Day 06 – Checking in on the triplets

Baby A – Note the Zip-Lock bag.

The first thing I did when I arrived to Annotto Bay Hospital is check on the triplets that were born on the day we arrived last week. They are 6 days old today. Dr. Ravi, a pediatric resident, was taking care of them when I arrived and he gave me the update. They can all best be described as stable, but they are having many of the complications that can be expected when they are in an inadequately equipped NICU. Infections are the most worrisome complication at this stage; all the babies had an infection of some sort. Baby A had an eye infection (ophthalmia neonatorum) even though he had reportedly been given preventive antibiotics. Baby B had an infection of his umbilical stump (omphalitis). And Baby C had signs of infection in his intestines (necrotizing enterocolitis) and possibly even signs of a worse infection (sepsis). They were all on adequate antibiotics and have a high chance of cure, however the conditions that set them up for these infections were still there.

Babies B and C sharing a cot – Note the many towels

The temperature irregularities (which actually now may be a reflection of their infections) are being treated by wrapping the babies with nonsterile towels, cotton, and fabric. Last time we were here, we recommended the babies be kept undressed under the warmers, with some plastic wrap covering the cot (acting like a greenhouse). This advice was only temporarily headed, as today they are still wrapped with all sorts of coverings, no doubt havens for bacteria. The use of a Zip-Lock bag in Baby A is ingenious, but clearly it is difficult for the caretakers to stop using additional fabric. Two babies are sharing a cot making it easier for infection to spread. None of the babies are in an incubator. Remember, these babies are sharing a room with other children as old as 13 years old, all of whom have bacterias and/or viruses that are making them sick enough to need hospitalization.

After infection control, nutrition is another top priority in caring for premature infants. However, intravenous total parenteral nutrition is not available. The babies are still receiving simple dextrose water. They will continue receiving this water until they are strong enough to receive formula into their stomach. However, Baby C (who might have NEC) cannot be fed because it could worsen the infection. He will be on sugar water for another week or so. Malnutrition sets him up to be even more easily infected and the cycle continues.

The odds are definitely stacked up against our kiddos, but the doctors are doing the best with what they have. They are using pretty much the same antibiotics we would use in the United States, and everyone is instructed to wash their hands before touching the babies. The bubble CPAP is still working fine. Dr. Ravi told me that he has stayed several late nights at the babies’ bedside.

Last week when these babies were born, I remember telling Stacy and Diane that these babies had a good chance of survival. Infants born at 28-30 weeks routinely survive with minimal or no complications. I neglected to take into account that the many facilities we take for granted in our modern NICUs are absolutely necessary for that survival. I’m learning new lessons about what we can do to help. Sure they need equipment like the warmers we donated a few weeks ago. Those warmers allowed the babies to survive the first few days. But the next few weeks depend on education as much as anything else. Nurses would benefit from learning about warming techniques. And someone who has influence needs to see the value of a separate newborn care unit. In a country where the birth rate is 50% higher than that in the United States, there will obviously be enough babies to keep that room filled.

Walking outside of the pediatric ward, I saw the Adolescent and Child Mental Health Building. I suppose this was God’s way of letting me know that all is not lost. The goat was the perfect accessory to help put a smile on my face.

Lesson learned
I wish we could get an adequately equipped NICU.