Though each is small enough to fit in an adult’s hand, the septuplets born in Iowa on Wednesday are big by the standards of a modern newborn intensive care unit and are likely to fare well.
Doctors who specialize in the care of the smallest of the small say that while nothing is guaranteed, the outlook is undoubtedly good for the three girls and four boys born to Bobbi McCaughey.
“It’s an astoundingly happy beginning,” said Dr. Steven Ringer, director of newborn medicine at Brigham and Women’s Hospital in Boston.
Babies born after 27 to 28 weeks in the womb have a better than 90 percent chance of survival. These infants were in their 31st week of gestation.
“They’ve made it through a difficult hurdle by being born alive and surviving for the first few hours,” said Dr. Marilee Allen of Johns Hopkins University.
She said their size - the babies ranged from 2 pounds, 5 ounces to 3 pounds, 4 ounces - “suggests good growth and development” while in the womb.
While prematurity is the single greatest cause of problems and death after delivery, doctors have become adept at saving children much smaller than the septuplets. Even those at just 23 or 24 weeks of gestation weighing about a pound often survive.
For newborns this size, breathing often is a problem. Because the babies left the womb early, their lungs are not fully developed, and their air sacs are not able to open fully and fill with air.
Because of this problem, the septuplets were put on mechanical breathing machines. Doctors typically give such babies surfactant, a substance that keeps the immature lungs from collapsing.
Another difficulty for such small babies is eating.
“They can’t suck, swallow and breathe at the same time. They don’t have the coordination to do all those things concurrently,” said Dr. F. Sessions Cole of Washington University in St. Louis.
Usually, doctors first feed such babies intravenously for a few weeks. Then they are given a special formula that is delivered directly to their stomachs by a soft tube that is put down their noses or throats.
Because their immune defenses are weak, such babies are often given antibiotics to ward off infections, especially E. coli and group B streptococcus. Both of these kinds of bacteria can cause brain damage in babies so young and lead to blindness and deafness.
Another worry is bleeding in the brain, which can trigger cerebral palsy and hearing loss. Doctors check for this with ultrasound scans.
“The more mature the brain is, the less the chance of bleeding. At their size, this is very uncommon,” said Dr. Ron Goldberg of Duke University.
Doctors will also watch for another complication called retinopathy of prematurity, a kind of eye damage that often afflicts babies born too soon.
A common heart condition also complicates life for infants born early. While still in the womb, babies don’t breathe, so blood is shunted around the lungs by a detour called the ductus arteriosus.
If this doesn’t close after birth, it puts increased stress on babies’ hearts. Medicines can help resolve the problem, but if that fails, surgery may be necessary.