HJNO Mar/Apr 2023

42 MAR / APR 2023 I  HEALTHCARE JOURNAL OF NEW ORLEANS CHILDREN’S HEALTH the best scenario was to deliver baby Emri at Children’s Hospital NewOrleans with the pediatric cardiac catheterization and neo- natology teams on stand-by. The delivery was made possible through collaboration between Children’s Hospital’s expert fetal cardiologists and the LSU Health Maternal Fetal Medicine providers to bring the MFM group and associated women’s services team fromTouro on-site. THE FIRST PLANNED MATERNAL DELIVERY AT A CHILDREN’S HOSPITAL IN THE STATE OF LOUISIANA The delivery of the baby two doors over from the cardiac catheterization lab al- lowed for immediate hand-off of the baby from the OB/GYN to the neonatologist, who rushed the infant immediately into the cath lab, onto the table, making it possible for the infant to receive care within seconds of birth. Baby Emri had a successful cardiac catheterization procedure, creating a large COLUMN CHILDREN’S HEALTH OCCASIONALLY, and thankfully rarely, in- fants are born with a very severe form of congenital heart defect. In these cases, there is often at most minutes, and sometimes only seconds, before the infant will suffer permanent brain damage and likely death if an emergent cardiac catheterization proce- dure is not available. The vast majority of severe heart defects in the modern era can be managed with the infant being delivered at a maternal hospi- tal, stabilized, and then transported in an expedient manner to a children’s hospital for the procedure. However, very rarely, this is not enough. This was the recent scenario for one Lou- isiana mom-to-be. Expectant mom, Jayden, from New Ibe- ria, was referred to Children’s Hospital New Orleans by her local physicians due to concerns of her baby’s critical congeni- tal heart disease. A fetal cardiology review confirmed the diagnosis of d-transposition of the great arteries (d-TGA), which is when the two big arteries that arise from the heart are switched in position. This affects the ne- onate’s circulation after birth and leads to lower oxygen saturations. Unfortunately, the fetal echo in this case also showed that the atrial communica- tion, or hole between the top chambers of the heart, was very small, which made the baby’s case even more complex. Neonates with d-TGA rely on blood being able to mix for survival prior to the corrective surgery. When restriction at the atrial level occurs, babies can develop severe hypoxemia and metabolic acidosis necessitating immediate cardiac catheterization to enlarge the hole in the atrial septum. THE SOLUTION: DELIVERY AT CHILDREN’S HOSPITAL NEW ORLEANS, PROVIDING IMMEDIATE ACCESS TO LIFESAVING CARE Careful planning and coordination en- sued with all involved parties. After much discussion across maternal fetal medicine, fetal cardiologists, and pediatric cardiac interventionalists, it was determined that Multidisciplinary Approach Leads to First-Time Delivery at a Children’s Hospital in Louisiana with Immediate Access to Lifesaving Cardiac Care Shannon K. Powell, DO, FAAP, FACC Pediatric and Fetal Cardiologist Children’s Hospital New Orleans