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.
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 Cerebral palsy.