Multidisciplinary care team prevails against heart defect in newborn

Marlo Greenfield was halfway through her pregnancy when she and her husband, David, received bad news: Their eagerly awaited daughter had a congenital heart defect.

The fetal aorta and left side of the heart were smaller than normal, ultrasound scans indicated. At first, the couple was told the problem might resolve on its own, but over the next several weeks of Marlo’s pregnancy, follow-up scans did not show enough catch-up growth. The baby, whose parents planned to name her Kennedy, would need heart surgery in her first few days of life to ensure she could get enough oxygen.

“It was very scary information to hear when we were hoping for a healthy baby,” David said. When Marlo was 32 weeks pregnant, she was referred to the Johnson Center for Pregnancy and Newborn Services at Lucile Packard Children’s Hospital Stanford, which helped the couple feel more confident about what was coming.

“Knowing we would be at one of the best hospitals in the nation, with doctors and nurses that strictly deal with children and pregnant women, was reassuring,” David said.

Assessing heart with echocardiogram

Physicians in the hospital’s Fetal and Pregnancy Health Program assessed Kennedy’s heart with a detailed fetal echocardiogram. They recommended that the family move to Palo Alto from their home in Oakley, California, a few weeks before Marlo’s due date so that Kennedy could be born at Packard Children’s.

On July 24, soon after the move, Marlo’s water broke. Kennedy arrived a few hours later, and several Packard Children’s neonatologists and cardiologists immediately began working to stabilize her.

Kennedy was started on medication that would help maintain her circulation until surgery. Her caregivers in the neonatal intensive care unit, led by neonatologist William Rhine, MD, professor of pediatrics at the School of Medicine, watched her closely.

“There’s a certain amount of stabilization that occurs in the first few days of life,” Rhine said. “The blood pressure in the baby’s lungs drops; you want that to occur before you do cardiac surgery. We also evaluate other organ systems, such as the brain and kidneys, to make sure they are ready for surgery.”

From the start, Kennedy was also being monitored by a cardiac intensivist, a pediatric cardiologist who specializes in cardiac care in the intensive care unit. The close collaboration between doctors from different specialties is a hallmark of the top-notch care Packard Children’s offers to children born with congenital heart defects. “Whether a baby is in the NICU or the CVICU, they’re going to see both a neonatologist and a cardiac intensivist every day,” Rhine said, referring to the neonatal ICU and the cardiovascular ICU. “We think it represents the highest standard of care.”

Ready for surgery

On July 31, at 7 days old, Kennedy was ready for surgery. In a five-hour procedure, Katsuhide Maeda, MD, clinical associate professor of cardiothoracic surgery, and his team put Kennedy on a heart-lung bypass machine and carefully removed the too-small portion of her aortic arch. Once the abnormally narrow region of blood vessel was gone, Maeda reconstructed an aortic arch from the infant’s own blood vessel tissue. “This is a relatively straightforward procedure for our team,” Maeda said.

Kennedy did well, staying for four days in the CVICU and then transferring back to the NICU. Her multidisciplinary care team followed her the whole time.

“Every time we spoke to someone, they knew exactly what was going on with Kennedy,” Marlo said. “Every single person was on the same page. They really knew what they were doing and had it under control.”

The coordination will continue after the cardiovascular intensive care unit relocates to the new main building of Packard Children’s when it opens in December. The NICU will stay in the hospital’s west building, and will eventually expand as existing hospital spaces are renovated and repurposed into a world-class mother and baby center over the next few years.

In the meantime, Kennedy has been home with her family in Oakley since August.

“She’s absolutely beautiful, very content and happy,” David said. “Of course, I’m a little biased, but I think she’s perfect in every way.”