When Seconds Count
from Children's Magazine, Spring 2006
Story by Melissa Howell
Photography by Steve Kast
“We’re Just Happy He’s Alive.”
That’s how Tim and Kim Egan describe their 31/2-month-old son, Benjamin. When Ben became extremely sick an hour after he was born, his family, physicians and nurses didn’t know if he was going to survive. Ben’s parents say his eyes tell a story. That story begins at Poudre Valley Hospital in Fort Collins and journeys to The Children’s Hospital in Denver. It includes a team of caregivers who refused to give up on him, an airlift in a Flight For Life helicopter, and his family’s courageous love and support.
‘My Strongest Little Boy’
Kim Egan went to Poudre Valley Hospital on Dec. 29, 2005 for a scheduled Caesarean section. The Egans have a 21/2-year-old daughter, Bridget, and were looking forward to a “normal, healthy, happy baby boy.”
For the first hour after Ben was born, that proved to be the case. Then, Ben started coughing up blood.
“When the blood initially came out of his mouth, we didn’t know if it came out of his lungs or his stomach,” said Jan Paisley, MD, an attending neonatologist at Children’s and Poudre Valley. “We knew something was wrong, but didn’t know what. He was one of those unusual babies who within an hour was on full support.”
Dr. Paisley and her team of caregivers put a tube into Ben’s stomach and lungs and found that both organs were bleeding. Ben had developed persistent pulmonary hypertension of the newborn (PPHN), a condition where a newborn’s circulatory system doesn’t transfer from its fetal circulation.
“Before a baby is born, the resistance to blood flow in the lungs is very high because the fetus isn’t breathing; the placenta is acting as the gas exchange organ,” said John Kinsella, MD, attending neonatologist in Children’s Newborn Center and professor of Pediatrics at the University of Colorado School of Medicine. “When they’re born, there’s this remarkable transition that has to happen where the lungs get inflated with gas, the blood vessels in the lungs open up and blood flow into the lungs increases. Now the lungs can serve in the same capacity as the placenta before the baby is born. Sometimes that transition doesn’t happen very well, so the blood vessels in the lungs remain sort of squeezed down tight. The pressure in the arteries in the lungs is high. That causes blood to essentially back up and shunt from the right side of the heart to the left side and also out to the body. That causes the oxygen level to drop dramatically – that can be a life-threatening problem.”
Kim said, “I remember my father-in-law coming in and sitting down next to me and saying that Ben was really sick and that they were really scared.”
Ben was placed on a high-frequency oscillator, a breathing device that delivers very rapid breaths, 600 to 800 times per minute. A normal newborn takes 30 to 40 breaths per minute. An oscillator can deliver much lower pressure at a faster rate, causing significantly less damage to an infant’s fragile lungs than a conventional ventilator.
In addition to the oscillator, Dr. Paisley and her team treated Ben with nitric oxide, which helps open up the blood vessels in the lungs. Children’s physicians were among the earliest researchers to discover this use.
“After he got really sick, we were literally just suctioning blood and pushing blood products,” Dr. Paisley said. “We gave him 10 times the normal dose of blood products and had six or seven people at the bedside the entire time. Even after all that, blood just poured out of his mouth. We were just trying to get him somewhat stabilized.”
“I was sitting next to him, talking to him the whole time,” Tim said. “I kept saying to him that he was my strongest little boy, my biggest fighter, that I was so proud of him, that he was doing good. I told him our family loved him and everyone was praying for him.”
‘He Was Really, Really Sick’
“Oftentimes, babies are born who are sick and no one could have predicted it,” Dr. Kinsella said.
To ensure that the highest level of neonatal care is available when there are emergencies, Children’s Neonatal Nurse Practitioner (NNP) program provides varying levels of coverage across Colorado . And Children’s Perinatal/Neonatal Outreach program supports the development of the University of Colorado Perinatal program at outlying hospitals with fetal concerns support and consultations.
“It’s our presence in the community,” said Lynn Cavaliero, Clinical Director of Children’s Newborn Center. “It’s our way of absolutely being present out there and making sure good neonatal care takes place, and supporting education and knowledge base.”
Dr. Paisley said, “I think Ben was probably the sickest baby I’ve had. There’s always one more step, something else you can do. The next step for this baby was ECMO, and I didn’t have that. John (Kinsella) was my next step.”
ECMO, or extra corporal membranous oxygenation, is the highest level of neonatal care. It’s a surgical bypass machine that allows the lungs to be temporarily bypassed, and is used for the sickest babies. Poudre Valley doesn’t have an ECMO machine, and Ben’s caregivers knew Ben’s only chance for survival might require him to be transported to Children’s to go on ECMO.
“When it became apparent that he was as sick as he could possibly be and he needed to be in John (Kinsella’s) hands, I called John and joked, ‘can you just come here?’ and he knew I was actually serious because I had done absolutely everything I could think of and I was so worried we would lose him,” Dr. Paisley said.
Dr. Kinsella, who was enjoying a day off, didn’t hesitate. He got in his car and drove from Denver to Fort Collins to care for Ben.
“It makes me want to cry, really,” Dr. Paisley said. “This affiliation I’ve dreamed of for years couldn’t have worked out more perfectly to have somebody like John to call, to be on the same team. I was able to tell Ben’s parents that the world’s expert and one of the people who pioneered nitric oxide was coming here to do everything he could.”
Kim said, “I could not believe he was driving up to help save Ben. At that point it clicked with me that Ben was really, really sick.”
Dr. Kinsella said, “I know Jan well, and she’s a tremendous neonatologist. But part of the frustration I could sense in her voice was that this was a baby for whom, if he continued on this path, ECMO could be life-saving. But to get him safely from Poudre Valley to Children’s did not seem feasible at all.”
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