have a breathing tube placed so they could receive surfactants. They'd be kept on the ventilator for a period afterwards. The time frame would depend on how quickly they recover. The 2 in serious condition may need respiratory support short of a ventilator. They may recover without needing a ventilator, or they may need some surfactant replacement within the next day or so themselves.

Sextuplet update

Actually, no news is good news at this point - and there isn't much. You won't be seeing the irate bloggers talking about litters for at least a few more days. Hopefully closer to 2-3 weeks.

Karoline Byler (more here) was admitted to the hospital over 2 weeks ago and is 28+ weeks now. The docs hope to get a few more weeks with medical management and bed rest, but the survival rate at 28 weeks is pretty good.

The Sodani family has been quiet, too. They should be about 27 weeks by now. The last update on Brian and Gracie's web site says that she's in the hospital - no date, but it's been there for a month or so.

The Masche's are all home and doubtless too busy to do much in the way of updates. I don't even see any new pictures in their photo gallery.

There hasn't been an update on the remaining Morrison baby. He was still in critical condition at the last update, nearly a month ago. He may well be in critical condition for another month. Possibly even longer. He was tiny and it takes a long time for those tiniest babies to outgrow their respiratory and feeding issues.

The families all still have their "how to help" links on their web sites. I hope they're getting what they need. I won't be contributing to any of the sextuplet families. There are plenty of families in need in my own community.

I also found a web site called MOST - Mothers of Super Twins.

This is how they describe themselves:

MOST is a network of families with triplets, quadruplets and more that provides information, resources, empathy and good humor during pregnancy, infancy, toddlerhood and school age

If I had the resources to donate outside my own community, I'd support their adopt-a-family program. With the upsurge in higher order multiples, people with 3-5 babies at a time just don't get the publicity (and the assistance) that they did a few years ago.

Summer of Sextuplets

The Mache sextuplets last update was 10 days ago. At that time, the babies were 2 lbs, 7 oz to 3 lb 7 oz. Babies that size gain 10-30 grams/day (1/3-1 ounce), so it's possible that one or more is over 4 lbs by now.


The Morrison 6 are down to 2, but according to a regular poster at Quintland, those 2 are growing and tolerating their feedings. It sounds like they are probably still "critical" and there is no news yet on the Morrison6 web site.

There are 2 more sets of sextuplets whose families have chosen to publicize their pregnancies:

The Soldani's, in San Jose, CA, are a little over 21 weeks. They're hoping to make it to at least late August, when they'll be closer to 28 weeks. Single babies born at 28 weeks have about a 75% chance of surviving with no major handicaps. If they can hold out to 30 weeks, like the Mache's, that increases to about 85%. The linked article is worth a read - the Soldani's are about halfway down, but it starts with a set of quads and there is some discussion of couples who have made the choice to reduce or to limit the number of embryos implanted.

The Bylers, in Florida, are 22-23 weeks gestation. They are at the cusp of viability and hoping to hold off delivery until September.

I work in a 20+ bed level III community hospital NICU. A parent recently asked me how we'd manage sextuplets. I told him I didn't think we'd ever have to. There are several larger (40+ to 70+ bed) units within an hour of us. It would make much more sense for quintuplets or sextuplets to deliver at one of those hospitals.

There is no reason for a hospital to be surprised by sextuplets (or quints, quads, or triplets for that matter). Women who are expecting higher order multiples know about it ahead of time and most of them are admitted to the hospital days or weeks before the babies are delivered. One reason is that it's very difficult to eat enough to support that many babies and some moms are supplemented with high calorie IV feedings. The other reason is to monitor the babies and the mom. There are significant risks to both with these higher order multiples.

We've managed quads with relative ease, but the babies were 28-32 weeks and the deliveries were elective -- and in daylight. We prefer our triplet deliveries to be elective too, but we've managed them emergently several times - and anywhere from 23 weeks to 35 weeks. We don't get too stressed about triplets any more. We just put on our roller skates and kick it up a notch.

So how does a NICU prepare for higher order multiples? I can't speak for everyone, but I know how we do it. As soon as we know that triplets or quads will be delivering at our hospital, we start making contingency plans. That means casual lists of nurses who are willing to be called in on short notice for that particular delivery. They might not be willing to give up sleep or a scheduled event for just any busy night, but they're willing to make the sacrifice for what, to us, is a relatively unusual occurrence. They're hoping not to get that call. The nursing supervisors on each shift check in with us about those contingency plans and keep lists of personnel in-house they can send us if anything changes before we can get our own personnel in.

We also make sure that we have the appropriate number of baby beds available for the delivery and for the admission to the NICU. They may not actually be IN the NICU until we know that the delivery is imminent, but we'll make sure they're "dressed and ready" (stocked with the basics for an admission).

We hope that the delivery will be elective -- a scheduled C-section with all of the necessary staff pre-scheduled, the beds set up, and all the little details in place. That doesn't always happen, of course, but it's the ideal. The larger units have proportionally larger staffs with more nurses scheduled on any given shift. They'll have their own contingency plans, too. I'm sure they still prefer to have their higher order multiples delivered electively, though.

So how do you stress a NICU nurse?

"Oh. There's another one in here" The mom had no prenatal care and arrived crowning - a true OMG moment. Fortunately baby #1 was doing fine, because there was NO time to get a second team into the DR.


Updated to delete links that are no longer relevant.

Sextuplet Buzz

A lot of hits here are people looking for updates on the Masche and Morrison Sextuplets. The Masche family updated their web site last week. It's on the newsletter link (left side of the page). They have new photos of the babies as well, if you're curious. In the photos, I see that the babies are still in incubators - no surprise, given the sizes listed in the newsletter. They're growing, but still small. They have feeding tubes and monitors, and according to the newsletter, Cole will need some sort of surgery on his colon - no details given. The family requests that the pictures not be forwarded, but they've been very generous in posting pictures on their web site and it must have enormous bandwidth to still be up at this point. They expect to start bringing home the most stable babies in 2-3 weeks, or shortly before what would have been the due date for a singleton pregnancy. The Maches have huge challenges ahead even if the babies have no developmental delays or other issues related to prematurity.

I haven't found any updates on the remaining Morrison Sextuplets, but their photographer friend had posted a short note on July 5th stating that there would be an update soon from the family. Your best bet for news about them will probably be the Morrison6 web site. I'm sure both families will appreciate your ongoing prayers.

Masche sextuplet update

MSNBC has an on-line article and a 7 minute video update about the Masche family on their web site. It gives more information about Jenny's medical problems and some fascinating footage of the babies and the equipment still in use.

Watch the tops go up on the special intensive care beds being used for some of the babies. Unless you're driving a luxury car, you paid less for it than the sticker price on just one of those beds. They're worth it, though. They save lives. You can maintain a precise level of humidity to protect fragile skin in a micropremie. As demonstrated, you can raise the top for instant access if you need to perform a procedure -- and it converts automatically to radiant warmer mode, so the baby won't get cold while you're working. There are many more features that make life easier for baby, parents, and - of course - NICU staff.

According to the article, some of the babies' nutrition is coming from breast milk banks. We've had a few moms of multiples who could pump enough breastmilk for them - and, we joked, the rest of the unit. That's uncommon with higher order multiples, especially when mom is seriously ill in the immediate postpartum period. Formula is also being used - and will doubtless be a necessity in the future as well.

The neonatologist mentions an "unexpected complication" with one of the babies which will require surgery before discharge, but doesn't elaborate. Overall, mom and babies look really good. It's going to be a long road over the coming years, but the family seems to have lots of support from their extended families and their church.

I'm happy for them and I wish them well. I hope that the 2 additional sets of sextuplets expected to deliver later this summer will be so fortunate. These higher order multiples, even with good outcomes for mom and baby, are considered a failure in infertility treatment, though. The goal is always one healthy baby. Selective reduction isn't the answer either. It's a choice no one should have to make. What is needed is more research and optimum management of infertility treatment.

On Despair and Miracles.

My condolences to the Morrisons. Their grief must be immense with the death of the fourth of their children. The hospital still isn't releasing information about the remaining 2, aside from the fact that they are still in critical condition. I would speculate that they will remain in critical condition for 6-8 more weeks at a minimum - if they survive at all. The family has my prayers for this struggle.

We've had 23-24 week infants from singleton or twin pregnancies who were in our NICU for 7-8 months, and rarely longer. Some have been transferred to other hospitals and more commonly to extended care pediatric facilities - not getting home for the first time until as long as 2.5 years after birth. Surfactants and improvements in technology tend to shorten this for many of the survivors, but the reality is that many weeks, often months, and sometimes years of medical attention (inpatient and/or at home) is needed for virtually all babies born so early.

I read an interesting piece on Errant Thoughts from a Disquieted Mind today on the costs of short and long-term care of micropreemies. There are some errors in the first part of the story. She describes the release of even 2 eggs spontaneously as "exceptionally, unbelievably rare" when the actual number is 1 in 80 pregnancies and who really knows how many cycles. Spontaneous triplets are 1 in 8000, which I wouldn't call unbelievably rare either. Relatively minor gripes, those. What you should look at is her estimate of the costs -- in 1994 dollars -- of neonatal care. It is staggering -- and in line with what I know of the costs.

She then goes on to describe what she expects will be the complications. I'd take exception to describing Necrotising Enterocolitis as an expected event, although it's certainly very high risk for such tiny babies. She doesn't say where she gets the numbers for her statistics, but I think they're pretty close. My description of their challenges was described by another blogger as chilling - hers is even more so. Go read it.

In view of all that pessimism, why would anyone even bother to try to save such tiny babies -- or any other desperately ill infant, for that matter? It's because we all know at least one child who has beaten those odds. If you ask anyone who has worked in neonatology for any significant time, they have at least one story. I've already written about one in my post titled Thanksgiving. To me, that child clearly represents a miracle, but I've seen others as well in the 25+ years I've been a NICU nurse. That's what makes it possible for me to do what I do when I don't believe that a baby has a chance. I've been wrong before. I live with the hope that I will be again.

This field requires such a delicate balance. Sometimes neonatologists have to tell families that the hope for survival is very small -- and for intact survival even smaller. Sometimes they must approach families to offer them the option of withdrawing life support when it appears that there is very little hope of recovery. Occasionally it is the parents who approach us when they believe that it is time to let go. Never is it an easy choice, but sometimes it is in the best interests of the baby.

Enlightenment?

A commenter on a previous post asks questions. We've never had quints or sextuplets in our NICU, but I have talked to moms of quads who were offered the choice and opted not to reduce.

I, too, am an NICU RN. I don't understand, but I am open to listening, to those--docs, fertility specialists, OR parents--who think that having 6 babies at one time is a good idea.

The mom of the 30-weekers was in trouble after the birth because she had such a large increase in blood volume to support that pregnancy . . . The kids, even at 30 weeks, are still at risk for developmental delays, learning disabilities, and more.

What would entice someone to take such risks? Please enlighten me.


I don't believe that ANYONE thinks having 6 babies at once is a good idea. People want one baby, maybe two. They find that the less risky forms of intervention either don't work (clomid), are out of their price range (IVF), or violate religious precepts (IVF and/or IUI). They opt for one of the follicle stimulating drugs, perhaps with intrauterine insemination, and find that they are pregnant with way more babies than they'd planned for.

If they choose not to selectively reduce, they may lose all the babies -- or the babies may have multiple challenges as a result of prematurity. If they choose to selectively reduce, they may lose all the babies (miscarriage is one of the risks) or the babies may be born very premature as a complication of the selective reduction. Odds of carrying to term do increase with reduction, but there are no guarantees. Either choice is perilous and heart-wrenching.

There is also the religious objection to selective reduction. If you believe, as I do, that life begins at conception, then choosing to reduce may not be an option. I couldn't do it and neither could the moms of quads with whom I've spoken. Some people do make this choice, in spite of their religious beliefs, because they fear that all the babies will die if they do not.

The reason you hear so much about "miracle pregnancies" and "gifts from God" is that the people who decide to reduce almost always decide to maintain their privacy. I understand that choice - although if they were willing to share their experiences, anonymously or otherwise, it might help people to realize just how big a problem there is with the current state of infertility treatment. Women shouldn't have to make the sorts of choices presented by a higher order pregnancy.

Those who choose not to reduce for religious reasons cannot spend their days worrying. They have to hope that their babies will survive -- and possibly thrive. They must rely on their faith to get them through a very challenging experience.

If anyone would like to share their experiences anonymously, they can email me at tiggersdontjump at gmail dot com. Tell me how much or little you would like shared. I am willing to post a composite or actual experiences.