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Wednesday, July 16, 2025

Doctors forewarned about sextuplets' care

Af­ter­care for ba­bies a crit­i­cal con­cern

by

20130506

The coun­try's first sex­tu­plets should have been de­liv­ered over­seas to en­sure they got the care they need­ed.That was the rec­om­men­da­tion of lo­cal and over­seas spe­cial­ists.And as ba­by Per­sia Meleigh Lee Foon-Cum­mings, the fifth-born of the sex­tu­plets, bat­tles with pneu­mo­nia, se­ri­ous ques­tions are be­ing asked as to why the warn­ings of con­sul­tant/head of the Neona­tal In­ten­sive Care Unit (NICU), Dr Ca­ma­nee Lutch­man, were ig­nored.

Two of the ba­by's broth­ers, Kaelon Nasir and Pae­ton Christo­pher, both died from up­per gas­tro-in­testi­nal bleed­ing weeks af­ter par­ents Pe­tra Lee Foon and Kieron Cum­mings wel­comed the bun­dles of joy in­to the world. The oth­er three ba­bies are said to be in sat­is­fac­to­ry con­di­tion.In Jan­u­ary, Lutch­man warned hos­pi­tal au­thor­i­ties that the lives of the sex­tu­plets would be at risk if they were de­liv­ered at the Mt Hope Women's Hos­pi­tal (MH­WH).

Af­ter their birth on March 4, chair­man of the North Cen­tral Re­gion­al Health Au­thor­i­ty (NCRHA), She­henaz Mo­hammed, and the med­ical team, led by Prof Bharath Bas­saw, con­sul­tant ob­ste­tri­cian and gy­nae­col­o­gist, were elat­ed.But the ba­bies' ill­ness­es and sub­se­quent com­pli­ca­tions should have been fore­seen, in Lutch­man's view.

On Jan­u­ary 9, Lutch­man wrote to the hos­pi­tal's med­ical chief of staff, Dr Esau Joseph, ex­press­ing con­cern about the lack of equip­ment, space, trained nurs­es and se­nior med­ical staff to cope with such a high-risk de­liv­ery. She re­peat­ed her ear­li­er rec­om­men­da­tion that the moth­er should be flown abroad for man­age­ment of the preg­nan­cy and births.

The T&T Guardian un­der­stands that the ex­pec­tant par­ents were ad­vised by med­ical sources at the MH­WH about the risk in­volved.The warn­ing fol­lowed an ear­li­er let­ter that Lutch­man had sent to deputy med­ical chief of staff Dr Andy Bhag­wan­dass on De­cem­ber 28, in which she ex­pressed con­cern that she had been left out of the prepa­ra­tions un­til then, on­ly two months be­fore the birth.

"I was not in­volved in the plan­ning of this high-risk de­liv­ery since ad­mis­sion of the pa­tient to our ante-na­tal ward," she wrote."I am still await­ing a for­mal re­fer­ral from the pri­ma­ry care­givers, the ob­stet­ric unit, so that I may pro­ceed with coun­selling the ex­pec­tant moth­er about the risk in­volved."My first rec­om­men­da­tion is to trans­fer this pa­tient to an in­ter­na­tion­al high-risk ma­ter­nal and foetal fa­cil­i­ty."

Con­tact­ed yes­ter­day, Lutch­man con­firmed she rec­om­mend­ed in­ter­na­tion­al care was best suit­ed for the pa­tient."I ad­vised the pa­tient of my rec­om­men­da­tion. I had a meet­ing with all stake­hold­ers and ad­vised what need­ed to be put in place. I ad­vised the pa­tient of my rec­om­men­da­tion."When she de­cid­ed to con­tin­ue, I made rec­om­men­da­tion for every­thing to be put in place. Even though there is a chron­ic short­age, per­son­nel was arranged and we had the sup­port.

"De­liv­ery was on­ly the be­gin­ning of the process. We now need to deal with the com­pli­ca­tions. The com­pli­ca­tions are ex­pect­ed, even though the de­liv­ery went well but the work just start­ed," Lutch­man said.Com­ment­ing yes­ter­day, Mo­hammed con­firmed that Lutch­man had ex­pressed con­cern over the de­liv­ery of the sex­tu­plets."We were ad­vised that we did not have every­thing to deal with the de­liv­ery and we did every­thing pos­si­ble to fa­cil­i­tate the births," Mo­hammed told the T&T Guardian.

"We met with all the team play­ers and we were able to come to­geth­er to get every­thing in place for this de­liv­ery."I am in­formed that the com­pli­ca­tions are com­mon with the birth of pre­ma­tu­ri­ty. The av­er­age sur­vival rate of sex­tu­plets is four out of six. Sex­tu­plets is some­things that ob­stet­rics frown up­on be­cause it is a risk. These ba­bies that sur­vived are at risk."It is not a pret­ty sit­u­a­tion by any means. It is a very com­plex sit­u­a­tion."

Mo­hammed said ba­by Per­sia Meleigh was re­moved from the ven­ti­la­tor yes­ter­day.In re­sponse to a text mes­sage yes­ter­day ask­ing why arrange­ments were not made for Lee Foon to re­ceive in­ter­na­tion­al care as rec­om­mend­ed, Health Min­is­ter Fuad Khan said: "We were equipped and the NCRHA put every­thing in place to pro­duce ex­cel­lence in NICU."

In her ad­vice to col­leagues, Lutch­man warned: "The birth de­part­ment/op­er­at­ing the­atre at MH­WH lacks the ap­pro­pri­ate in­fra­struc­ture to fa­cil­i­tate favourable out­comes of this ex­treme­ly high-risk preg­nan­cy.

"The NICU at MH­WH al­so lacks the ba­sic space and in­fra­struc­ture re­quire­ments and ba­sic equip­ment to ac­com­mo­date and man­age six ex­treme­ly low birth weight (ELBW) pre­ma­ture in­fants de­liv­ered with­in a very short time. In­ter­na­tion­al best prac­tice re­quires that this preg­nan­cy be man­aged by a high-risk joint care team, com­pris­ing an ob­ste­tri­cian and peri/neona­tol­o­gist."

Lutch­man al­so said no neona­tol­o­gist was em­ployed at the NCRHA, adding: "There is al­so a chron­ic and dire short­age of reg­is­tered nurs­es as­signed to the NICU and on­ly a small per­cent­age of these are NICU-trained."These high-risk in­fants, while in the NICU, will re­quire one-to-one nurs­ing which we are un­able to pro­vide with our present co­hort of pa­tients.

"Giv­en the above lim­i­ta­tions, I con­tin­ue to strong­ly rec­om­mend in­ter­na­tion­al in­tra-uter­ine trans­fer of Ms Lee Foon in an at­tempt to ob­tain the best ma­ter­nal and in­fant out­come of this preg­nan­cy. De­spite my reser­va­tions, how­ev­er, we con­tin­ue to pre­pare the NICU for de­liv­ery."A re­port on the equip­ment and staff re­quired in the birth de­part­ment/op­er­at­ing the­atre was at­tached to the let­ter.

Lutch­man's con­cerns were al­so echoed by Dr Mar­lon Tim­o­thy, a clin­i­cal fel­low of the peri­na­tal and neona­tal med­i­cine de­part­ment at the Uni­ver­si­ty of Toron­to.In an e-mail to Bhag­wan­dass, dat­ed De­cem­ber 10, Tim­o­thy wrote: "If here in Toron­to we are stretched thin for a quadru­plet de­liv­ery at the num­ber one re­fer­ral cen­tre for neonates in Toron­to, I shud­der to think what will hap­pen with a sex­tu­plet de­liv­ery that is not prop­er­ly planned or pre­pared for.

"Ear­li­er this year the NICU at the MH­WH had one work­ing laryn­go­scope. Six ba­bies re­quire in­tu­ba­tion, sur­fac­tant ther­a­py, ven­ti­la­tion, cen­tral lines, in­cu­ba­tors and can­not be left to chance or poor­ly planned." He said since he be­came aware of the case when Lee Foon was 11 weeks preg­nant, he had been try­ing to get the moth­er flown abroad for ei­ther foetal re­duc­tion or high-risk care but the cost ap­peared to be a prob­lem and he had no re­sponse from the lo­cal au­thor­i­ties.

"This case has the po­ten­tial to high­light the skill, prepa­ra­tion and man­age­ment of the NICU but al­so can be a dis­as­ter with all six ba­bies dy­ing."Noth­ing leads to greater dis­as­ter than ego­tis­ti­cal be­hav­iour and lack of com­mu­ni­ca­tion," Tim­o­thy warned.

Med­ical risks

Lutch­man warned that pre­ma­ture birth was very like­ly with mul­ti­ple preg­nan­cies, es­pe­cial­ly in the case of the sex­tu­plets, which in­creased their risk of ill­ness or death.Lutch­man al­so sent a two-page list of ma­jor com­pli­ca­tions that might arise be­fore, dur­ing and af­ter the birth of the sex­tu­plets.Among them were:

�2 In­trauter­ine growth re­stric­tion.

�2 In­trauter­ine or neona­tal demise (death).

�2 Ner­vous sys­tem prob­lems, such as brain in­jury caused by lack of oxy­gen; seizures and brain haem­or­rhages; menin­gi­tis.

�2 Heart prob­lems, such as car­diac fail­ure.

Lung is­sues such as res­pi­ra­to­ry dis­tress re­quir­ing a ven­ti­la­tor, which might in turn lead to pneu­mo­nia; chron­ic lung dis­ease

Pos­si­ble long-term com­pli­ca­tions in sur­viv­ing ba­bies in­clude:

�2 Men­tal re­tar­da­tion.

�2 Hear­ing or vi­su­al im­pair­ment.

�2 Learn­ing dis­abil­i­ties.

�2 Gross de­vel­op­men­tal de­lay.

�2 Seizures.

�2 Cere­bral pal­sy.


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