A Modern Lazarus
Three days ago in late afternoon, I walked over to the pediatric ward for my usual teaching session with the interns. As often happens, our meeting was interrupted by an acute admission. The story was that a mother had given birth as a home delivery two months prematurely to a baby who initially did well for a few days, then quit nursing and became progressively inactive. The mother took the baby to a district clinic, and was told to take the baby immediately to Maua Hospital. On arrival on the pediatric ward, the baby was breathing only intermittently, was cold and unresponsive. The core temperature was 91 degrees and the incubator was not functioning. I quickly found out that hospital policy was that babies over one week old could not be admitted to the nursery. The charge nurse made a quick phone call insisting on transfer, and we bundled the baby to the mother kangaroo style, and rushed to the nursery. By then the baby had quit breathing entirely and was limp and unresponsive. We began resuscitation with bag and mask, and filled four rubber gloves with hot water and placed them around the baby for immediate warmth. Although we maintained the heart rate above 60, over the next 1 _ hours of bagging, the baby made no respiratory effort, and remained completely limp and unresponsive. We very reluctantly made the decision to stop our resuscitation. We prayed together with the grieving mother, who had watched the whole effort. Within a minute or so after the prayer the baby took a breath. I thought it was just a terminal gasp, but then he took another, and another, and then began spontaneous regular breathing and moving all extremities. The heartbeat became full and strong.
Three days ago in late afternoon, I walked over to the pediatric ward for my usual teaching session with the interns. As often happens, our meeting was interrupted by an acute admission. The story was that a mother had given birth as a home delivery two months prematurely to a baby who initially did well for a few days, then quit nursing and became progressively inactive. The mother took the baby to a district clinic, and was told to take the baby immediately to Maua Hospital. On arrival on the pediatric ward, the baby was breathing only intermittently, was cold and unresponsive. The core temperature was 91 degrees and the incubator was not functioning. I quickly found out that hospital policy was that babies over one week old could not be admitted to the nursery. The charge nurse made a quick phone call insisting on transfer, and we bundled the baby to the mother kangaroo style, and rushed to the nursery. By then the baby had quit breathing entirely and was limp and unresponsive. We began resuscitation with bag and mask, and filled four rubber gloves with hot water and placed them around the baby for immediate warmth. Although we maintained the heart rate above 60, over the next 1 _ hours of bagging, the baby made no respiratory effort, and remained completely limp and unresponsive. We very reluctantly made the decision to stop our resuscitation. We prayed together with the grieving mother, who had watched the whole effort. Within a minute or so after the prayer the baby took a breath. I thought it was just a terminal gasp, but then he took another, and another, and then began spontaneous regular breathing and moving all extremities. The heartbeat became full and strong.
In fifty years of practice I can only remember one other such a recovery. The initial failure to respond was certainly in part due to the low body temperature. That same low temperature may have helped save the baby’s brain from severe damage. The gloves filled with hot water certainly helped save a life, as did the expert bagging by the interns that I had just trained in resuscitation the week before. Yesterday the baby began breastfeeding, and the neurological exam remains normal.
You might call it coincidence that the baby started to breathe within a minute or two after we had prayed for him and his mother. I would call it a miracle.
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