Caroline’s Cold

By Loretta Coureas 

Can (pronounced “Jon”) came 16 weeks early and weighed less than 1½ pounds.
The CHKD transport team knew she had much more than RSV at 4 weeks of age.

Jill and Brian Wainger held their breath as first one and then the other of their baby twin daughters got the sniffles last winter. They knew premature babies like Caroline (below) and Erin are especially vulnerable to the cold viruses that abound during the winter.

The twins were born December 27, five weeks early. They had done well until the sniffles arrived in early January.

“We took Erin to the doctor because she seemed more sick than Caroline,” Jill recalls. “Caroline was eating fine and seemed to be handling the cold symptoms.” But Erin soon improved, and Caroline’s symptoms turned suddenly to severe distress. “She ate, took a nap, and then when I tried to wake her for her next feeding, she was unable to open her eyes, focus or respond.”

Jill and Brian knew that RSV – a common cause of colds in most people – could be devastating to their baby, who at 4 weeks of age weighed barely 6 pounds. So when Caroline’s condition became worse so rapidly, the frightened parents dialed 911. They were grateful only minutes passed before help arrived.

“I wanted them to take her to CHKD, but they had to go to the nearest emergency room,” Brian recalls.

Baby Caroline was now having seizures. The emergency responders could do little more than get her to the ER fast. In the Beach emergency room, an initial blood sample revealed very low sodium in her blood, a rare potential side-effect in RSV cases. But subsequent attempts to draw blood to determine the actual level of sodium were impossible because her blood was clotting.

The call went out to the CHKD mobile intensive care unit to come to the Beach and get her.

“You can imagine our relief when the CHKD team walked in,” Jill said. “I will never forget that sight.”

In a letter praising CHKD transport nurse Susan Frey and her team a few months later, the Waingers wrote: “Susan Frey exuded confidence in a room full of uncertainty, calm amidst a sea of panic. We could all look at Caroline and understand the gravity of the situation.”

The CHKD nurse was aware that seizures could be a result of low sodium in an infant’s blood. Frey recalls, “We knew immediately that this was not a typical RSV infection.”

Lori Kaliher, CHKD respiratory therapist, and Rob Munro, paramedic, worked to establish an IV line in the baby’s arm. “It’s really hard when a child is dehydrated and so small,” Kaliher said. While en route, the team was on the phone with the pediatric specialists at CHKD who would help them decide what to do next.

Critical care physician Robert Gomez in CHKD’s intensive care unit remembers the call. “Low blood sodium is a rare and dangerous complication of respiratory problems, especially in small babies,” he said. “It can cause seizures.”

Precise addition of sodium to the baby’s IV was imperative. There was no time to wait.

The transport team didn’t have the luxury of additional blood tests to determine exactly what amount of sodium to give. Too little or too much could cause brain swelling and damage. Guided by the physicians at CHKD and her own instincts, the nurse added sodium to Caroline’s IV.

Erin, left and Caroline with their sister Julia, 4.
Erin, left and Caroline with their sister Julia, 4.

The baby began responding.

By the time they arrived at CHKD, Caroline’s seizures had subsided. Fully awake, her eyes focused and she screamed “a blessed scream,” her mother recalls. “We were all greatly relieved,” Frey said.

At CHKD, emergency physicians put Caroline on a ventilator to help her breathe. “We were so grateful that Caroline was in such good hands at CHKD,” her mother said. “They were professional, yet so tender with Caroline and sensitive to us. Every test they did helped put the puzzle together.”

There was a CT scan which indicated a possible swelling of her brain, and X-rays of her lungs marked the extent of the congestion from the RSV virus. Though she was a very sick little girl, no other problems with her lungs or heart were apparent. Later, an MRI of her brain yielded good news: No signs of residual swelling or other permanent complications.

Caroline’s next several days were spent in the intensive care unit where she slowly improved. To her parents’ surprise, she had frequent visits from transport team members Kaliher, Munro and Frey who had whisked her from the Beach to CHKD.

“We never expected to see them again,” Brian said. “We thought their job was done, but we were wrong.”

“We learned that the depth of their compassion matched the quality of the care they gave our baby on that cold January night,” Jill said.

“We have a huge list of people to thank: the transport team; the staff of the CHKD Emergency Center that night; the amazing nurses, doctors and respiratory therapists in the PICU; pediatric neurologist Matt Frank, and every single person we felt warmly embraced by as we spent weeks in the hospital.”

Brian added, “We both grew up in this region and have known about CHKD all our lives. But until you need the hospital like we did, you might not know what a fantastic place it is and what wonderful people work there.

“The transport team saved Caroline’s life and indelibly touched ours. We will be forever grateful.”

Drs. Gomez and Frank practice with Children’s Specialty Group PLLC at CHKD.

This story was featured in the fourth quarter 2008 issue of KidStuff, a publication of Children's Hospital of The King's Daughters.