When first-time parents Genell and Daniel Reynolds held their newborn little boy, Grayson, they were overjoyed. Genell had a healthy, uneventful pregnancy and Grayson was delivered by a midwife in August 2018.
Excited to get home with their new baby, the couple took Grayson home after about 12 hours. Over the next day, Genell began noticing that when Grayson cried, he turned a purplish color.
Although she admits she didn't have much experience with babies, her instincts told her something wasn't right.
A few hours later, the midwife's assistant visited the Reynolds' home to conduct a pulse oximetry, or "pulse ox," screening to check Grayson's pulse rate and blood oxygen level. In 2014, "Chloe's Law" went into effect requiring all Missouri hospitals to perform this test within 24 hours after birth to detect newborn critical congenital heart disease.
In 2013, Missouri Gov. Jay Nixon signed Chloe's Law at SLCH, requiring pulse oximetry screenings for all newborns in the state. The hospital supported the legislation.
The Centers for Disease Control and Prevention says that among all birth defects, heart defects are the leading cause of infant death.
This screening may have saved Grayson's life.
Rushed to Children's
Grayson's oxygen levels were dangerously low -- under 63 percent -- and his lips had a bluish tint. He was quickly taken to the SLCH emergency department.
One of the first physicians to see Grayson was Ginnie Abarbanell, MD, a Washington University pediatric cardiologist and co-director of the echocardiography lab at SLCH.
"This pulse ox screening is key to picking up congenital heart disease, because it's not always obvious from the outside," she says. "What Grayson had may not have been picked up in a fetal echocardiogram."
Grayson's echocardiogram at SLCH didn't immediately show the problem. It took some detective work by Dr. Abarbanell and her team.
A deadly defect
"At first, we had to scratch our heads to figure out why he was having symptoms, because what we saw on the echo didn't fit with why he was blue," Dr. Abarbanell says.
Dr. Abarbanell learned that Grayson had an extremely rare heart defect, cor triatriatum dexter. The defect usually occurs on the left side, which is called cor triatriatum sinister.
Cor triatriatum is a rare congenital (from birth) cardiac defect in which the atrium is divided into two chambers by a membrane, causing obstruction to the blood flow in either the left atrium (cor triatriatum sinister) or the right atrium (cor triatriatum dexter). It eventually leads to heart failure.
"He was getting sick quickly," Dr. Abarbanell says. "When we first saw him, he was not only blue, but also turning grayish because he wasn't getting enough oxygen. Once he was put on a medication called prostaglandin, he stabilized."
Surgery was the only option to fix Grayson's heart, long term.
That's when Dr. Abarbanell's husband, Aaron Abarbanell, MD, a Washington University pediatric cardiothoracic surgeon at SLCH, met Grayson and his family. He performed surgery two days after Grayson was born.
"Grayson's heart defect was tricky," he says. "It was hard to pick up on the EKG. His defect is uncommon on the left but extremely rare on the right side. Grayson had a severe defect with quite a large flap that needed to be addressed."
Because cor triatriatum dexter is so rare, Dr. Aaron Abarbanell hadn't performed corrective surgery on the right side before, although he has performed corrective surgery on the left side.
"The concept is the same," he explains. "We put Grayson on cardiopulmonary bypass, removed the membrane and he was good to go."
"The best of all stories"
"When we realized he needed surgery, I felt overwhelmed -- it was the first moment I felt helpless as a parent," Genell says. "But I was grateful there was a solution for his heart problem, and I trusted Dr. Abarbanell. He explained everything and kept me in the loop. He also was passionate about his work, which I think makes you better at your job. He told me he would treat Grayson like one of his kids until he could get him back to me. We had such a good experience with the hospital in less than ideal circumstances."
While it takes about eight weeks for the breast bone to heal after this surgery, Grayson was home in about a week. At his follow-up appointment two weeks later, Grayson was gaining weight and was happy and healthy.
"This is the best of all stories," Dr. Ginnie Abarbanell says. "Since Grayson's heart was fixed through surgery, he shouldn't have any cardiac issues for the rest of his life. Grayson's good outcome illustrates the importance of pulse ox screenings."
Dr. Aaron Abarbanell agrees. "This is proof positive the system works. When the pulse ox is different than it should be, it means something is wrong, and it's worth investigating," he says.
Says Genell, "I don't know if I can do anything to repay what the hospital did for my son, but I want to raise awareness about the importance of this pulse ox test and listening to your instincts as a mother."