Parvovirus puts twin in danger before birth

By Maureen Gilmer, Riley Children’s Health senior writer, mgilmer1@iuhealth.org

Christian and Brittney York left Riley Hospital for Children last week with two tiny additions to their family, and their kids at home, ages 2, 3 and 8, couldn’t be more excited.

Twins Haylin and Waylin York were born Aug. 6 after a pregnancy that didn’t go exactly as planned.

Brittney contracted parvovirus from her older kids last spring while pregnant and knew that while it’s not a serious illness for kids or adults, the virus can pose risks if it crosses the placenta and infects the fetus, particularly in the first half of pregnancy.

(In humans, parvovirus B19 is known to cause fifth disease, also known as slapped cheek syndrome, and can cause complications in individuals with weakened immune systems or certain blood disorders, as well as during pregnancy.)

The risks during pregnancy include miscarriage and severe anemia, which can cause hydrops, or heart failure, in the fetus.

“I would tell other moms to just be cautious, know your body and know the signs and symptoms of parvovirus B19,” Brittney said. “Not just for yourself, but for your other children and other people you’ve been around.”

Although she showed no symptoms, she said her obstetrician (Dr. Jennifer Harbaugh) was already cautious and observant about her high-risk twin pregnancy and referred her to Riley’s Maternal-Fetal Medicine Center for proper diagnosis and treatment after a routine ultrasound in April revealed anemia in one of the twins she was carrying and fluid in the baby girl’s belly. Brittney was not sick, but one of her twins was in danger.

On April 25, at just over 20 weeks pregnant, Brittney underwent a fetal blood transfusion, with Dr. Hiba Mustafa, director of fetal surgery for Riley, guiding a needle into the umbilical cord to reach the baby girl twin.

“It was scary,” Brittney acknowledged, recalling the brightly lit operating room and the anxiety she felt before the spinal block took effect.

“It was nerve-wracking, but I had a lot of faith in Dr. Mustafa. I trusted her wholeheartedly. And the anesthesiologist I had was phenomenal and helped keep me calm.”

While fetuses with anemia can require multiple transfusions, the couple’s baby girl needed just one, and her twin brother was not affected by the virus.

“Brittney’s been through a lot, and she learned a lot about parvovirus,” Dr. Mustafa said, adding that the virus affecting a pregnancy is typically rare, but lately there has been an increase in such cases.

“It’s one of those things you don’t hear about until you have it,” she said. “Adults who are not pregnant don’t really have symptoms, and kids typically have just a rash on the face and fever.”

But she credits Brittney for being aware of the risks of parvovirus and alerting the medical team to her exposure.

“When she came in for an ultrasound, we could see that the baby was in distress.”

Parvovirus can cause bone marrow suppression in the fetus, she explained, leading to a drop in red and white blood cells and platelets.

“The transfusion we do can be risky because you need the platelets to stop the bleeding where you put the needle,” said Dr. Mustafa, who added platelets and applied pressure with the ultrasound probe to control the bleeding during the procedure.

Fortunately, she was able to boost the baby’s blood levels enough that she recovered without needing an additional transfusion.

“Because they are twins, the risk of preterm birth is high, so adding multiple procedures adds to the risk, the fetal surgeon said. “That’s why we wanted to give a chance for baby girl to recover on her own.”

Within a few weeks, the hydrops was gone, and hemoglobin levels had stabilized.

Brittney went on to deliver the twins by C-section at 36 weeks and three days. Waylin came out strong and healthy at 7 pounds, 9 ounces, and Haylin weighed a respectable 5 pounds, 2 ounces. She was doing well at first but eventually was transferred to the NICU when her sugar and oxygen levels dropped.

Even in the NICU though, Haylin was “eating like a champ,” her dad said. “And she loves to snuggle,” Brittney said, adding that the twins seemed to calm down once they were together again.

“They seem happier, and he has chilled out a little,” she said as she snuggled both babies in her daughter’s NICU room a couple days before Haylin was discharged.

Among the visitors in the NICU was Dr. Mustafa, who came by to congratulate the Kings and steal a cuddle with the babies.

Both look amazing, she said, with “kissable cheeks and expressive eyes.”

“Thank you for taking care of our babies,” Christian said to her as she reminded them to send birthday and holiday pictures to her and the team.

“I can’t thank Riley Hospital enough for all they’ve done for me and our babies,” Brittney said.

Mom and baby boy Waylin were discharged Aug. 10, and Haylin got to go home Aug. 13, much to the delight of their older siblings, who couldn’t wait to see them, their parents said.

While there are no vaccines or specific treatments for parvovirus B19, the CDC recommends clinicians and those with underlying health conditions, including pregnancy, be alert to symptoms of the virus and take appropriate precautions, including handwashing and physical distancing when possible.

“When you have kids, it’s hard to stay away from sickness,” Dr. Mustafa acknowledges, but because Brittney understood the illness and the effect it could have on her unborn babies, she advocated for proper testing and treatment.

And now she and Christian are settling back home in Greencastle with five kids, something Christian still can’t quite get his head around, especially four under age 4.

“I love it though,” he said.

His wife agrees.

Life is hectic, she said, “but full of baby snuggles and love.”

Photos submitted and by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org