January - March 2013 Edition: Naples Health

HOW SWIFT DIAGNOSIS AND TARGETED ACTION KEPT THIS NEWBORN FROM SUCCUMBING TO A SERIOUS HEART PROBLEM .

SAVING CADEN PAUL

Trained eyes save lives. Erin and Chris Paul might consider getting that aphorism cross-stitched to hang on their nursery wall, for with- out the sharp eyes of nurse Joyce Campbell and quick intervention by neonatologist Jignesh Patel, M.D., and pediatric cardiologist Tankut Onal, M.D., their newborn son, Caden, might not have survived his first night. A SWIFT TURN FOR THE WORSE When Erin Paul went into labor on April 10, 2012, she was a week past her due date. Her pregnancy had been normal, and she was able to deliver Caden (her first child) naturally at the BirthPlace in North Naples. He was 8 pounds and 21 inches long, a seemingly healthy baby. As is customary, an Apgar assessment was done one min- ute after birth and repeated five minutes later. Developed in 1952 by anesthesiologist Virginia Apgar, the name has evolved into an acronym for Appearance, Pulse, Grimace, Activity and Respiration. Each category receives a score of from 0 to 2 (with 2 being the highest). The five scores are then added together for a final score of between 0 and 10 (with 10 as the best possible score). “Caden scored 8 and 9 on the Apgar,” Erin Paul recalls. “Everything seemed normal.” And at first everything was fine. But about six hours after birth, Caden was taken to the normal newborn nursery for his initial nursing assessment. Registered nurse Joyce

Campbell regularly works in the newborn intensive care unit (NICU); but there were few patients there that night, so she was floated to the regular nursery. “When [Caden’s] nurse brought him in to weigh him and perform his initial nursing assessment, I offered my help to her,” Campbell reports. “When I looked at the baby, I noticed the palms of his hands, soles of his feet, and his lips and gums were purple. He had an overall pallor as well.” The nurses placed Caden on a radiant warmer and put a pulse oximeter (a non-invasive device to measure the amount of oxygen in the blood) on his foot. Because Caden’s blood oxygen readings were low, Dr. Patel, the neonatologist, used an ambu bag mask to pro- vide the infant with artificial ventilation. When his oxygen levels didn’t improve, Dr. Patel suggested he might have a cardiac problem. The staff moved him to the NICU and summoned Dr. Onal, the pediatric cardiologist. Dr. Onal performed an echocardiogram (a special ultrasound that uses sound waves to produce images of the heart) and Dr. Patel’s suspicion was confirmed: Caden had transposition of the great arteries—a serious congenital heart defect. In this situation, the aorta (which carries oxygen-rich blood throughout the body) is not hooked to the left ventricle as it should be but instead connects to the right ventricle. Normally, the pulmonary artery (which carries blood from the heart to the lungs to receive oxygen) is attached to the right ventricle. But when transposed, it connects instead to the left ventricle.

PHOTOGRAPHY BY ERIK KELLAR

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JANUARY-MARCH 2013 | Naples Health

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