Most very low birthweight infants born at 25 weeks gestation require multiple blood transfusions, neonatologists say, which could be a dilemma in the case of Vancouver's four-day-old sextuplets, whose parents are Jehovah's Witnesses.
Although it is not known how devout the parents are, Jehovah's Witnesses are generally adamant about refusing blood transfusions on the grounds that the Bible states people should "abstain" from blood.
Dr. Brian Lupton, a neonatologist at B.C. Women's and Children's Hospitals, where the six infants weighing just 700 to 800 grams were born last weekend, confirmed Tuesday that blood transfusions are often required in infants so premature.
Dr. Susan Albersheim, another neonatologist at the hospital who also has a PhD in ethical issues in neonatal decision-
making, said that in 2004, 10 of 14 babies who entered the intensive care unit at 25 weeks gestation required transfusions, each receiving an average of six transfusions.
In 2005, 22 of 23 premature (25 week gestation) infants in the hospital's neonatal intensive care unit received an average of five transfusions during their hospital stay.
Blood transfusions are often required because premature babies have low volumes of circulating blood and are anemic (with too few red blood cells and insufficient iron) during the first months of life. As well, their blood counts drop due to blood loss from frequent blood-drawing tests that must be done to monitor their health.
Neither Lupton nor Albersheim would disclose whether the transfusion issue has already arisen for the sextuplets or what the hospital would do if the babies' parents refused to follow their medical recommendations.
"In our unit, a significant proportion of babies require transfusions. It's such a stressful experience for parents who have a baby in intensive care. But we certainly do our best to work with parents and not get to the point of conflict with parents," said Albersheim.
"Health care teams must do their best to inform parents as well as possible and to take time to really listen well. It is a very complex situation . . . We have to weigh treatment benefits, risks and outcomes, the short and long term, and it is not a simple matter," she said.
The parents of the babies, believed to be the first sextuplets in Canadian history, have not given the hospital permission to reveal any information about their treatment or current status.
They have asked for total privacy and have not even allowed a church leader to visit them, according to church elder Roland Alford. However, their faith was one of the few pieces of information they asked the hospital to divulge.
Summing up the position of Canadian case law recently, Arthur Schafer, one of the nation's leading ethicists, said judges generally decide that competent adults have a fundamental right to refuse medical treatment, but the situation is different when it comes to children and "if there is a safe and effective treatment that would save a child's life and if the family refuses to give its consent, then Canadian courts usually feel obliged to intervene.
"In this manner, many Witness children have been forced to have blood transfusions even though they and their families object strenuously," Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba, said in a CanWest newspaper opinion piece.
Mark Ruge, the Ontario-based director of public information for the Jehovah's Witnesses Watchtower Bible Society, said Tuesday that while the Bible obviously says nothing about high-tech fertility treatments -- a form of which was likely used to produce the sextuplets -- it is clear on blood transfusions.
He said numerous medical institutions are using synthetic alternatives to blood and blood byproducts for Jehovah's Witnesses followers, who number about 110,000 across Canada, and expressed hope that such alternatives would be used for the sextuplets if treatment is required.
"Jehovah's Witnesses want the best medical care -- but without blood transfusions," he said.
Albersheim said the synthetic product to which Ruge referred -- recombinant human erythropoietin -- is not used routinely because of some concerns about potential complications but "we do use it in extenuating circumstances. In some circumstances, it helps the body to produce red cells earlier."
A study done at B.C. Children's Hospital in 1995 found the product had only a modest impact on anemia in premature babies and that some babies would still require conventional blood transfusions.
"Strategies to minimize blood loss, such as the development of microtechniques for laboratory monitoring, the avoidance of unnecessary laboratory tests, and, perhaps clinical acceptance of lower hemoglobin levels, are likely to be most most effective in reducing transfusion requirements at this time," the B.C. authors said in the study published in The Journal of Pediatrics.
Albersheim said all of those suggestions are followed, but transfusions are still a required intervention in many premature infants.
pfayerman@png.canwest.com
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Six premature babies born in Vancouver, British Columbia could get a blood transfusion, if the parents allow it. Premature babies are usually encouraged to get them, especially the sextuplets born on Sunday, which weigh 700 to 800 grams.

The parents are Jehovah's Witnesses, a faith that has a doctrine against blood transfusions. (Officially, the church holds that blood transfusions consisting of blood products, rather than whole blood, may be accepted by Witnesses in some circumstances as a matter of individual conscience; however, de facto all blood transfusions are forbidden to Witnesses. Many people who are a part of the faith create an Advance Medical Directive card ordering that no blood transfusions be given under any circumstances.)

"Non-blood treatment is way superior in every situation and many doctors in hospitals worldwide are calling it the gold standard," said Mark Ruge, director of public information at the Canadian headquarters for Jehovah's Witnesses, from his office in Georgetown, Ontario. "Even for young children and babies, there are alternatives – no (blood) transfusion doesn't mean you're going to die."

"To have blood is not the superior way, even though the little jingles on TV say blood gives life...Parents want the best for their children and so do we; we consider life very precious," said Ruge. "We love our children dearly; we're very family oriented... but there can be a public misperception."

Peter Cech, a spokesperson for B.C. Women's Hospital said their religious status was leaked by the media.

"I'm very curious about that," said a man of the Jehovah's Witnesses Assembly Hall in Surrey, B.C. "So what if they're Jehovah's Witnesses? What difference does it make? If they were Catholic would the hospital have said that?"

"If a Catholic had sextuplets would people call the Vatican?" he added. "When there's a car crash or someone has won the lottery, do they mention religion? This isn't a religious issue."

No information has been released since the babies were born after the parents publicly asked for privacy. The first child was born 8:30 p.m. on Saturday, the others Sunday.