CASE STUDY: Caring for a newborn with a cardiac condition

The client contacted Logimedex on 11 December, requesting medical information about a 17-day-old patient who had been receiving hospital care since birth, in the paediatric intensive care unit (PICU) of a public general hospital in Northwest Mexico, close to the US border. They stated that it was a highly sensitive matter timewise, as the patient had been diagnosed with a high complexity cardiac anomaly at birth, as well as a hospital-acquired bacterial infection.

First steps Public hospitals in Mexico do not release information to medical insurance or third party payers, and they are legally obliged only to release medical information to the patient or a direct family member. Consequently, we had to establish direct contact with the patient’s mother to request her cooperation. The treating physician gave the parents an appointment for noon on 12 December to provide medical updates. So, we sent a medical field agent, under the parents’ authorisation, to gather as much information as possible, to provide our client an insight in order to plan the following steps.

Receiving news

The medical team recommended that the patient was transported to a higher level of care (HLOC) facility, due to the confirmed diagnosis. A total anomalous connection of Type 2 pulmonary veins to the coronary sinus was causing pulmonary hypertension – requiring urgent surgical intervention of the kind the current hospital couldn’t provide. Despite information gathering yielding a big step forward, we faced a big obstacle: the patient’s mother would only authorise surveillance, as she hoped the US Consulate will expedite her visa and the patient’s documentation to continue with the surgical treatment in the US.

Planning continues

On 13 December, our client mentioned they were working on the arrangement of admission at a Children’s Hospital in San Diego, and requested our assistance in arranging ground transport on both sides of the border. However, with the patient being born in Mexico and lacking US documentation, this transfer would have to wait. The mother also mentioned she had a consulate appointment as part of the visa expedition process – but didn’t receive any confirmation. Despite this, she decided to wait.

Running out of time

By 16 December, there was still no clear timeframe of when a visa might be obtained. By this time, both we and our client had serious concerns about the patient staying at the current hospital while waiting for a decision. We began searching for the best HLOC Hospital nearby – which luckily was located in the same city as the first facility.

We contacted the HLOC Hospital to confirm they had the necessary medical capabilities to provide the medical care to our patient: A PICU; paediatric specialists; paediatric intensive nurses; ECMO facilities. They did – the Medical Director accepted to treat the patient. When offering the patient’s parents the option of transferring to a local HLOC, they accepted – but only for surveillance, as they were still hoping to get some news from the consulate.

Coordinating services against the clock

On 17 December, under our client’s approval, we submitted our guarantee of payment to the HLOC hospital and arranged a ground ambulance transfer with advanced cardiac life support and an appropriately certified paediatrician and paramedics. At 10am local time, the patient was admitted to the hospital and properly assessed. At this time, the parents had received a request for the baby to be brought to the US consulate on 19 December. The medical team warned that performing another transfer was risky, as the patient’s condition was much worse than reported by the first hospital – requiring urgent surgical procedure. The prognosis for this kind of diagnosis is poor, and surgical treatment had to be performed within the first 30 days of birth.

The proposals – life threatening conditions require speed and swift coordination

Options and time were limited. Despite the hospital having a great high specialty staff, there was no paediatric cardiac surgeon in town. We could either have doctors from Mexico City, or San Diego in the US, brought in to perform the procedure at the hospital. However, the San Diego option would require them to have credentials to operate legally in Mexico, potentially taking more time.

On 18 December, the parents and client elected to bring a surgical team from Mexico City to perform the surgical procedure at the HLOC hospital. We quickly coordinated with the hospital to bring a team in – comprising three paediatric cardiac surgeons, a paediatric cardiac anaesthesiologist, a cardiac instrument technician, two perfusionists and a cardiovascular intensivist. They were flew in during the evening, and the operation was scheduled for the next day – 19 December.

A successful outcome

At 25 days old, the patient underwent a high complexity cardiac operation, resulting in the total correction of all detected cardiac defects. After surgery, the patient remained stable, with vital signs within adequate ranges, and was kept under surveillance in PICU. He was kept for one more week to complete a program of antibiotic scheme for the initial nosocomial infection, and was discharged successfully on 27 December.