Lotus hospital doctors achieve a rare feat

A premature baby was born a few weeks ago with a very rare heart disease of having a very slow heart beat. Normally, any unborn baby with a slow heart beat less than 60 / mt is a danger signal to immediately deliver the child as the life is in grave danger. This little baby had a slow heart beat ( 55 – 60 / mt ) right from the first few months of life. The normal heart beat of a newborn at rest is : 120 – 150 beats / minute. During crying, or any painful procedure, the heart rate goes up to 160 – 180 / minute only transiently.

Born at the eighth month of pregnancy, Mrs Soujanya's baby girl was prematurely delivered due to a very rare heart disease called Complete Heart Block. The incidence worldwide is very rare and occurs in 1 in 15,000 to 20,000 deliveries. Several scientific studies report only case series of less than twenty across the world over a span of 25 years. This is a rare condition wherein the heart beat of the baby is very slow, in his/ her case it was only 55 – 65 beats / minute. Even during crying, her heart rate never crossed 70 / minute. This is a condition where the conduction system of the heart is affected. Signals from the atria ( upper chambers of the heart ) are conducted through a nerve conduction system of muscle fibers to the ventricles ( lower pumping chambers of the heart ). Following the electrical activation of the heart, the pumping chambers pump blood on a regular basis throughout life. When Complete Heart Block develops, there is a danger to the life of the baby as the heart muscle can fail to pump adequately and lead to ' heart failure '. Blood Pressure falls, and oxygen and glucose cannot reach the various organs in the body leading to demise.

The cause for Complete Heart Block in a newborn baby are many, some associated with deformations in the heart, viral infections, etc. In this child, the cause was due to a mother's illness called SLE ( Systemic Lupus Erythematosus ). In this disease certain antibodies ( proteins ) from the mother are transferred to the unborn baby's blood which attack and damage the heart muscle fibers in the atria ( Neonatal Lupus ) causing disruption of conduction of the electrical impulses to the rest of the heart. The slow heart beat can cause a fall in blood pressure leading to grave danger to the life of the child. In this baby, fortunately, there were no deformities the heart as the detailed evaluation by a child heart specialist with ECG and echocardiography. Baby's blood pressure remained normal throughout, and his/her heart rate has always been between 55 – 65 / minute.

The mother was shifted from another major corporate hospital in Hyderabad to Lotus Hospitals due the high risks involved. Cesarean Section was performed and this baby girl was delivered prematurely at 32 weeks (eight months of pregnancy ). The Newborn Intensive Care Team at Lotus Hospitals attended the delivery fully prepared to handle all emergencies. Upon delivery, the baby developed lung failure and was placed on a ventilator . Her heart condition was stabilized with special medicines to improve blood pressure. We have successfully managed baby of Soujanya dealing with the initial lung maturity problems (needed artificial respiratory support with a ventilator) and heart problems.

The child is being discharged today after almost a month's intensive care in the Newborn ICU. There is a need for close follow up of this baby with serial cardiac evaluations to detect heart failure and deal with them : usually with the insertion of a pacemaker for the heart or even surgery, said Dr VSV Prasad, Chief Consultant Neonatologist, and Managing Director of Lotus Hospitals, Hyderabad. In about 15 -30% of children, cardiac problems later in life are likely to develop. In his 31 year career as a children's specialist, Dr Prasad said that this is the third baby with Neonatal Lupus that he has managed and treated.