Tiny twins get double the care in the Central Plateau

	The Joli twins shortly after birth

Babies born prematurely and underweight rarely survive in rural central Haiti. Could the Jolie twins beat the odds?

Weighing less than two pounds, the tiny baby would have struggled to survive in even the most well-equipped neonatal intensive care unit in Boston. But born on the rural central plataeu of Haiti about a month prematurely, the small infant and her equally tiny twin brother faced grim odds, said Dr. Koji Nakashima, a resident with Boston's Brigham and Women's Hospital who also works with Zanmi Lasante, PIH's partner organization in Haiti.

Being born so early and underweight left the Joli twins without the simple mechanisms for life, wrote Koji in a recent email. "They had no body fat to keep warm, no sugar stores to fuel their bodies, immature nervous systems to coordinate breast feedings, immature skin that allowed vital fluids to evaporate away," he added.

	The Joli twins about 2 months old.
	The Joli twins and their parents.

Luckily for the Joli twins, the Cange pediatric ward and its tireless nursing staff were able to accommodate their early arrival into the world, and their slow and fragile transition to independent life.They were placed in incubators, warmed to maintain a safe body temperature, and humidified to maintain vital body fluids. The began their nutrition through a tube placed from the nose into the stomach every three hours, and slowly over weeks advanced until breastfeeding could give them enough fluid to maintain hydration, sugar to maintain energy, and protein to grow.

"Throughout this time, the twins' mother maintained an equally steady vigil, spending every day of the three weeks, at first pumping her breast milk to nourish her children through feeding tubes, then gently coaxing them to her breast," said Koji.

They were recently deemed healthy enough to go home with their parents after spending two months in the hospital. "They're doing great," said Koji in a follow-up email. "They have gained weight rapidly and their mother says they are voracious eaters."

[posted June 2009]