Nationwide Children’s Hospital and Riverside Methodist Hospital announced today that the first-ever planned birth at Nationwide Children’s occurred on Dec. 3, 2007. Baby girl Brenlee Lane was delivered at Nationwide Children’s by a team of specialists from Riverside Methodist Hospital to Jessica Lane of Ross County, Ohio.
The unusual arrangement was made necessary due to a serious heart condition identified by Riverside Methodist perinatologists during pregnancy; the condition required transcatheter and surgical therapy immediately after birth by the The Heart Center team at Nationwide Children’s.
Diagnosing the Problem
Jessica, a single mom, began her journey during a routine visit to her obstetrician at Riverside Methodist, Ronda Gaiser, MD, of Women Physicians in OB-GYN, Inc. “She was 18 weeks along and measuring a little bigger than normal,” said Dr. Gaiser, “so I referred her to Maternal-Fetal Medicine at Riverside.” Riverside Maternal-Fetal Medicine is a comprehensive perinatal diagnostic center that provides highly specialized care for women with high-risk pregnancies.
During Jessica’s Level II anatomic ultrasound, Riverside Methodist perinatologist Matthew Mingione, MD, detected an abnormality in the baby’s heart and diagnosed Brenlee with Hypoplastic Left Heart Syndrome (HLHS). Only four out of every 10,000 babies born in the United States are born with HLHS, a condition in which infants do not have normal development of the left side of the heart and can not survive after birth without immediate intervention. Dr. Mingione then referred Jessica to specialists at Nationwide Children’s for an echocardiogram of the baby’s heart.
Identifying a Rare Condition
John Kovalchin, MD, director of Echocardiography at The Heart Center at Nationwide Children’s Hospital, and an associate professor of Pediatrics at The Ohio State University College of Medicine, further diagnosed Brenlee with not only HLHS, but also with a rare variation of Intact Atrial Septum.
“This rare variation of Hypoplastic Left Heart Syndrome is a condition where the oxygenated blood from the lungs cannot reach the baby’s body,” said Dr. Kovalchin. “If left untreated immediately after delivery, it is typically fatal.
It was this rare combination of congenital heart defects and the need for specialized treatment immediately after birth that led to two months of intense planning between medical professionals and administrative staff at Riverside Methodist Hospital and Nationwide Children’s Hospital to give Brenlee the best chance of survival.
The solution — while not simple to operationalize — was clear: since Riverside Methodist does not operate on babies and Nationwide Children’s does not deliver babies (except in an emergency), Drs. Kovalchin and Mingione, along with a team of healthcare professionals from both institutions, decided that Brenlee should be delivered by Riverside Methodist staff at Nationwide Children’s where all the resources were available to treat Brenlee immediately.
Delivering a baby at a free-standing children’s hospital is a rare occurrence nationwide and one that could only happen with the remarkable collaboration between these two institutions. The two hospitals have a long history of partnering on the care of expectant mothers and their babies. The Level III Newborn Intensive Care Unit at Riverside is operated by Nationwide Children’s and provides the highest level of care to sick newborns.
For this delivery, nearly 60 medical professionals from the two hospitals met for two months to plan for the delivery and subsequent treatment. The team included physicians, nurses and other specialists in Obstetrics, Maternal-Fetal Medicine, Neonatal Intensive Care, Pharmacy, Anesthesia, Fetal Cardiology, Pediatric Interventional Cardiology, Pediatric Cardiothoracic Surgery and more.
Birth and Surgery
With more than 20 medical professionals standing at the ready, Jessica gave birth to Brenlee by Caesarean section at Nationwide Children’s Hospital on Monday, Dec. 3, 2007.
While Brenlee was whisked away for treatment, her mom, Jessica, was cared for by Riverside Methodist’s team of obstetrical and perinatal physicians and nurses.
Meanwhile, the race was on to save Brenlee. Immediately after birth, she was transferred from the Congenital Cardiac Hybrid Operating Suite across the hall to the Hybrid Cardiac Catheterization Suite where she underwent an emergent catheterization procedure. These suites accommodate any cardiac surgical case, catheterization or collaborative hybrid procedure in which cardiothoracic surgeons and interventional cardiologists work together to reduce the amount of time required to correct a heart problem and the amount of emotional and physical stress placed on a patient or their family.
“A small wire with an electrical tip was placed against the tissue between the upper chambers of Brenlee’s tiny heart in order to ‘burn’ a hole that would allow oxygen-rich blood to reach her body,” said John P. Cheatham, MD, George H. Dunlap Endowed Chair in Interventional Cardiology, director of Cardiac Catheterization and Interventional Therapy, co-director of The Heart Center at Nationwide Children’s, and professor of Pediatrics and Internal Medicine at The Ohio State University College of Medicine. “Because she had three layers of tissue to burn through, a balloon catheter could not be safely placed. Therefore, she was immediately placed on the heart-lung bypass machine where surgical removal of the tissue was performed.”
After Brenlee’s surgery, Jessica was finally able to touch her daughter but only by holding her hand and only for a few minutes. Jessica was then transported to Riverside Methodist for recovery while the critically ill Brenlee remained in the Cardiac Intensive Care Unit at Nationwide Children’s. All had gone well but recovery from this condition is a long road.
A week later, Brenlee was finally stable enough for her next procedure.
“Brenlee was transferred back into the Hybrid Congenital Cardiac Operating Suite where we placed and tightened a small band of material [Gore-Tex] around her left and right pulmonary arteries taking blood to her lungs,” said Mark Galantowicz, MD, Murray D. Lincoln Endowed Chair in Cardiothoracic Surgery, chief of Cardiothoracic Surgery, co-director of The Heart Center, and an associate professor of Surgery at The Ohio State University College of Medicine. “This controls the large amount of blood that was flooding Brenlee’s lungs and improves her breathing.”
Another week later, Brenlee again returned to the Hybrid Cardiac Catheterization Suite and had a metal cage, or stent, placed in a blood vessel that would provide adequate blood flow from her single right pumping chamber to the rest of her body. These procedures are collectively called the Hybrid Approach to HLHS, for which Nationwide Children’s has become internationally known.
Before Brenlee could go home, she needed one more catheterization procedure where a second stent was inserted to allow adequate flow to reach her tiny aorta and coronary arteries. This is performed to keep her heart healthy until she can have open-heart surgery at approximately six-months-old.
Finally, after more than five weeks in the hospital, and after surpassing her birth weight, Brenlee was discharged from Nationwide Children’s and went home on Jan. 11.
Brenlee returned to Nationwide Children’s on Jan. 14 for an echocardiogram, and has another follow up Jan. 28. She passed the Jan. 14 echocardiogram with flying colors and is scheduled to come back every two weeks for clinic appointments with Dr. Kovalchin. Meanwhile, Jessica has recovered fully from her Cesarean section.
“This was an incredible example of modern medical science and passionate caregivers coming together to bring all this expertise to bear on one mother and one baby,” said Dr. Mingione. “By collaborating together, we gave this baby her only chance of survival. If it meant moving mountains, that’s what we were going to do. We are all very proud to have been able to help.”
“I was hoping for the best, but preparing for the worst at the same time,” Jessica said. “I am so grateful that it has turned out this way. Brenlee still has a ways to go but at least now we have a great chance. Thank you.”
About The Heart Center at Nationwide Children’s Hospital
The Heart Center at Nationwide Children’s Hospital is one of five comprehensive centers in the nation dedicated to pediatric cardiac care, education and research. The Heart Center features the latest surgical equipment and diagnostic technology available. After opening the world’s first Hybrid Cardiac Catheterization Suites in 2004, the nation’s first Congenital Cardiac Hybrid Operating Suite was completed in late 2007. These specialized Suites allow interventional cardiologists, surgeons, anesthesiologists, echocardiographers and other team members to work side-by-side on a single case without ever moving the patient. This, in combination with comprehensive specialty programs and outreach services offered throughout Ohio, The Heart Center is able to deliver the most comprehensive care for children without ever having to leave central Ohio.
About Nationwide Children’s Hospital
Ranked in the top 12 on U.S. News & World Report’s 2007 list of “America’s Best Children’s Hospitals,” Nationwide Children’s Hospital is one of the nation’s largest pediatric healthcare networks providing wellness, preventive, diagnostic, treatment and rehabilitative care for infants, children, adolescents and adult patients with congenital disease. A medical staff of nearly 900 and a hospital staff of 6,000 provide state-of-the-art pediatric care for more than 700,000 patient visits annually. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s Hospital physicians train the next generation of pediatricians and pediatric specialists. The Research Institute at Nationwide Children's Hospital is one of the top 10 National Institutes of Health-funded free-standing pediatric research facilities. In honor of a $50 million transformational philanthropic gift from Nationwide Foundation, Columbus Children’s Hospital became Nationwide Children’s Hospital September 24, 2007. This renaming reflects the hospital’s national stature while staying true to the original mission since its founding in 1892 of providing care regardless of any family’s ability to pay. More information is available by calling (614) 722-KIDS (5437) or by visiting www.NationwideChildrens.org.
About Maternity Services at Riverside Methodist Hospital
Riverside Methodist Hospital is a leader in maternity care, which is why more than 6,800 babies were born at Riverside Methodist last year. As a Level III maternity center, Riverside Methodist’s experienced team of physicians and nurses cares for any woman – regardless of risk level – during pregnancy and during and after delivery. Riverside Methodist’s comprehensive offerings include: Maternal-Fetal Medicine at Riverside for expectant mothers with high-risk pregnancies; a dedicated unit for women with high-risk pregnancies who need to be hospitalized; private home-like birthing suites; state-of-the-art technology; a Newborn Intensive Care Unit operated by Nationwide Children's Hospital; and education and support for expectant and new parents at the Elizabeth Blackwell Center for Women.
About Riverside Methodist Hospital
Riverside Methodist Hospital is a member of OhioHealth, a nationally recognized not-for-profit, charitable, healthcare organization serving and supporting the community. It was named by FORTUNE magazine as one of the “100 Best Companies to Work For” in 2007 and 2008. Based in Columbus, Ohio, OhioHealth is a family of 15 hospitals, 20 health and surgery centers, home-health providers, medical equipment and health service suppliers throughout a 46-county area. OhioHealth Hospitals in central Ohio are Riverside Methodist Hospital, Grant Medical Center, Doctors Hospital, Grady Memorial Hospital and Dublin Methodist Hospital. For more information, please visit our web site at www.ohiohealth.com.
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