How twins born at 25 weeks survived

Ms Mary Asha, a 30-year-old resident of Nsambya in Kampala was pregnant with four babies, but started experiencing serious complications at 25 weeks (five months) of her pregnancy. 

She said doctors at Women’s Hospital Bukoto in Kampala, where she was getting antenatal care, told her they couldn’t help.
“The doctors told me the babies were fine but that they were [too] small [to be delivered]. The doctor told me that even if they did an operation, the babies wouldn’t survive,” she added.

Normal delivery happens between 36 and 39 weeks (9 months).

Ms Asha said she was referred to Nakasero Hospital in Kampala for emergency care, but decided to go to International Hospital Kampala (IHK).

“When I came [to IHK], they checked the babies and said they were going to operate me,” she said.  The babies were delivered through C-section, but two of them died after two weeks.

According to information from IHK, the babies died because of immature organs that could not support their lives even with technological support. 

Asha had conceived three girls and a boy through an IVF procedure because she had been trying to have children for eight years without success.

The hospital said the babies weighed  between 720 grammes and 760 grammes, which was slightly above the expected weight, according to UK standards.

Dr Victoria Nakibuuka, a consultant neonatologist, said: “It is rare in Uganda to have babies at 25 weeks. There could be less than 20 that have survived in Uganda.”

She said at 25 weeks, the baby normally weighs about 660 grammes, the brain and the nervous system may not be fully developed. 

Dr Nakibuuka said the neonates are prone to infections and breathing difficulties because their lungs are not fully developed to produce surfactant and so is their gut which is not fully developed to enable digestion.

Neonates at 25 weeks often experience anaemia and jaundice caused by immature bone marrow and liver, respectively. 
“The chances of survival for a neonate delivered at that age are very minimal and mostly depend on the environment and hospital where they are delivered. They require functional neonatal facilities and specially trained neonatal nurses and a paediatrician with specialist training in management of babies born prematurely also known as a neonatologist,” Dr Nakibuuka said. 

“Fortunately, these children were delivered at International Hospital Kampala, a hospital with these facilities and staff are available to support these delicate lives,” she added.

A study done in the country in 2019 on the burden of pre-term birth by Ivan Walufu Egesa and published in the Journal of Paediatric Health, Medicine and Therapeutics, states that the death rate among children born prematurely is very high at 31.6 per cent in hospitals in the country.

The report, which focused on Fort Portal Regional Referral Hospital, however, states that more than 90 per cent pre-term births in the country occur at 28 weeks and above, unlike Asha’s case.

“Preterm babies account for 0.7 per cent of all hospital admissions in Uganda, and yet are responsible for 11.1 per cent of under-five deaths, and five per cent of deaths among children of all ages,” the report reads. 

The World Health Organisation defines preterm birth as any birth occurring before 37 weeks of pregnancy.
“Despite these positive trends [preventable deaths in the country], progress has been slow with neonatal mortality stagnated (at about 27 per 1,000 live births) and is responsible for 42 per cent of all under-five deaths,” information from Unicef reads.

The global Sustainable Development Goals target that Uganda is pursuing, stipulates that by 2030, neonatal death rate should be reduced to 12 deaths per 1,000.

Asha’s remaining two girls battled through growing from 25 weeks to 34 weeks, gaining up to 1.1kg more than their birth weight, according to information from the IHK.

The hospital said at the time of discharge last week, the babies weighed 1.8Kgs and had a normal head circumference, among other key growth indicators.

“It is a privilege to work with IHK to ensure these babies survive. The nurses were very important in this, especially how they cared for these babies. We are happy to discharge the babies with normal weight after being born at 25 weeks. I thank the mother for listening to us,” the hospital said.

A recent study by Makerere University School of Public Health recommended mentorship of health workers on key existing evidence-based practices to improve newborn outcomes and urged government to provide equipment to handle pre-term babies.