Congenital Heart Defects – Be Aware, Be Prepared


February is Congenital Heart Defect Awareness month. You might have read my post about my baby, Zaki and his broken heart and how his life was saved by some amazing cardiologists, surgeons, consultants and nurses. Our outcome was a happy one but we all would’ve found it so much easier to cope if we’d been aware and been prepared.

Before Zaki was born I knew absolutely nothing about congenital heart defects and assumed that if there was anything wrong with my baby’s heart it would have been picked up at my 20 week anomaly scan. Wrong. Only 50% of the type of defect Zaki had are spotted during the anomaly scan. When I was told about the diagnosis I wish I’d known more about it; instead I felt confused and helpless. I’m passionate about raising awareness wherever I can now, so here are some helpful facts about congenital heart defects:

  • Congenital heart defects are problems that have occurred with the structure of the heart as it was formed (‘the plumbing’)
  • There are 18 recognised main congenital heart defects, with variations of each one
  • 1% of babies will be born with a congenital heart defect and it is the most common defect in newborns
  • That’s 12 babies a day in the UK that are affected
  • Out of those 12 babies, 4 will have been diagnosed pre-natally, 4 will be diagnosed shortly after birth and 4 will go home undiagnosed until they fall ill or die
  • The heart is formed within the first 6 weeks of a foetus’ life and the defect has probably occurred before the mother even knows she is pregnant
  • Congenital heart defects kill twice as many children as all childhood cancers combined

 

Scary stuff isn’t it? But it isn’t all bad news. With early intervention 90% of babies born with a congenital heart defect go on to live happy, long lives.

 

My baby after his open heart surgery, just days old

 

My baby at 6 months old
There really isn’t anything a mother can do to prevent her baby being born with a congenital heart defect but there are steps that can be taken to make sure it’s picked up as soon as possible.

At the 20 week anomaly scan the following questions can be asked of the sonographer:

  1. Can you see the 4 chambers of the heart?
  2. Are there 2 upper chambers and are they controlling the blood flowing out of them with valves?
  3. Are there 2 lower chambers and are they controlling blood flowing out of them with valves?
  4. Do the two great arteries (aorta and pulmonary artery) cross over each other as they exit the heart?
  5. Are there any holes in the wall between the two lower chambers?
  6. Can you see any abnormalities at all with the heart?


If you are pregnant, write those questions down, take them with you and ask. It’s worth it. The sonographer might not be able to answer all of those questions and might put it down to the position of the baby. If that happens offer to go for a walk and come back in 10 minutes. You might sound like a pushy mother-to-be but who cares? It might just save your baby’s life. I so wish I had asked those questions. Knowing about a congenital heart defect prior to the birth increases the baby’s chances of survival and also means the parents can mentally (and practically) prepare themselves for what’s to come.

There’s an amazing charity called Tiny Tickers who do great work in funding training for sonographers so that more CHD’s will be spotted at the anomaly scan. You can order a card free of charge from the Tiny Tickers website here which you and the sonographer can go through together at your scan if you’d prefer to do that rather than ask the questions above.

If a congenital heart defect isn’t picked up at the 20 week anomaly scan there are signs and symptoms that might become apparent once the baby is born:

  • Rapid breathing
  • Rapid heartbeat
  • Cyanosis (skin looks blue, especially hands and feet)
  • No interest in feeding
  • Fatigue (baby will not wake)

 

Zaki was too tired to feed, which prompted a doctor to checks his sats.

If you have any concerns AT ALL please insist that a pulse oximetry test is carried out on your baby. It’s a really quick, non invasive test that involves a sensor being placed on a finger or toe. The oxygen saturation levels (sats) in the blood can be measured that way and if they are lower than expected, that suggests a problem with heart function and further tests can then be carried out to establish exactly what’s going on.

Don’t be embarrassed/shy/too polite to ask for that test to be carried out if you are genuinely worried that your newborn isn’t behaving as he or she should. That simple sats test saved my baby’s life. (For the first time, his life was about to get saved several times over the following weeks but that’s another story.) Don’t sit there quietly panicking, just explain your worries and ask for the test.

If you go home with your baby and later notice something isn’t quite right go to a&e. Heart defects are time critical and every second matters. Don’t worry that you are being over-cautious, just get your baby checked out. Your instinct might save their life.

Of course 99% of babies do not have a congenital heart defect so please do not let this post worry you sick. The chances are that your baby will be absolutely fine. But it doesn’t hurt to be prepared. Something that I definitely wasn’t when I was told there was something wrong with my baby’s heart a few hours after I had given birth.

If you find yourself in the position that I was in try to take comfort in the fact that the cardiologists and surgeons will do absolutely everything possible to save your baby and above all else, stay strong.

My Baby’s Broken Heart (Transposition of the Great Arteries)

This is a pretty heavy subject matter for a blog post but what happened changed me, it changed my outlook on life and it changed the way I think and even the way I feel. I  have a need to write about it. So here we are…

Day 1

Newborn Zaki. Not a hint of anything wrong.

On 17th July 2015 at 4.48am I gave birth to my second baby boy, Zaki. I’d had a c-section with my first and I was pretty pleased that I’d managed a vaginal birth with 8lb 5 Zaki, mainly because it meant I could go home soon and bask in the post-birth afterglow and mist of love that surrounds you when you’ve just had a baby, and be with my two precious boys. Or so I thought.

Everything seemed fine at first. I took some snaps of my new arrival and texted my nearest and dearest to let them know that he’d arrived.

Zaki took his first feed from me. Not much, hardly anything really. But hey, he’d just been born, he needed a rest, so we let him off. When I attempted another feed around an hour later Zaki wouldn’t wake or attempt to drink at all. Not too worried, I told the midwife who was in the room at the time. She suggested we try with a syringe to get him interested and left the room to get one. It just so happened that there was a doctor outside when she opened the door. She asked him if he’d come to check over Zaki. He hadn’t, but he would do, as he was there. I still wasn’t worried.

The doctor started checking over Zaki and after around a minute shouted outside that he needed help. A midwife rushed in. I started to worry. He told the midwife that Zaki’s sats (oxygen saturation levels) were very low. The midwife replied that they couldn’t be because Zaki was “a good colour” and his machine must be wrong. He tried again with another machine; still very low. He told the midwife to get Zaki to special care immediately. There was absolute panic in his voice. I was crying now.

We found out over the course of the next few hours that Zaki had been born with a congenital heart defect (CHD) called Transposition of the Great Arteries (TGA). I won’t go into too much medical detail (if you want to know more this website explains well) but basically two arteries were in the wrong position and pumping blood to the wrong parts of the body. They needed to be swapped over and a consultant who came in especially to diagnose Zaki told us that if something wasn’t done that day Zaki would die.

Zaki being prepared for the journey to Leeds General Infirmary by air ambulance.

Zaki was deteriorating rapidly. He was put into an induced coma and onto a ventilator. The air ambulance was called, and he was flown to Leeds General Infirmary within the first few hours of his life. I couldn’t fly with him, I had to say goodbye, knowing that it might be a forever goodbye. Not knowing if he’d be alive when I saw him again. My heart was broken into a million pieces seeing his tiny body in that pod, knowing there wasn’t a thing I could do to help him. I put my trust in the air ambulance doctors who were amazing at trying to reassure me. They told me he was “very very sick but we’ll do everything we can”. The looks on their faces gave more away than their words though.

I was told that as soon as Zaki got to Leeds a procedure called a balloon septostomy would be performed on him to create a hole in his heart so that the blood could mix and more oxygen would be circulated around his body.

The rest of that day is mostly a blur. I don’t remember the journey to Leeds. I do remember that I Googled like mad to try and find out as much as I could about TGA. I’m the kind of person that clings onto statistics, so I was comforted when I read that 90-something percent of babies born with TGA are successfully operated on and go on to live healthy lives with no need for further major surgery. Zaki’s case was more complicated, although nobody knew why until the surgeons actually opened his chest and looked at his heart. But if your baby is born with TGA, the chances are, he or she will be fine.

In Zaki’s case we didn’t know that he had TGA before he was born, it wasn’t picked up at his 20 week anomaly scan and apparently around 50% of cases are not picked up pre-natally. If we had known, Zaki would have been born in Leeds, rather than in our local hospital.

Usually the balloon septostomy will buy time for a baby to grow and become strong enough for heart surgery, around 7-10 days after being born. When I arrived in Leeds I was told that the procedure hadn’t improved Zaki’s sats as much as was hoped or as much as it usually would. Sats should be as close to 100 as possible; Zaki’s were in the 60’s. The doctors couldn’t work out why.

Day 2


The next day was probably the worst because it really hit home what was happening. The doctors couldn’t understand why Zaki was so poorly. A consultant in the Peadiatric Intensive Care Unit (PICU) told me that “Zaki probably wouldn’t survive”. I looked at her blankly. She said it again. I nodded but I didn’t believe her. My brain wouldn’t let me believe her because it knew that if I did I wouldn’t be able to function.

A few hours later she told us that Zaki was so ill they might have to operate as an emergency that day. It was a Saturday but she had called the surgical team in to discuss whether to operate. She told us that if they didn’t Zaki would probably die but if they did, he was so ill that he would probably die in surgery. I really don’t know how I survived as she was telling me this. I was on autopilot. I was hearing the words but not taking them in. I was responding to her but it wasn’t me speaking. It was decided the doctors would try  everything they could think of to improve Zaki’s condition as much as they could and he would be operated on the next day.

Day 3

Zaki looked so ill that day. His whole body and face were extremely swollen due to the extra fluids that were being pumped into him.  
I signed the consent forms. The surgeon and cardiologist spoke at length about the operation and the risks. I only heard “death, brain damage, organ failure”. I begged the surgeon not to let him die.

I was told the operation would last around 3 hours. It was more like 9. The longest 9 hours of my entire life, it felt like days. Some people go shopping, go for a meal, go to sleep while their baby is in theatre. I couldn’t do any of that. I didn’t eat or drink anything. I was in a daze. My stomach was in knots, I could feel my heart physically aching. The last thing the doctor had told us was that Zaki was in a really vulnerable situation and that I had to prepare myself for the worst.

For the majority of the 9 hours I sat in the waiting area of PICU, I moved only to go into a private side room to express the milk that by some miracle, kept on coming despite the stress. The doctors had said they’d come and get me as soon as the operation was over. It was excrutiating and when the nurse finally came to tell us the operation was over I was shaking, through anxiety and sheer exhaustion.

I was taken into a room with the surgeon, a cardiologist and a nurse and it was explained to me that upon opening Zaki’s chest they had found that he had TGA and 2 holes in his heart. But what was causing the biggest problem was his coronary artery, which was too narrow; a quarter of the size that it should have been. That’s the reason he had been so sick. The amazing surgeon, Stefano Congiu, had managed to make it bigger but he had no idea how successful the surgery was going to prove to have been. He’d never performed this kind of surgery before and neither had anyone else. Newborn hearts are the size of a walnut, the suture the surgeon was stitching with was finer than a strand of my hair. That this kind of surgery can be performed at all is a miracle to me.

The surgeon told us that 1 in 4 babies in this situation would die. I immediately flipped that statistic and replied that that meant that 3 in 4 would survive.

While Zaki was in theatre his heart was stopped and he was put onto a bypass machine (called an ECMO machine) so that the surgeon could operate. The ECMO machine pumps the blood around the body, bypassing the heart and lungs.

I’d been warned that he might come out of theatre still on that life support machine so that his heart and lungs could rest, but he didn’t, which I was told was a very good sign.  But it didn’t last. After about 2 hours the doctors asked everyone to leave PICU because they needed to implement theatre conditions to put Zaki back on the ECMO machine. His heart was too weak after the surgery and couldn’t function, it was failing, so he needed the ECMO machine to do the work for him while he recovered. His surgeon told us that 1 in every 2 babies in this position would die. Again I flipped it and said “yes but that means 50% survive”. The odds don’t sounded much better when I put them like that.

The ECMO machine is on the right.

After surgery Zaki’s chest was left open. I was warned that it would be. I could see his poorly heart trying its hardest to beat. Looking around the intensive care bay I could see that none of the other babies or children were in the same situation as Zaki. He was the only one on ECMO, as well as being on a ventilator and an enormous amount of life support drugs. We were told the situation had to be assessed on an hour by hour basis. The number of consultants, registrars, surgeons and nurses caring for Zaki was overwhelming. Each of them really trying their absolute hardest to save my baby. I owe each of them, and the NHS, so much more than I will ever be able to give.

Days 4-9 


Zaki’s surgeon told us that the maximum number of days he could be on the ECMO machine was 10. After that the blood would start clotting and there were other risks that came with the machine that would become greater, such as organ failure and brain damage. Also, in their experience, if a heart isn’t well enough after 10 days of rest, it’s never going to be. Each morning an ECHO (scan) was done on Zaki’s heart to assess the function. Each day I was told there was a slight improvement and that’s what I clung onto. As I walked down the hospital corridor on my way to PICU each morning I would beg and pray to God that the ECHO showed an improvement.

I was told on several different occasions that Zaki probably wasn’t going to survive and I should prepare for the worst; that he was deteriorating, that I should call people to come and say goodbye.  But I always kept the belief that he could fight through it. I never once allowed myself to fully process that I might not be taking my baby home to meet his brother. And he was such a fighter, he always bounced back after each set back, his strength gave me strength.

After 5 days on the ECMO machine the doctors decided to try to take Zaki off it. It was another agonising wait, this time for 4 hours. But he came off it and his heart and lungs were now working, his body was working, with the help of a ventilator, a dialysis machine and too many drug infusions to count. I was ecstatic, I started to dare to think about taking my baby home one day soon. That night though, Zaki took a turn for the worse. I stayed with him until 4am when his nurse persuaded me to go and sleep and she would call if there was any change. I didn’t get a call and when I called PICU at 8am they told me that Zaki had started to improve again and was doing much better.

Days 10-17 


 Generally, things improved and improved from there on in. We had a few blips, a few blood transfusions, a few bad blood gas results and changes in medication. But we were starting to slowly relax and daring to believe he would be ok soon. His chest was closed 2 days after being taken off the bypass machine and as the sedatives were reduced he became more alert and opened his beautiful eyes on day 11.


Zaki was still sedated and on a huge amount of morphine, which was gradually being reduced. The next big hurdle was coming off the ventilator and making sure Zaki could breathe for himself without tiring. After a few failed attempts he mastered the breathing thing on day 20, which meant that I could finally hold him!!! I was so happy I thought my heart would burst. I still tear up thinking about that moment he was placed into my arms.

The first photo of me and my boy.

He spent 3 weeks exactly in PICU before he was transferred to the high dependency unit (HDU) of the paediatric cardiology ward.  

Days 21-28

My oldest boy, Omar, only just 2 himself, finally got to meet Zaki when he was transferred to HDU. During the whole time Zaki was in hospital Omar stayed with my parents while I stayed in a house on hospital grounds for families of sick children. The Sick Children’s Trust relies on charitable donations to run the houses and it was a godsend. I missed Omar so so so much and felt unbelievably guilty for leaving him but leaving Zaki wasn’t an option.

Omar meeting Zaki for the first time.

After one week on the cardiology ward Zaki was transferred to our local hospital to be weaned off morphine and oxygen and establish feeding.

The ambulance journey from Leeds.


Days 29 – 42

I had been expressing milk since Zaki was born but my neglected and stressed-out body couldn’t make enough by week 5, so he was having formula top-ups. Because he was sedated for so long Zaki had lost his sucking reflex though, so he was being tube fed. There was talk of Zaki being discharged with oxygen canisters and his feeding tube still in situ but in the end he needed none of that. He started to take his feeds from a bottle, ditched the oxygen and exactly 6 weeks after he was born, on day 42, we went home.

It wasn’t all plain sailing once we got home. Zaki was prescribed (what seemed like) all the medicine in the world. It took me an age to prepare and administer it three times a day. He also had an undiagnosed cow’s milk protein allergy and vomited every single one of his feeds. Omar was confused and annoyed about being left for so long and I bore the brunt of it. Plus I was constantly (and I mean constantly) checking that Zaki was breathing and not blue.

My boys.

Things have settled down a lot now. Omar loves me again and Zaki only takes two medicines a day. He’s also on hypoallergenic formula and gaining weight well. He had an appointment with his cardiologist this week, who was very pleased with his heart function and how he presented.

Neither Omar nor Zaki will remember those 6 weeks of hell when they’re older, thank goodness, but I can honestly say I’ll never be over it. Sometimes I look back and wonder how I got through the days. I think about the other children that were in PICU over the weeks. The boy that was brain damaged during his surgery, the baby that didn’t make it after her surgery, the 11 year old girl that had such a rare type of cancer nothing was known about it and her mother’s wails as she died.

Me and my baby were lucky. I’ll never stop counting my blessings and I’ll never ever stop championing the NHS for saving my baby’s life.

 

A Bit Of Everything

Kid Constipation

*Warning: this post contains poo talk and general rankness*

I know I’ve been AWOL for a while and as per my previous post, the reason was my poorly 2 year old. Well, we got the the bottom of the issue (literally the bottom) and he seems to be almost back to his usual self. 

He had been vomiting every day, starting  around 2-3am, for a week and he’d had diarrhoea as well. So in the early hours of Wednesday morning I decided to take him to a&e because he appeared to be dehydrated and was refusing liquids. And quite frankly I couldn’t handle the prospect of further nights of hardly any sleep. 

It wasn’t the first time he’d gone through a longish period of diarrhoea and vomiting either. The previous times our GP had said it was virus and I’d just assumed he’d picked up a bug at nursery. But after the third episode I thought it must be something more than just a bug. 

Sleeping in the pretty grim looking children’s ward room

From a&e he was admitted to the children’s ward to be rehydrated and so a few tests could be done to figure out what was going on. Long story short – he was so impacted with poo that the new foods he was eating had no room to digest in his already full gut, so they were coming back up. Lovely. Constipation had been an ongoing problem but because of the diarrhoea I’d assumed he was clear. Not the case. The diarrhoea was food squeezing around the mass of stuck poo, in a desperate bid to escape the overcrowded gut of my son. 

As I said, constipation had been an ongoing issue. My second child was born with a congenital heart defect, very nearly died, and was in hospital for 6 weeks after he was born. During that time I stayed in hospital with him, for the most part in a hospital a few hours away from where we live. My eldest had just turned 2 and he stayed with my parents, and although he was well looked after, he was unsettled. It was the first time he’d been away from me for more than a few nights at a time and I was only seeing him once or twice a week when he visited the hospital. It was during those awful weeks that the constipation took hold. 

What causes constipation in children?

I had no idea constipation in children was so common until I took my boy to a clinic and it was rammed full of bunged up kids. The paediatric specialist explained that it is really common and there are several causes for constipation in a child; it’s not always as simple as just putting it down to diet. 

Illness – a period of illness, just a simple cold or tummy bug, can cause constipation.

Habit – if a child passes a painful stool once they might be fearful of going again and try to hold their poo in. Leading to harder stools and a vicious cycle. 

Diet – obviously if a child isn’t eating much fibre it can cause them to be constipated. 

Historic – some babies are born with bowel issues and might be constipated from birth. 

So how can it be dealt with? Initially I tried all the usual remedies; apple juice, prune juice, lactulose, etc. When they didn’t work my GP prescribed Movicol (a powder that is dissolved in water) but that still didn’t work. What was required was a disimpaction regime, which was started off at the hospital. The backlog (log! Haha!) had to be cleared out so the number of sachets of Movicol I gave my boy was doubled every day until he had the worst diarrhoea anyone in the history of the universe has ever had. I’m talking a tsunami of brown water from the bog of eternal stench exploding from his backside. In fact it was worse than that, I don’t even have the words.  

 

The universal chart of poo. Aim for a 5!
 
Once the stuff coming out was brown water with bits in I knew he was cleared out and we could reduce the Movicol to a maintenance dose. I’d been given a handy poo chart so I knew what consistency of poo I needed to aim for. (Seriously, I can’t believe the words I’m typing sometimes.)

When a kid has been constipated their colon becomes enlarged (doctors call it megacolon but that makes me snigger!) so Movicol is required, sometimes for years, to help retrain the gut and get it back into shape.

Although the doctors were generally great, no one really told me what to expect with the disimpaction regime or how I would know the poo mass had been cleared out but I found this great website, which has a lot of info: The Children’s Continence Charity. I’d recommend checking it out of you’re ever faced with a poo query. 

Or you could always ask me. I’m pretty read up on kid constipation now. Can’t say it was ever something I intended to master but such is a mum’s life!

When Silence Isn’t Golden

My son is two and a half years old and he doesn’t talk. He doesn’t say mummy, he doesn’t say daddy. He never has. At the moment the only thing he does say is “oh no”.

As a baby he babbled away, giggled and cooed when I expected him to; there was no sign that he would be late talking or that anything was wrong.


 IMG_7843-0
With each day that goes by without him saying anything I get that little bit more worried and that little bit more sad. I’m desperate to have little chats with him; to hear about what he did at nursery; to listen to the nonsense that 2 years olds come out with. I feel like we’re missing out on so much. And I feel guilty. Did I do something wrong? Did I not chat to him enough? Did I chat too much so that he couldn’t get a word in?

Last night I dreamt that he was singing along to ‘heads, shoulders, knees and toes’ whilst doing the actions and I was so so happy in that dream.

Until about 4 months ago I didn’t worry at all. He was so good at other things I just thought he was a late talker and he’d soon be chatting away. But when his 27 month check up came around with the health visitor he was extremely behind when it came to speech and language. That included understanding. He didn’t understand simple instructions. He understands more now (get your shoes, get your cup, etc.) but he’s still very behind. And my fear is that he won’t catch up; that he won’t ever talk normally.

I’m a natural born worrier and when I’m faced with something I don’t know much about I read and I research. Inevitably that means a lot of Internet research, which isn’t always a good thing. So far I’ve convinced myself that my boy has several different disorders (speech apraxia, autism, even brain damage) and occasionally convinced myself that actually he is fine and any day now I’ll hear that word I’m so desperate to hear; mama.

We have a speech therapist involved and my son goes to a really good Montisorri nursery 3 afternoons a week and they’re really trying to help him along too. We follow all the advice given; my sister bought him lots of different flash cards; my brother tries to encourage speech through play with his favourite toys; but so far nothing. And it’s really hard to keep up the enthusiasm when you’re faced with a wall of silence.

My family and some close friends know how much the issue is affecting me as a mum. And I end up explaining it to other people too, for example when a friendly old lady in a shop tries to talk to him. “Sorry, he’s not being rude, it’s just that he doesn’t talk yet, he’s got a speech therapist, I’m sure it won’t be long now, he says ‘oh no’…”. I end up with verbal diarrhoea to compensate for my boy’s lack of speech.

People tell me not to worry because worrying won’t change anything. Well, yes, I know that, but to get my brain to chill out about this I’d probably have to be sedated. When it comes to our kids how can we not worry?

And the biggest worry is that he won’t ever talk properly and he won’t lead a happy life. Everything will be harder for him, he won’t be “normal”. It probably sounds dramatic but I’m being honest and laying out my fears. And I know this might seem like something trivial to be fretting over to another parent whose child has a severe disability for example, and I get that, but for us right now for me this is my biggest worry.

For now I just have to keep encouraging him and keep hoping speech will come. On the one hand I’m told that the earlier the intervention the better the outcome but on the other hand no diagnosis can usually be made before a child is 3. It’s really frustrating not knowing what the problem is but the thought of him being diagnosed and labelled almost has me in tears too.

Sorry for the melancholy post, I just felt the need to share. And maybe someone might read who has some helpful advice. Although if I hear “well Einstein didn’t talk until he was four” one more time I reserve the right to climb the nearest tree and lob apples at people’s heads indiscriminately.

  

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A Bit Of Everything