Code 5 Quintuplets

The message that popped up on dozens of pagers at 8:52 a.m. on Thursday, Aug 9, was direct and to the point: CODE 5 Quintuplets

With those few words, months of meetings, drills, and planning went into effect as UT Southwestern prepared for the arrival of the first set of quintuplets born in North Texas in nearly 15 years — Will, David, Marcie, Seth, and Grace Jones.

It takes a village

Quintuplet Collage
Above: Parents Carrie and Gavin Jones meet the press days after the birth and talk with UTSW maternal-fetal medicine specialists (l-r) Robyn Horsager-Boehrer, M.D., Patricia Santiago-Muñoz, M.D. (who delivered the babies), and Julie Lo, M.D.

Orchestrating the birth of five babies, all born at the same time but with different degrees of medical needs, requires triple-checking everything and planning for anything , says Gary Burgess, M.D., Medical Director of UT Southwestern St Paul University Hospital Neonatal Intensive Care Unit (NICU).

"With five babies it's tough," he says. "You won't worry constantly about all the things that can happen."

Quintuplets born at 27 or 28 weeks face enormous challenges. Their bodies and organ systems are premature and small. Their lungs are typically immature, and they have trouble breathing. There's a risk of bleeding in the brain, and cardiovascular problems can occur. These tiny babies often have difficulty feeding, have poor digestion, and face serious diseases, including necrotizing enterocolitis, a serious health threat affecting the intestines.

The UTSW team had been preparing for weeks and knew the babies could face numerous challenges. What they could not predict was which babies would need special equipment. The solution: The hospital rented five of everything – including oscillating ventilators that would keep the babies’ fragile lungs open and conventional ventilators if the didn’t need the more complex oscillators.

“We could guess that we might need two of one thing of three of another,’ says Aziza Young, Manager of the NICU at St Paul. “We had to have five of everything.”

A color-coded system was designed to match each baby with all of his or her supplies. Weeks before the delivery, plastic containers were filled with everything each baby would need in his or her color.  Everything, including charts and monitors, associated with the infants was color-coded for quick identification.

Dry runs gave team members the change to practice their roles. One nurse would direct traffic as each baby was moved to the NICU.

“We looked at everything,” Dr. Burgess says, “even where people might trip.”

The big day

For Patricia Santiago-Munoz, M.D., Associate Professor of Obstetrics and Gynecology, the timing was more than she had expected. After being paged around 5:30 a.m., she arrived at the hospital within 30 minutes. Although she hoped to delay the delivery, by 8:50 a.m. there was no postponing it. Mom Carrie Jones was prepped for a cesarean section.

At 10:01 a.m. Dr. Santiago- Munoz delivered baby A, followed by B, C, D, and E.  Within five minutes she had delivered five babies.

As planned, Mrs. Young held the hand of dad Gavin Jones and kept him calm throughout the experience.

Later, the medical team would notice only one very small miss, Seth, the fourth baby delivered, was matched with pink supplies. His assigned color would soon be changed to silver.

You can follow the quintuplets’ progress on the Jones family blog at gavincarrie.blogspot.com.