'Cool bag' therapy kept little boy alive

Published Jun 21, 2010

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It looks positively cruel. Baby Finley Burton lies paralysed on a freezing hospital bed in nothing but a nappy, hooked up to a bewildering array of machines.

But such harsh treatment ultimately saved his life.

Finley's tiny body was "frozen" to try to bring his erratic heartbeat under control after a heart operation.

It took four days for him to recover - an agony of waiting for his mother, Donna Link-Emery, and father, Aaron Burton, 31, who just wanted to gather their little boy up for a warming hug.

Link-Emery, 27, said: "It was very frightening. We thought we were going to lose him. His heart was beating really quickly and we prayed he would survive."

The couple took Finley to the doctor when he was 10 weeks old because he was not putting on much weight and had breathing difficulties.

He was immediately transferred to University Hospital of North Durham.

"I had a normal pregnancy and nothing was picked up on any of my scans so I was expecting it to be a routine visit," Link-Emery said.

But the consultant who checked her son's heart thought he could hear a murmur and sent him for an echocardiogram, also known as cardiac ultrasound. He also had an electrocardiogram, which measures electrical activity in the heart, and an X-ray.

The tests showed Finley had a large hole at the top of his heart and a small one at the bottom. He was transferred the following day to Freeman Hospital in Newcastle where staff also discovered an aortic coarctation, a congenital condition in which the heart's main artery narrows. The condition meant that his heart was working at 200 beats per minute.

This had made him breathless and too tired to eat properly, while the few calories he could take on were used up by the hard work of the heart and lungs.

Finley underwent two emergency operations a month ago, when he was 16 weeks old, to block the larger hole and correct the faulty artery, but experienced complications when he came round.

His heart went into junctional ectopic tachycardia, a rapid beat which can be fatal, and doctors decided to lower his temperature to 33.4?C to stabilise the organ. Normally, a baby's temperature is around 37?C.

The process involved placing his body in a "cool bag", through which cold air was pumped to keep his temperature down. This reduced his metabolism which in turn slowed his heart rate. He was then placed on a cooling blanket.

Drugs

Finley was also hooked up to an external pacemaker and intra-venous drugs were used to paralyse him to make sure he didn't disturb the equipment by shivering.

"It was all so sudden and upsetting. Nothing at all prepares you for seeing your baby in hospital like that. I just cried," Link-Emery said.

"Then he was weaned out of his paralysis and his temperature was brought back to normal and his heart started to beat properly again."

Finley spent another 12 days in hospital before he was allowed to go home and is now recovering well, although he needs check-ups every eight weeks.

His mother added: "Now he's doing really well and has already put on lots of weight."

Asif Hasan, the surgeon who operated on Finley, said: "After heart surgery the heart rate often goes up because of the stress of the operation. You have to cool patients down to get a normal heart rate again.

"Finley had a big operation for such a small baby and we're really pleased with how well he did."

After major cardiac surgery, it was no surprise that Finley's heart rhythm went into overdrive, doctors say. This can be life-threatening, because it places huge stress on the organ.

With adults, surgeons would usually use drugs to solve the problem, or shock the heart to return it to its natural rhythm.

These methods can be too dangerous for tiny babies. In Finley's case, surgeons used overdrive pacing, in which the body is cooled to such a level that the heart slows to slightly below its regular rate.

The baby is then placed on a pacemaker. Heart muscle always follows the fastest heart rate which means it will be attracted to the pacemaker rate rather than the one it had been cooled down to, and will settle there. - Daily Mail

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