On the refrigerator of their Honey Brook home, Robin and Jack Skosko proudly displayed a new ultrasound image that clearly featured two babies, marked "A" and "B." With the twins expected to arrive the following June, the young couple and their toddler son, Carter, could not have been more excited. They truly felt blessed - a little surprised by the news - but ultimately overjoyed.
The Skosko's initially chose to deliver at Chester County Hospital because of their pediatrician's affiliation with The Children's Hospital of Philadelphia (CHOP). Knowing CHOP doctors also managed the Hospital's Neonatal Intensive Care Unit (NICU) and provided care to pediatric patients in the Hospital added to their confidence with the decision.
Half-way through the pregnancy though, the couple realized just how much faith they would need to put in their Hospital of choice and its relationship with its world-renown counterpart.
At 20 weeks, their Chester County Hospital perinatologist monitoring the high-risk pregnancy noticed an abnormality in the ultrasound - one baby's umbilical core had thickened. Concerned, the Maternal Fetal Medicine department referred them for a fetal echocardiogram downtown at CHOP to gain more clarity about the babies' health.
Worried but faith-filled, Robin says, "When we found out they were boys and that they had problems, our first priority was to give them names so we could pray for them specifically." Baby A and Baby B soon became Landon and Nolan. Their survival was not guaranteed, but they had a world of support with friends and family, far-and-wide, hoping beyond hope for the best.
"I think the doctors were almost certain that Landon was not going to make it," recalls Robin. Diagnosed in utero with cardiomyopathy, Landon's condition was critical. The couple returned to CHOP every other week for 10 weeks to monitor their babies' conditions.
Landon's cardiomyopathy meant his heart was enlarged and his heart muscles were becoming thickened, causing problems with his valves and the blood flow through the umbilical cord. It was causing Landon to have more amniotic fluid and Nolan not enough. For Nolan, a decreased amount of amniotic fluid could have affected his lung development. The doctors also realized Nolan had a perforated bowel, and if that didn't heal, the Skosko's were at risk of losing him as well.
Because of the complications, the couple needed to determine if the boys were identical or fraternal to know if other problems might occur. Their placentas were intertwined so tightly - rare for fraternal twins - the doctors were concerned they might dangerously share fluid and blood.
Robin recalls, "After one particular echo appointment at CHOP, they told us ... Landon would not survive the next two weeks."
Signs of Improvement
The Chester County Hospital's Maternal Fetal Medicine physicians continued monitoring Robin's pregnancy close to home. At 30 weeks, Landon began showing some improvement and Nolan's perforated bowel had begun to heal. With small glimmers of hope and more prayers for continued improvement, the early plan was for the twins to be delivered downtown at the University of Pennsylvania so Landon could immediately be taken to nearby CHOP after his birth.
"When he began to improve in even more dramatic ways, the doctors agreed that delivering at The Chester County Hospital would be fine because of its neonatology connection to CHOP," she says.
The Skosko's met several of the neonatologists at the Hospital and received a tour of its Level III NICU. The doctors collaborated to understand the particulars of Landon and Nolan's health, so they were prepared when the boys were born. With the affiliation with CHOP, either of the twins could have been flown immediately downtown if necessary.
At 36 weeks, the family's prayers were answered. On May 28, with two CHOP neonatologists in The Chester County Hospital's delivery room, Robin and Jack welcomed Landon (4 lbs. 10 oz.) and Nolan (4 lbs. 11 oz.) into their lives. Immediately afterward, CHOP's Pediatric Cardiologist Marie Gleason, MD, traveled to see Landon in the NICU to check his heart and she has followed his care ever since. As a result of his pre-natal circumstances, he only has a thickened mitral valve, but it has not caused him any complications.
Miraculously, the twins' prognosis was good at the time of delivery. As the most stable newborns in the NICU, they spent a mere 36 hours the unit before moving to the Pediatric Unit to make room for more critical newborns. CHOP hospitalists Karen Pinsky, MD, and Helen Matthews, MD, then managed Landon and Nolan's daily care.
In Pediatrics, Robins says the boys were "tired and stubborn" and didn't want to nurse. To help ease her concerns, "Dr. Pinsky would make growth charts for me and post them in their room so that I knew they were both growing. The fact that she did that really made a lasting impression and I was so encouraged by her." Within two weeks when the boys topped the five-pound mark, all the Skosko's were able to leave the Hospital.
"With everything we went through during the pregnancy, we were able to bring them home relatively quick," Robin says, who was happy to be able to stay with them the entire time.
Good Health is a Blessing
Calm and levelheaded throughout her turbulent pregnancy, Robin says, "We had a lot of peace through the whole situation. It was peace that only God could have given us. And, we couldn't have asked for a better hospital experience, from the delivery to the pediatric care, and of course, everything leading up to their birth."
Today, Robin and Jack are the proud parents of four children. Robin describes Carter, age 6, as the leader of the bunch who often create games to play with his younger siblings. Of the twins, now age 4, Landon is the adventurous one and will do anything for a laugh. Nolan - a cuddler - is a little more shy, but definitely does his share of the twin mischief. Their youngest, Ellie, is nearly 2 and a happy girl. She is very much loved by her brothers. (Not to be outdone, Ellie was born faster than they could get to the Hospital and calmly delivered at home by Robin's mother.)
With four active and happy kids, Robin and Jack's life has changed drastically in six years. But, she says with a knowing smile of what was at risk, "We can't imagine life without any one of them."