Double is trouble when caring for premature babies

Essential Baby member Melissa gave birth to baby Jake at 26 weeks.
Essential Baby member Melissa gave birth to baby Jake at 26 weeks. 

Care facilities for the most fragile premature babies are under mounting pressure in NSW, as a baby boom collides with rising numbers of twins - the result of fertility treatment and the increasing age of new mothers.

Doctors said that half of the state's neonatal intensive care units were now regularly closed to new infant patients, as unpublished figures released to the Herald show twins and higher multiple births made up 22.5 per cent of such admissions in 2006 - despite in-vitro fertilisation clinics' insistence they are reining in multiple births. More recent statistics are not available.

Doctors said the state's 10 units for the sickest newborns were now often on "code red" - meaning they cannot accept any more infants.

NSW's birth rate leapt 3 per cent in 2007 alone, to 93,583 births, and may reach 95,000 when last year's figures are finalised. Demand for intensive care has also been rising steadily, by 14 per cent between 2001 and 2006, when there were 2296 admissions.

Nick Evans, head of the Department of Neonatology at Royal Prince Alfred Hospital, said twins conceived in profitable private clinics frequently fell to the public hospital system for care when they were born sick and fragile. "The cost to the public purse is huge and the people who are running [fertility clinics] are very wealthy."

Associate Professor Evans, who runs the hospital's newborn intensive care unit, said twins were born on average at 37 weeks of pregnancy, and those born before 35 weeks could suffer feeding and breathing problems. Along with the overall rise in births, he said, "there's no doubt [twins] create a significant service load for us".

Doctors said the state's 10 units for the sickest newborns were now often on "code red" - meaning they cannot accept any more infants. On one typical day last week, three were code red, while another was amber, meaning it was closed for all but the most serious emergencies.

"Half the state is full almost every day," said the head of another neonatal department. "In the past it was less common. Our safety margin continues to be diminished." But hospitals would always find a place for a premature infant among the 88 beds statewide, he said.

Andrew Berry, who co-ordinates babies' transfer between hospitals, said most very premature babies had a short period of intensive care, then a longer convalescence, and it was sometimes hard to find a "step-down" bed after they could breathe independently. But parents could be "hesitant to leave the comfort zone" of intensive care, putting further pressure on those beds.

Dr Berry said the number of high-levels beds - each costing $1 million annually - was probably adequate, but authorities were reviewing the provision of $400,000 lower-level beds, of which there are about 390 across 45 NSW hospitals.


Michael Chapman, a senior fertility specialist at clinic group IVF Australia, said the proportion of IVF births that were twins or triplets was falling as single embryos were replaced in most cases. But two embryos were still transferred in 10 per cent of procedures. "Most of it comes from patient pressure," Professor Chapman said. "Ultimately the decision is a balance between what the patient wants and what doctors believe is correct."

IVF clinics did not benefit financially from producing twins over single pregnancies, said Professor Chapman. They were paid more if they instead froze a second embryo for a future pregnancy attempt.

When Lea Carswell agreed to have two embryos replaced, twins were the last thing on her mind. Then aged 39, she was motivated only to maximise her chance of pregnancy. "I went in expecting to fail," she said.

Lillian and Erin, now three, were born at 30 weeks, after Mrs Carswell's blood pressure soared as a result of pre-eclampsia. The girls needed hospital care for two months but have avoided long-term consequences.

Mrs Carswell and her husband, Jeff, from Merrylands, now make financial donations in recognition of their daughters' intensive care. "People need to understand how much they have to be grateful for," she said.

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Article image on homepage supplied by Essential Baby member Karen who had her baby Ethan at 33 weeks. To to experienced EB mums of premmies in our forum.