Sextuplets need more specialised staff and equipment

In short order they will need six names, six newborn wardrobes, six savings accounts. But the sextuplets being carried by an 28-yearold woman who is now warded at the Mt Hope Maternity Hospital have even more immediate needs: Six incubators, six ventilators and six separate teams of specialised neonatal staff. All this is in addition to the separate medical team that will work to ensure their mother makes it safely through the high-risk delivery.

The sextuplets will be a first for both the country and the Caribbean but T&T’s healthcare system has been tasked with multiple births before. In 2006 Lystra Aberdeen gave birth to quadruplet girls at the Port-of-Spain General Hospital. A teacher from La Brea did the same 30 years earlier in San Fernando. Now it’s Mt Hope’s turn to manage a historic multiple delivery. The North Central Regional Health Authority held a press conference to announce the imminent birth last month. The media were allowed to speak very briefly with the mother, who lives in central Trinidad but her name was not revealed. A delivery plan was developed last month, but with the scheduled caesarean less than two weeks away and labour possible at any moment, the NCRHA is still working with distributors to speed up the delivery of some neonatal intensive care unit (ICU) equipment. NCRHA chairman Dr Shehenaz Mohammed, said even before the sextuplet case the hospital had been tendering for neonatal equipment. In an interview, she said most of the equipment would be delivered “in the next couple weeks” and that delays surrounding the delivery of the ventilators in particular were being specifically addressed with distributors. At the time of writing that process was still going on.

“Equipment really and truly does not provide medical care. It is important but it is not the essential ingredient. Once we can get the babies to go to 32 weeks, the need for ventilation support is much less. The thing is to prevent her from going into labour,” Mohammed said. Dr Juliet Skinner, consultant gynaecologist at the Barbados Fertility Clinic (which was not associated with this pregnancy), pointed out that all multiple births “come with substantially higher risk to mother and babies” and require a careful delivery plan to be developed months in advance and put into action at a moment’s notice. Although the aim is to deliver at 32 weeks, she noted that it is highly likely that the babies could be born before. “You don’t want them born before 30 weeks, but the probability that it can happen at any point after 24 weeks is very high,” Skinner said. The sextuplet pregnancy is almost at 30 weeks gestation. She stressed that the ICU must be capable of accommodating, monitoring and treating babies who were likely to be “no more than a couple of pounds” at birth.

There must be six teams of paediatricians, nurses and aides on standby to stabilise and, if necessary, resuscitate each infant. Skinner said while it was possible to stabilise and move the infants to another facility, that was not ideal. The NCRHA chairman said the entire senior team at Mt Hope was on call for the delivery, including an obstetrician, two consultant anaesthetists, neonatal doctors and ante- and post-natal nurses. The San Fernando and Portof- Spain General Hospitals have agreed to accept other high-risk pregnancies in the meantime. Mohammed couldn’t say exactly what the capacity of the Mt Hope neonatal ICU was, but stressed that the nursing and neonatal teams have made arrangements to expand the area to host babies that required ventilatory support. If necessary, an ambulance can transfer stable babies to other neonatal wards “to free up incubators if she goes into labour before elective day.” She added: “We have more than six ventilators but we need six to be available at the material time. This can happen at any time so we need to keep our ventilators available. Other mothers delivering around the same time are just as important. “The three institutions are working together to deliver the level of care that is necessary