Baby B and Baby C, the last of two Anne Arundel County triplets whose birth was interrupted 2 1/2 weeks ago to give them a better start in life, have finally joined Baby A in the secluded, special care nursery on Union Memorial Hospital's fourth floor.
And, Dr. Norman H. Daikoku, the obstetrician who chose to go against conventional wisdom that dictates delivery of multiple births within minutes of each other, says his strategy worked.
Experts agree that it's rare -- but not without precedent -- to be able to hold back labor in such cases and to deliver one baby without delivering the others.
Baby B and Baby C, who arrived Aug. 9 -- 11 days after Baby A -- are more robust and have been spared many of the problems of Baby A, who had the rockiest start and is still struggling the hardest to hold on, hospital specialists said yesterday.
"My opinion is: If I can save one of three, that's good; if I can save two of three, that's better; but, doggone it, we've saved three of three and that's fantastic," said Daikoku.
He cautioned, however, that while all three of the babies are stable, they are not out of the woods yet.
None of the tiny girls weighed more than 2 1/2 pounds. They are the "instant family" of a formerly childless couple who live in Gambrills and do not want to disclose their identity now. The mother was on fertility drugs and enrolled in GIFT, a program similar to in vitro fertilization.
Baby A -- the smallest of all and weighing 2 pounds and one-half ounce -- was born 26 weeks after her mother conceived. A full-term pregnancy runs 40 weeks. Baby B and Baby C were delivered surgically by Caesarean section at almost 28 weeks.
"And, that's a very big difference," said Dr. Jay Gopal, the neonatologist who is caring for the babies. "I wish everyone would learn from this experience. The lesson is this: If one of the babies comes early, leave the rest inside the uterus so they can grow a bit more."
To illustrate how more time in the womb helps, Gopal compared Baby A with Baby B and Baby C.
Baby A had "very immature lungs," he said, and immediately required 100 percent oxygen, a ventilator and three doses of artificial surfactant -- a mixture sprayed onto the airways to strengthen underdeveloped lungs. Baby A also had a low platelet count which required a transfusion of platelets, which are clotting agents in blood. She also needed four blood transfusions.
Baby B and Baby C, sheltered longer in the mother's womb, were bigger and stronger for their birth.
Baby B is the sturdiest, Gopal said. She weighed 2 pounds, 6 1/2 ounces and she did not require a ventilator or oxygen to assist her breathing or surfactant to inflate her lungs.
Baby C had fewer problems than Baby A and appears to be pulling out of them more quickly, Gopal said. She weighed 2 pounds, 8 1/2 ounces. But, she did get one dose of surfactant, one blood transfusion and was on a ventilator briefly.
The triplets are being fed breast milk through a tube and are also getting nutritional feedings through the veins.
The babies were delivered by C-section, Daikoku said, after the appearance of a maternal stomach infection, known as chorioamnionitis, that could have spread to the two fetuses. The mother had undergone daily temperature, blood and other tests for infections.
"There is no way we could have missed that infection," he said.
About five years ago, Daikoku had a similar case -- the woman went onto labor, miscarried and lost all three of her babies.
"This time I chose not to say, 'One is coming, so they must all be delivered now,' " he said. "I chose to deliver one and see if the others [who were located higher up in the womb] would stay there and be OK."
Daikoku used anti-contraction drugs to halt the labor after Baby A, who could not be deterred, was born.
Gopal said he expects the triplets will be hospitalized another two months. Their father has the kind of work schedule that has permitted him to visit the triplets twice a day. The mother was discharged from the hospital yesterday.