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Tough call for conjoined twins' parents

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Pretoria - The chances of separating seven-day-old conjoined Mpumalanga twins Neo and Reneilwe are slim. This is because of the way in which they are joined. The organs they share would be vital for the survival of each child if they were to live apart.

The girls, who are joined at the chest and share some major organs, were born last Wednesday to a 23-year-old woman, known only as Patience (surname not provided).

Neo and Reneilwe were airlifted to Steve Biko Academic Hospital immediately after being delivered by Caesarean section.

The babies were admitted to the paediatric intensive care unit and have been receiving specialised medical attention from a team working in the hospital’s department of paediatrics and child health.

Aptly named “Gift” and “We are given” by their Pedi father, Richman Malapane, the babies share a liver, most of their bowel, a bladder, anus, rectum and urethra.

“They have independent lungs and hearts,” said the unit’s director, Professor Robin Green.

The “intimate” way in which they were linked made their separation almost impossible, he said.

The twins’ shared body has two sets of arms and legs, positioned at difficult angles.

Professor Green said: “The arrangement of the limbs is not normal, so that even if they were separated they would be difficult to use.”

Procedures to separate conjoined twins are performed only when the babies are five or six months old and older.

This is to give them time to develop, and to allow the growth of soft tissue and muscle to ensure that there is enough to cover their individual bodies.

A lot of tests have been done since the girls were admitted to hospital, among them a full-body sonar and CAT scan, to establish what organs they share and to determine their condition.

In the ICU they are under the watchful eyes of medical staff who include paediatric specialists and surgeons.

Neo, the smaller of the babies, is being kept on a ventilator because she was born with malformations.

The little girl has a hole in her heart and an underdeveloped right lung. Green said these “intrinsic” problems were not life-threatening, but were also not guaranteed to be overcome in the short term.

The cause of these, he said, could be linked to rotational processes of the system that align organs before birth, being constrained due to the twins’ development as conjoined babies.

On Tuesday, the babies lay in an incubator with tubes in their noses and drips in their arms, peacefully sleeping, their faces turned away from each other.

Although their mother refused to be interviewed, she gazed fondly at them, indicating who was who and explaining how their names came about.

The mother, who also has a two-year-old child back at home, is staying in a ward not too far from her newborns.

She is receiving support from the hospital as part of its holistic treatment plan, which entails staff giving the mother extensive counselling to help her accept and deal with her conjoined babies.

Green said that the mother, like all parents of conjoined babies, was consulted when decisions were made about her children.

The ultimate decision on whether to separate them lies with the mother, who would be overruled by the hospital only if her decision would compromise the babies.

“By the time it comes to making a decision on separation, mothers are normally experts on everything about their children, and they make well-informed decisions,” he said.

Until that time came the babies would be afforded the best treatment possible. Green said there was a long way to go before discussions about separation took shape and form. “We’ll have to (overcome) a lot of stumbling blocks, long- and short-term,” he said.

ntando.makhubu@inl.co.za

Pretoria News


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