Transportation "in utero" and implantation of the pacemaker in a premature baby during the first hours of life

Doctors of University Clinic Centre of Medical University of Warsaw set the highest standards of care for a child with congenital heart block. On July 17 2020, Dr. Michał Buczyński, MDPhD from the Department of Cardiac and General Pediatric Surgery UCC MUW, headed by Prof. Maciej Karolczak, and Dr. Piotr Wieniawski, MDPhD from the Department of Pediatric Cardiology and General Pediatrics UCC MUW, headed by Prof. Bożena Werner, successfully performed an implantation of a pacemaker to a premature infant, delivered at week 30 of fetal life, with congenital complete atrioventricular block.

The mother of the child was under a care of the specialist center, where a wait-and-see strategy together with symptomatic treatment of the fetus were implemented. When the baby's condition worsened: the symptoms of a heart failure intensified, the effusion in the fetal body cavities increased, and a heart rate slowed down, the mother contacted the University Clinical Center of Medical University of Warsaw (where her older son with congenital complete heart block after a pacemaker implantation is under care) to ask for help. She was transported to UCC MUW.

A baby, born by a caesarean section, was showing the symptoms of cardiopulmonary failure. The heart rate was 30-50 beats/min. The neonatologists started CPR and intubated the child. Due to the lack of response to the pharmacological treatment, the child was immediately transferred to the operating theatre where the Micron II SR+ ST. Jude Medical pacemaker was implanted. Currently, it is the smallest electrode stimulator available, weighing only 12.8 grams with a volume of 5.9 cm3. The operation was without complications. It took less than 2 hours from  mother’s admission to the delivery room to the completion of the pacemaker implantation surgery.

A newborn baby is in a good condition, breathing spontaneously, with a pacing system properly functioning and, most importantly, a significant improvement in left ventricular contractility is observed.

The therapeutic success was possible thanks to effective cooperation of cardiologists, cardiac surgeons, obstetricians, neonatologists and anaesthesiologists. The diagnostic and therapeutic process involved the following physicians from UCC MUW: Michał Buczyński, Michał Zawadzki, Jacek Kuźma from the Department of Cardiac and General Pediatric Surgery, Piotr Wieniawski, Cezary Niszczota  from the Department of Pediatric Cardiology and General Pediatrics, Michał Chojnacki, Agata Wierzba-Leszczyńska from the Department of Obstetrics and Perinatology (headed by Prof. Piotr Węgrzyn), Beata Borek-Dzięcioł from the Department of Neonatology (headed by Prof. Bożena Kociszewska-Najman), Tomasz Jarymowicz and Katarzyna Szymańska-Beta from the Department of Paediatric Anaesthesiology and Intensive Therapy (headed by Izabela Pągowska-Klimek, PhD) and teams of nurses, midwives, anaesthesiologists, technicians. The whole procedure of saving the child’s life would not be possible without all of them.

Cooperation between doctors from the Department of Cardiac and General Pediatric Surgery UCC MUW and the Department of Pediatric Cardiology and General Pediatrics UCC MUW with Prof. Marcin Grabowski, from the 1st Chair and Department of Cardiology UCC MUW (headed by Prof. Grzegorz Opolski), makes it possible to perform a full range of electrotherapy procedures in children and adolescents at the Pediatric Hospital UCC MUW.

 

Photos: the Department of Pediatric Cardiology and General Pediatrics UCC MUW

 

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