In the Nick of Time: Baby Born With Arrhythmia Undergoes Lifesaving Treatment in Cross-Collaboration Between Medical Teams
By Ashley Antle
The saying “timing is everything” could not be more true for Crystal Schnabel, Eric Massey and their son Rogan Massey. Rogan was born on April 13, nearly six weeks early, but not a minute too late.
A few days prior to her son’s birth, Schnabel had an appointment scheduled with maternal-fetal specialist Holly Dunn, M.D., an Abilene-based high-risk obstetrician with Cook Children’s Health Care System. Because Schnabel experienced low amniotic fluid levels in her first pregnancy, she needed to be monitored closely. But a scheduling conflict led her to cancel her 34-week appointment. Two days after her missed appointment, just to be on the safe side, Schnabel, a radiology technologist, asked a fellow sonographer to do a quick ultrasound to check her fluid levels. Her colleague told her to stop by the next day during a break in her schedule.
On April 13, at 2:45 p.m., Schnabel met her colleague for the scan, and they both noticed something peculiar. Rogan’s heart rate was irregular and beating faster than normal at 254 beats per minute. The sonographer urged Schnabel to go to the labor and delivery department at Hendrick Health in Abilene for an exam. Schnabel alerted her obstetrician, called her husband and made her way to the hospital.
There, she was hooked to a fetal heartbeat monitor that produced what appeared to be normal readings for the baby’s heartbeat, but Schnabel’s obstetrician asked Dr. Dunn to take a second look.
“Her OB called me, had me look at the monitor strip and something didn’t sit right with me. So I told her to send mom over,” Dr. Dunn said.
Schnabel and Massey immediately made their way to Dr. Dunn’s office located just across the street from the hospital. By this time, it was a little after 3 p.m.
Schnabel was seen and counseled by Dr. Dunn’s nurse practitioner who recommended that she be admitted to the hospital for overnight monitoring. As the couple left to make the short trek back across the street to the hospital, Dr. Dunn reviewed her sonogram images and made the call to act sooner than later.
When the couple arrived at Hendrick Health’s labor and delivery department they received shocking news. Schnabel needed an emergency cesarean section.
In the five minutes it took Schnabel and Massey to walk from Dr. Dunn’s office to the hospital, the labor and delivery team received a call from Dr. Dunn to alert them that Rogan’s heart was in supraventricular tachycardia (SVT), a fast and erratic heartbeat that prevents the blood from pumping throughout the body, potentially leading to congestive heart failure and death.
“The baby’s heart was barely moving,” Dr. Dunn said. “The rate was quick, so the electrical conductivity was passing through, which is what we were detecting on ultrasound and monitors, but the heart itself was barely moving and weary from working so hard. There can be some arrhythmias that are benign, that are sustained for days to weeks. But SVT, in this case, is something that can only be sustained for a few minutes to hours before the baby either comes out of it spontaneously or death occurs.”
Rogan needed to be delivered immediately. His life depended on it.
“We walked in and all of the nurses are standing around and anesthesia is ready,” Schnabel said. “The doctor was ready. The NICU team was there, and I was in a gown with all my jewelry off and an IV going within a matter of probably four minutes. It was very fast.”
The couple knew something was wrong but they had no idea how serious it was.
“Everything happened so fast that it was hard to understand the severity,” Massey said.
Rogan was born at 5:25 p.m., a little more than two hours after Schnabel met her colleague for that impromptu ultrasound.
Schnabel and Massey were able to see their newborn for a few brief moments before he was whisked off for care. Around 8:30 p.m., Cook Children’s Teddy Bear Transport arrived at Hendricks Hospital to transport Rogan to Cook Children’s Medical Center – Fort Worth for treatment of his dangerous heart arrhythmia.
Schnabel’s on-the-fly ultrasound that fateful Thursday set in motion a number of collaborative efforts between pediatric specialists that resulted in an accurate diagnosis and treatment plan, and much of it came together during the couple’s short walk from Dr. Dunn’s office to the hospital.
“It's a reassurance to know that they're in sync with one another to be able to communicate so quickly and get an accurate specialty-type diagnosis within five minutes of the scan,” Massey said.
After connecting the dots between Rogan’s unusual heart rate, the ultrasound, monitor readings and the report from her nurse practitioner, Dr. Dunn made an urgent call to Lisa Roten, M.D., a pediatric cardiologist at Cook Children’s Medical Center. Dr. Roten is the medical director of Cook Children’s fetal electrocardiography program. Scott Pilgrim, M.D., medical director of Cook Children’s adult congenital heart disease program, was also looped into the case.
“There's constant collaboration between us, but in this case, it was just so seamless and easy and I was able to orchestrate the management plan between Dr. Roten and myself, and then Dr. Pilgrim became involved as the handoff happened from here to the medical center in Fort Worth,” Dr. Dunn said. “There was also so much collaboration with the Hendricks Health staff, with anesthesia, the nursing staff and the neonatologist.”
Dr. Roten recommended an immediate c-section for any chance of saving Rogan’s life.
“SVT, or atrial flutter in this case, is not life-threatening if for a short duration,” Dr. Roten said. “However, if it does not break, as was the case here, it results in death. This baby’s heart function was very poor and we did not have time for medicines to be given to mom to try to correct the rate.”
Undetected arrhythmias are the suspected cause of many stillbirths where there is no known genetic syndrome or structural problem, according to Dr. Dunn. If the sequence of events had been any different, Dr. Dunn says it’s likely Rogan would not be alive today.
“I think a lot goes into Rogan’s story,” Schnabel said. “I had the sonogram on that specific day and at that specific time when my coworker had an opening on her schedule and I could have her scan me, and the fact that his heart did what it did at that exact moment is proof that he is here for a reason. We were able to go to labor and delivery and have him within 15 to 20 minutes of showing up and the OR team was ready. Every little thing had to happen for him to still be alive. Through it all I was reminded I’m not in control, God is. This was his plan, not mine. The progress we’ve made over the past few weeks has been from above and I’m thankful for every moment.”
It’s unclear what caused Rogan’s arrhythmia, as is the case with many babies who develop the condition. Rogan spent 19 days in Cook Children’s Neonatal Intensive Care Unit where he was diagnosed with a type of SVT known as atrial flutter, in which the upper chambers of the heart pump rapidly. He underwent two cardioversion procedures to shock his heart back into a normal rhythm and is now on medication to control his heart’s pumping function.
It’s possible he’ll grow out of the condition altogether. If not, he may need a cardiac ablation in the future. An ablation is a procedure where doctors burn or freeze tiny scars into the heart to block irregular electrical pulses so that the heart stays in a normal rhythm.
“The electrical system of a newborn is immature and most babies outgrow the arrhythmia by one year of age,” Dr. Roten said. “But this rhythm was harder to control and sometimes they need to go to the cath lab to have an ablation.”
For now, Schnabel and Massey, are back home in Abilene with their newborn enjoying their full house, which includes Rogan’s brother and sister, both 10 years old.
“I'm just thankful for the support that we've had from the community,” Massey said. “Our friends and family have been overwhelmingly supportive.”
Maternal Fetal Medicine
Maternal fetal medicine (MFM) is a rapidly evolving medical field that concerns the health of fetuses and pregnant women. Specialists in the field are obstetrician-gynecologists who focus on the assessment and management of high-risk pregnancies.
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