This story begins with a newborn’s foot.
It was Aug. 27, 2011, a day after Charlie was born at Tacoma General Hospital. He had been checked out by the pediatrician, cleared and released to go home. Just one simple voluntary test was between him and the door — a heart screening. Charlie’s mother, Lindsay, had the screening done on her older son two years prior and because the screening is painless and noninvasive, she agreed to have Charlie screened.
Nurses strapped a velcro cusp onto Charlie’s sweet little pink foot. The cusp sent a light bolt through his foot to test the oxygen levels in his blood. Low levels of oxygen can be indicative of a heart defect. Normal readings are in the 90s, Charlie’s was in the 50s and 60s.
The nurses assumed their machine was malfunctioning. So they switched to another one. Charlie’s readings were still in the 50s and 60s. They checked his other foot. There was no difference. They checked his hands. Again, no difference.
“It was just one of those surreal moments where his readings just kept coming back much lower than they were supposed to,” Charlie’s mom said. “I think at one point I just looked at my husband and we both knew something was wrong.”
Undetected heart defects are a leading cause of infant deaths. But this newborn heart screening is lowering that statistic. Charlie is one of 10,000 babies that have benefitted from MultiCare’s newborn heart screening program. Since 2008, MultiCare Tacoma General Hospital has been offering the heart screening, called pulse oximetry, for free. Tacoma General was one of the first in the state to start saving little hearts with this painless test. Because of their pioneering work, MultiCare Tacoma General Hospital’s Family Birth Center and the MultiCare Mary Bridge Pediatric Heart Center received the 2011 Warren Featherstone Reid Award for Excellence in Health Care.
The screening is not mandatory in Washington State. Many hospitals throughout the country don’t require or offer the test, despite having the ready access to the necessary equipment and the ease of the screening’s administration.
“Nine out of 1,000 infants are born with congenital heart disease (CHD). Of those, 25 percent are critical defects that require lifesaving surgery within the first month of life,” said Dr. Matthew Park, a pediatric cardiologist with NorthWest Children’s Heart Care and Pediatrix Medical Group that services children at Mary Bridge Children’s Hospital and Tacoma General. “Unfortunately, less than half of all infants are diagnosed by routine prenatal ultrasound,” Park said. “Due to normal cardiac and respiratory physiologic changes that occur during the normal transition infants go through during the first 48 hours of life, many infants with critical defects do not have signs, symptoms or exam findings that alert parents and caregivers to the possibility of a critical heart defect. These infants can become very sick very quickly with a high chance of sudden death.”
“Everybody thought Charlie was a completely healthy baby,” said Lindsay. But before she knew it she was sitting in the NICU, no longer holding her newborn. Doctors immediately started doing further tests on Charlie and within an hour they were able to completely diagnose his condition.
Charlie’s pulmonary artery and aorta were reversed, a condition called Transposition of the Great Vessels (TGV). Within another hour he was in his first surgery where doctors were able to temporarily stabilize him before they could transfer him to Children’s Hospital in Seattle.
“On Sept. 1, when he was 6 days old, he had his open heart surgery,” said Lindsay. The mother, as could be expected, was fearful for her baby. “Having no clue what this really means, being terrified that you’re going to lose your baby and then just transitioning into survival mode to a certain extent and figuring out what we need to do to get him healthy and get him home again.”
Charlie’s surgery was successful, but because the heart often swells after surgery, doctors left his chest open for a few days.
“Once he was closed up. it was incredible how fast (his recovery) was,” mom said. “Tubes started coming out and you could kind of start to see your baby again, from what you remembered before everything happened. Seven days after the surgery we could actually hold him and start feeding him.”
Charlie’s condition was quickly fixed due to the prompt screening, but Park has seen too many instances when the screening was not administered and a heart defect went undiscovered. “I have also tracked 25 infants that were born at outside regional hospitals that were discharged home and later presented to Mary Bridge or our clinic with significant heart failure from delayed diagnosis,” he said. “Many of these infants have had complications and prolonged hospitalizations that might have been avoided with more timely diagnosis.”
This is why Park believes every newborn should be screened before going home.
“Unfortunately, the Washington State Department of Health is not considering adding pulse oximetry screening to the state screening panel at this time. This means that each individual hospital can choose whether or not to screen infants born at their facility,” said Park, adding that parents should request the screening prior to discharge. If the hospital won’t do it, they should ask their pediatrician to do the screening at their infant’s first outpatient visit. According to Park, all hospitals and most pediatricians have the necessary equipment. “It might save their child’s life,” he added.
Some parents simply aren’t aware the test exists. At Tacoma General, five infants with potentially life-threatening conditions have been successfully operated on.
Today, Charlie is running around on those same two little feet that helped lead to the diagnosis and eventual surgery that made his heart healthy.
“If you saw him now you’d never know … Charlie seems to be exponentially happy,” mom said. “I always think, he just knows in some way, (and) he’s excited to be here. He loves life.”
Glowing Brain Tumors
MultiCare in Tacoma is conducting a neurosurgery trial using an oral medication that will turn a brain tumor fluorescent pink. The medicine is concentrated in the brain tumor and will glow bright pink under ultraviolet light. It enables the neurosurgeon to remove more tumor tissue and leave behind more of the normal brain tissue.
St. Peter Hospital in Olympia offers a unique, non-surgical liver cancer treatment called Y90. The Y90 “microspheres” — about the width of five red blood cells — are injected through a catheter from the groin into an artery and delivered directly to the tumor. This technique allows a higher local dose of radiation without damaging the surrounding tissue.
Social Media for Physicians
The Franciscan Health Information Exchange (HIE), allows physicians to quickly share medical information and diagnostic-quality medical images. Physicians and other providers who are linked to the secure HIE receive and share lab results, medical reports and other types of patient data from electronic records without having to purchase specialized, often-expensive computer hardware.
Dr. Brian Kott is the South Sound’s first endovascular interventional neuroradiologist and the Medical Director of MultiCare Health System’s stroke program. He goes through the blood vessels of the brain to treat strokes and aneurisms without invasive surgery. From inside the blood vessel, he goes up with catheters that are designed to run all the way into the brain. Through these catheters he can use other devices. For instance, to pull out a clot, he uses a miniature corkscrew device called a Merci Retriever. To operate in the brain successfully, he uses a Fluoroscopy, which is a 3-D, real-time imaging system built into the room itself. Even the treatment table is part of that system.
A Cyberknife for Cancer
The CyberKnife Robotic Radiosurgery System is the first and only robotic radiosurgery system designed to treat tumors anywhere in the body, including the brain, spine, lung, liver, pancreas and prostate. MultiCare’s CyberKnife is the first in Tacoma and Pierce County, and only the second CyberKnife center in the Puget Sound region.
A Surgeon Robot
The da Vinci Surgical System robot operated by thoracic surgeon Baiya Krishnadasan of St. Joseph Cardiothoracic Surgeons in Tacoma has three surgical arms, plus an imaging arm that provides the surgeon with a magnified, high-definition 3-D image of the surgery site. The robot is operated by the surgeon, who sits at the master console where his hand movements are transferred to precise robotic instrument movements inside the patient’s chest. Smaller incisions, smaller scars and faster recovery times for patients are among the benefits of the robot-assisted surgery. Surgeons across the country come to St. Joseph to learn how to use it from Dr. Krishnadasan.
Top photo courtesy MultiCare, middle photo by Molly Winn Photography and bottom photo courtesy St. Joseph Medical Center