Preemie Gets Pacemaker

Preemie Gets Pacemaker
By Chris Kaiser, Cardiology Editor, MedPage Today
Published: February 16, 2012

A baby born nine weeks premature with congenital heart block is the smallest ever to receive a pacemaker -- she weighed just 3.5 lbs and her heart was the size of a walnut.

Doctors at Stanford University's Lucile Packard Children's Hospital had diagnosed the heart defect before the baby was born and had planned the pacemaker insertion, according to a statement from Stanford University Medical Center in Palo Alto, Calif.

The initial plan was to surgically insert temporary pacing wires into the baby's heart and connect them to a device outside her body, then do a permanent placement a few weeks later.

But when she was born, via cesarean section, surgeon Katsuhide Maeda, MD, noted that she was stable enough to undergo permanent placement with the first intervention. Her heart rate was 45 beats per minute, below the threshold of 55 bpm when immediate artificial pacing is considered essential.

The girl's parents, Leanne and Kamneel Maharaj, of Hayward, Calif., were referred to Packard Children's when Leanne was 28 weeks pregnant.

From that time until the baby, Jaya, was born, physicians monitored her heart twice weekly, observing the heart rate and growth, as well as looking for fluid around her heart and lungs.

They gave the mother a steroid medication to help prevent further damage to the fetus's heart.

About 20% to 50% of patients diagnosed prenatally with heart block die in utero or in the first weeks after birth.

"We knew that at any time the baby's heart could give out," said neonatologist Valerie Chock, MD, who was involved in the birth, in a statement.

But the multidisciplinary team at Packard Children's decided it was safe to wait until 31 weeks' gestation for delivery because of the overall growth of the fetus and the absence of signs of heart failure.

When Jaya was born on Nov. 22, Leanne and Kamneel had a few minutes to welcome their new daughter into the world before she was rushed into surgery.

The pacemaker leads required eight stitches to the heart; the pacemaker was implanted in Jaya's upper abdomen. Within two hours of birth, the baby's heart rate was normal.

She spent six weeks in neonatal intensive care and went home Jan. 12.