Packard heart surgeon performs operation on smallest infant

PALO ALTO, Calif. - Serena Brown, believed to be the youngest and smallest baby ever to undergo open heart surgery, was healthy enough to leave Lucile Packard Children's Hospital at Stanford to be reunited with her family in Sacramento Thursday evening.

Serena was one of a set of triplets born prematurely on Dec. 27 after only 25 weeks of gestation. While one of her siblings has died, Serena and her surviving sister will remain hospitalized in Sacramento, where her family lives.

Serena was diagnosed almost immediately after birth with a rare congenital heart abnormality. Had she gone untreated, she would have died. She was transferred to the Children's Heart Center at Packard Children's Hospital, where she underwent surgery on Jan. 11. At the time of the surgery, she weighed only 640 grams or 1.4 lbs. - about the size of two cans of soda. Around 3,500 grams is normal weight for a newborn.

'Her chest was smaller than my palm, and her heart was the size of the tip of my thumb,' said Packard physician V. Mohan Reddy, MD - who performed the surgery. 'To the best of my knowledge, she is the youngest baby ever to have open heart surgery, and the smallest.'

Reddy, among the top surgeons in his field, has conducted a thorough review of existing literature regarding pediatric cardiovascular surgery and conferred with his colleagues across the country regarding Serena's surgery.

'Most surgeons don't do this operation before 1,000 grams,' says Reddy, chief of pediatric cardiac surgery at Packard Children's Hospital. 'It's technically difficult, and, in infants this premature, the risks are extremely high. But if you don't do anything, the baby will not survive.'

Serena suffered from a condition called total anomalous pulmonary venous return, in which the veins connecting her lungs to her heart were attached to the wrong side of the heart. This meant that oxygen-rich blood from her lungs was not circulating efficiently to the rest of her body. The condition was not related to her prematurity.

The only thing keeping her alive was a naturally occurring hole between the two halves of the heart, which normally seals itself soon after birth. To correct the condition, Reddy re-attached the veins to the correct side of the heart and sealed the hole.

'The operation gives her a chance,' Reddy said shortly after the surgery. 'Otherwise there is a 100 percent risk of death. Her prognosis now should be like any other 25-week premature baby. There are a lot of hoops she's going to have to jump through, and lung problems can be an issue.'

After some initial setbacks because of her lungs, Serena is healthy enough to be transferred from Packard Children's Hospital to Sutter Memorial Hospital in Sacramento, to join her sister Brianna. The third baby, Jocelyn, died earlier this year of necrotizing enterocolitis, or NEC, a severe inflammation of the infant's intestines in which tissue begins to decompose.

Serena is now nearly 900 grams. She no longer needs a ventilator to breathe, although she still receives oxygen. She is fed continuously -- about one milliliter of formula an hour through a feeding tube, says Kirsten Braccia, RN, who cared for Serena at Packard Children's Hospital.

'She's been through quite a bit,' Braccia said Thursday. 'She's really turned the corner. She's doing really well. She truly is a miracle...She's been very alert and very active.'

Her parents, Joshua and Lori Brown, are delighted that Serena is alive, improving and coming at least a little closer to home.

'We'll be able to see both of them more often, and I'll be able to hold Serena. I haven't been able to hold her, yet. We'll be able to be closer to her emotionally and physically. It feels strange not being able to hold your child. It's against a mother's nature being so far from her child,' Lori Brown said Thursday.

The Children's Heart Center is one of six centers of excellence at Packard Children's Hospital. The center brings together physicians, nurses and support staff of many specialties to collaborate in the treatment of congenital and acquired heart disease in children of all ages from across the nation and around the world.

The Children's Heart Center is one of the largest programs in the country performing such specialized pediatric cardiovascular surgery. The more surgeries that are performed at an institution, the higher the success rate, according to medical experts.

Reddy, Michael Black, MD, and Frank L. Hanley, MD, director of the center, specialize in correcting the congenital cardiac defects that affect approximately one percent of all newborns and are the leading cause of death from congenital anomalies. Reddy's primary interest is neonatal cardiac surgery on premature or low birth weight infants.

Serena's surgery, Reddy said, would not have been a success without intensive preparation and a team of specialists.

'This kind of operation takes a lot of planning and teamwork,' Reddy said. 'We had very good support and the team worked very well together. The neonatal respiratory team did an excellent, outstanding job. Although I do the surgery, the team has to be completely focused, because no one has done an infant this small before.'

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