'Duct Busters' team travels to perform newborn heart surgery at regional hospitals

December 08, 2003

An experienced pediatric cardiothoracic team can travel to regional hospitals to perform sophisticated heart surgery on premature infants without compromising safety or effectiveness, according to a new study. Bringing surgical care to the patient eliminates the risks associated with transporting a medically fragile newborn and reduces stress for families.

The Children's Hospital of Philadelphia team, known informally as Duct Busters, repairs a life-threatening heart defect called patent ductus arteriosus (PDA), in which a major blood vessel fails to close after birth. Most common in premature newborns, this open duct causes abnormal circulation in the newborn and can lead to heart failure and impaired lung function. Medication may succeed in closing the duct, but in some cases, surgical closure with small titanium clips is necessary.

"We can bring the same comprehensive, high quality surgical care available at Children's Hospital to the bedside of infants across the region," says Douglas S. Gould, C.R.N.A., M.S., a certified registered nurse anesthetist and lead author of the study. "In addition to avoiding the risks of transport, this approach allows families to stay in the environment that is familiar to them."

In the study, published in the December issue of Pediatrics, the team compares the records of 72 patients who had surgery for PDA by the Children's Hospital team between 1996 and 2002. Of the 72 patients, 38 had surgery on-site at Children's Hospital and 34 underwent the procedure at one of six referring hospitals. The team found no anesthesia-related complications reported in either group and there was no significant difference in the incidence of surgical complications between the groups.

In 1997, the Children's Hospital Duct Busters team began offering the traveling service to referring hospitals for patients with PDA. In addition to the expertise of a comprehensive team of pediatric cardiothoracic surgeons, cardiothoracic anesthesiologists, nurse anesthetists and dedicated cardiac operating room nurses, the team also brings its own surgical equipment and medication. To date, the Duct Busters team has performed more than 125 procedures in 12 hospitals across Pennsylvania and New Jersey, traveling anywhere from one block to 75 miles away from Children's Hospital.

"Having an infant in the hospital can be enormously stressful for families," says Susan Nicolson, M.D., director of Cardiothoracic Anesthesia at The Children's Hospital of Philadelphia. "If we can safely bring our services to them, then medically and socially it is the right thing to do."

The team credits the safety and effectiveness of this approach to the experience of a multidisciplinary team and extensive preoperative assessment, planning and collaboration with the referring hospital. "It takes an entire team of professionals working together to make this a safe and successful service for the community," adds Mr. Gould.

In addition to Mr. Gould and Dr. Nicolson, other co-authors from the Cardiac Center at The Children's Hospital of Philadelphia were Lisa M. Montenegro, M.D., J. William Gaynor, M.D., Suzanne P. Lacy, C.R.N.A., M.S.; Richard Ittenbach, Ph.D., Paul Stephens, M.D., James M. Steven, M.D., and Thomas L. Spray, M.D.
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The Cardiac Center at The Children's Hospital of Philadelphia is a comprehensive center for the care of infants, children and young adults with congenital and acquired heart disease. It was recently ranked as the best pediatric cardiac program in the United States by Child magazine.

Founded in 1855 as the nation's first pediatric hospital, The Children's Hospital of Philadelphia is ranked today as the best pediatric hospital in the nation by U.S. News & World Report and Child magazine. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second among pediatrics in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents from before birth through age 19. For more information, visit www.chop.edu.

Children's Hospital of Philadelphia

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