More than a Village: Meeting the Health Care Needs of Multiples

The successful delivery of America’s second set of octuplets on January 26, 2009, brings an entirely new meaning to the phrase, “It takes a village to raise a child.” Since the birth of Nadya Suleman’s infants, news stories have continuously questioned her ability to care for eight newborns, in addition to her six other children under seven years of age: how will Mom cope with the basic needs of each infant, like diapering, feeding, clothing, and nurturing, plus those of toddlers and school-aged children? On the other hand, the discussion of potential health risks to the infants following a multiple-gestation pregnancy and premature birth—and the need for extra vigilance due to these risks—has been less prominent. The newborn intensive care team in charge of tending this rare birth had the technology and expertise to care for the infants’ immediate health care concerns. However, some of the octuplets’ actual and potential health obstacles beyond the NICU will require myriad resources to be made available to their mother.

When word of the Suleman octuplets reached the newborn intensive care unit at Kaiser Permanente Hospital in Bellflower, California, the physicians, nurses, and other staff recognized that the stabilization and subsequent monitoring of the octuplets would be highly specialized. The standard of care in the NICU is that at least two individuals—either nurses, respiratory therapists, midlevel providers, or physicians—be assigned to each high-risk newborn. Because the octuplet case was both a preterm and multiple gestation delivery, additional skilled personnel would be on hand and available as well, as the chance of medical trouble to the newborn infants was significantly increased by the particulars of their birth. The team—forty-six professionals in all—likely comprised some combination of attending physicians, neonatology fellows, medical residents, nurse practitioners or physician assistants, respiratory therapists, and nurses. This team had completed practice runs before the big event to ensure the infants’ smooth stabilization following birth.

The buzz of forty-six staff members in and out of one delivery room may sound dizzying until one considers what it takes to keep eight preterm infants alive. Some team members were primarily responsible just for the babies’ admission beds, all of which were outfitted with resuscitation equipment, monitors, and assistive respiratory devices. Other members were on hand should the infants require more aggressive resuscitation following delivery. Once the babies were stabilized, additional health team members stepped in to draw blood for appropriate lab work, to obtain intravenous access, and to begin fluid administration. Everything normally done prior to and following a preterm delivery had to be multiplied by eight and happen simultaneously.

Still other staff were assigned to handle the specific risks brought on by each baby’s small size and early birth. With birth weights ranging from one pound, eight ounces, to three pounds, four ounces, each infant had many more health challenges than a larger baby. The babies would have had more difficulty stabilizing and maintaining their temperature because they had less fat than larger babies, as well as thinner skin. And at thirty-one weeks gestation, the babies had un-derdeveloped lungs, making breathing difficult for them. Initially, two of the infants needed breathing tubes and ventilators to assist in the maintenance of appropriate oxygen exchange, and a third infant required supplemental oxygen. The circulatory systems of the infants born at this gestational age are also more tenuous, with small blood volumes making blood pressure stabilization more challenging, and more fragile blood vessels enhancing the likelihood of bleeding in the brain and subsequent neurological effects. Finally, prematurity made these infants more susceptible to infection than newborns with a full gestation period.

Some of these initial health care risks are most pronounced in the immediate postnatal period and can abate as the infant grows. For instance, as premature infants evolve, their under-developed lungs mature and expand, lowering their risk of respiratory distress. However, preterm infants can also face long-term health risks that continue into childhood. Preterm infant growth may be slow, as these babies may tire more easily during feedings. They...