What to Expect When Nathan is Born

Two days after the fetal echo, we met with Dr. Eric Scaife, a pediatric surgeon and head of Trauma Surgery at Primary Children's Medical Center. This consult was also arranged by Dr. Ball.

Dr. Scaife explained the inner workings of a newborn's circulatory system:

Normal hearts pump blood from the right atrium to the right ventricle to the lungs to be oxygenated to the left atrium to the left ventricle and out to the body.

However, in an unborn child, there exists a bypass route that skips the right side portion of the normal route and instead sends the blood to get oxygenated by the placenta.

When the child is born, the bypass closes and generally seals itself within a few days. The baby is then able to oxygenate its own blood through its normal breathing.

If the baby has issues with his or her lungs that prevent it from properly oxygenating its blood (such as would be the case with Nathan), the child's body instinctively searches for another way to do it. Because the bypass has not yet sealed itself, the blood takes the path of least resistance and moves through it as if trying to still get oxygen from the mother.

However, since mom is no longer there, the blood cycles back through the body un-oxygenated. Eventually, the lack of oxygen and the build up of carbon dioxide in the blood becomes fatal. Many children who have this problem are placed on a machine called Extracorporeal Membrane Oxygenation (ECMO).

ECMO is a method for temporarily supporting patients with severe heart and/or lung failure (see above image). The ECMO circuit essentially adds oxygen to the blood and helps the heart pump blood to the body. Basically, it is similar to a heart-lung bypass machine used during open heart surgery but can be used for a longer treatment period. ECMO uses an artificial lung called a membrane. Blood is pumped through this lung by the machine where carbon dioxide is removed and oxygen is added.

Dr. Scaife also explained that 14 days is the longest a baby can generally be on ECMO successfully without increased danger to the child's life.

In addition to explaining ECMO, Dr. Scaife also explained about the surgery our son would need after birth to repair his diaphragm. This surgery generally takes place within a few days of birth to allow the baby some time to stabilize so it can better tolerate the surgery.

His overall prognosis was "worrisome, but not hopeless."

The consult with Dr. Scaife was very informative. It gave us a great idea of what to expect once Nathan was born. His overall prognosis was very sobering, but at the same time it still let us cling to the hope we had of Nathan surviving.