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Coarctation Fullow Up

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jackryan

Junior Member
What is the name of your state?
Michigan

Hello...I posted here a few months ago and have a follow up question. Old thread

https://forum.freeadvice.com/showthread.php?t=303571&goto=nextnewest

It turns out according to our sons vital records in the hospital preceding his discharge, were not normal. Our atty said he ran a fever the second and third day after he was born and also had a fast HR and low BP. I don't have all of the info at this time as it is in review by physicians right now. For the medical professionals in this forum would it be the norm to send a newborn home with these vitals? I only ask because I DON'T want to pursue a claim unless it was clearly obvious he should have been looked at more thoroughly. If it is border line I don't want to even if the atty thinks we should.
 


ellencee

Senior Member
jackryan said:
What is the name of your state?
Michigan

Hello...I posted here a few months ago and have a follow up question. Old thread

https://forum.freeadvice.com/showthread.php?t=303571&goto=nextnewest

It turns out according to our sons vital records in the hospital preceding his discharge, were not normal. Our atty said he ran a fever the second and third day after he was born and also had a fast HR and low BP. I don't have all of the info at this time as it is in review by physicians right now. For the medical professionals in this forum would it be the norm to send a newborn home with these vitals? I only ask because I DON'T want to pursue a claim unless it was clearly obvious he should have been looked at more thoroughly. If it is border line I don't want to even if the atty thinks we should.
Compared to adult heart rate and BP, newborns have fast heart rates and low BPs. What were the measurements? It is important to remember than one or two highs or lows mean nothing; it is when either is sustained that it becomes a 'true' measurement.

As for running a fever: newborns and infants do not have developed thermo-regulation and an elevated or decreased temperature may have absolutely nothing to do with the health status. What was the temp and for how long?

EC
 

jackryan

Junior Member
Not sure yet..All I know is temp was consistently high when charted. Same with BP and HR. Not sure what it means. Said that there is some other concerns but didn't elaborate. Have to wait for a full report.
 

ellencee

Senior Member
jackryan said:
Not sure yet..All I know is temp was consistently high when charted. Same with BP and HR. Not sure what it means. Said that there is some other concerns but didn't elaborate. Have to wait for a full report.
I did not forget about your previous post and in the interim have done some reading on the subject. I find nothing that differs from this information:

Clinical Manifestations of Newborn with Critical Coarctation of the Aorta:
1) Asymptomatic until the ductus arteriosis begins to close (within the first fews days after
birth

2) After PDA closure:
1. Severe congestive heart failure, poor perfusion (cool
skin, pale extremities, etc.),

2. Tachypnea (fast breathing),

3. Metabolic acidosis,

4. Absent femoral pulses.


Diagnosis:
1) Auscultation--varies; nonspecific systolic murmur

2) CXR--varies

3) ECG--varies, normal or left and right ventricle hypertrophy

4) 2-D echocardiogram with Doppler study and color flow mapping identifies aortic arch
narrowing and associated lesions (bicuspid aortic valve, VSD, PDA)

5) MRA (like an MRI but is an angiogram)

6) Invasive studies (cardiac cath) usually not needed for initial diagnosis, may need
aortic angiography to identify collateral vessels before surgery.

Treatment of the Newborn (neonate):
1) Stabilize with prostaglandin E1 infusion to maintain cardiac output through the PDA;
treatment may cause fever and apnea (not breathing)

2) Intubation and ventilation as needed

3) Assessment of renal (kidneys), hepatic (liver), and neurologic function

4) Refer for surgical intervention (some coarctation recurs after surgery and requires 2nd
surgery)

Complications:
1) Hypertension

2) Congestive heart failure

3) Cerebral hemorrhage

4) Endocarditis

(This does not touch on problems associated with hypoplastic transverse aortic arch and mitral valve stenosis.)

Normal values for Newborns/Neonates:
Heart rate: Rate: 110-160 while awake, 80-110 while asleep;

Rhythm: common to find periods of decelertion followed by periods of
acceleration

BP: Newborns who weigh more than 3K (>7 pounds): 60-80 systolic, 35-55
diastolic; BP measurement is only recommended for infants in distress.
Immediately after birth: 70/45; 10 days after birth: 100/50. BP elevates with crying.

A blood pressure >20 mm Hg in the upper extremities than the BP in the
lower extremities strongly suggests coarctation of the aorta (remember BP
is not routinely measured in neonates who are not in distress.)

Respirations: Rate: 40-60 breaths per minute, influenced by sleep/wake status,
when last fed, drugs taken by mother, and room temperature.
May be as high as 80 breaths per minute or > when HR elevated.

Rhythm: may be shallow with irregular rhythm; symetrical and mainly
diaphragmatic; periodic breathing (5-15 seconds of apnea).

Cyanosis: Common finding: Acrocyanosis of distal extremities r/t transitional period
hemodynamic changes in the pattern of blood flow through
the newborn's heart and pulmonary circulation limiting
blood flow to peripheral vessels in the extremities.

Temp: 98.6 + or -, depending on many factors, including room temperature and
being held and immature thermo-regulation.

Back to your posted information:
During what period of time was the temperature elevated?
I remain convinced there is no viable claim of malpractice but I am going to point out one area that does concern me: If the OB/GYN knew there was a chance of a congental birth defect, why were the OB/GYN and pediatrician not aware of the need to place this neonate in the intermediate care nursery where nurses with specialized skills and additional education are available to look for the subtle changes and the more definitive changes that present in neonates with congental malformations? Why would the pediatrician discharge a high risk neonate without performing a complete physical examination, looking for subtle indications of malformation?

EC
 
Last edited:

rmet4nzkx

Senior Member
Thank you for the update.
Unfortunately, the review process is ongoing and you will have to wait to see what the expert's say about the data in your son's medical records and how the isolated data fits into the whole clinical picture and may or not be within normal limits. As previously stated in your original thread, this condition rarely appears immediately following birth and this was a high risk pregnancy with several other congenital defects and potentially an adverse drug reaction.

You have asked the attorney to review the case with the possibility of litigation, it is their job to do that and inform you of all your options based upon the facts in evidence, then it is your decision as what to do with those options.

I recently watched a PBS program about "the boy in the bubble" David Vetter who had a condition called Severe Combined Immune Deficiency (SCID) http://www.pbs.org/ who lived years longer than he would have without medical intervention and the ethical issues involved in such cases, there are no simple answers.
 

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