Medical Mysteries: Infant's monitor kept shrieking, but doctors didn't know why

By Sandra G. Boodman
Special to The Washington Post
Monday, January 17, 2011; 7:20 PM

Jennifer Kahler was having trouble understanding what the doctor was telling her.

The clinical psychologist had spent a quiet July 4 weekend at her Northern Virginia home with her husband and two small sons when a pediatric cardiologist she had never met called with frightening news. The specialist had just reviewed test results on 6-week-old James, and she told his mother he needed to be brought to Inova Fairfax Hospital immediately.

"I kept saying to her, 'Now? You mean right now?' " recalled Kahler, who remembers being baffled and frightened by what the specialist, Margaret Bell Fischer, was saying.

Fischer was adamant: "Now," she told Kahler firmly.

The doctor's sense of urgency was jarringly at odds with what Kahler and her husband, Roger, had been told in the weeks after James was born at another hospital. The baby had some mild breathing problems and had been sent home with an apnea monitor. To Kahler and her husband, the monitor, which tracked James's respiration, seemed like a gigantic pain: It kept emitting an ear-splitting shriek, but each time they checked, nothing seemed to be wrong with James. A visiting nurse also found nothing awry.

Less than two weeks before that phone call from Fischer, the alarm sent the family to the emergency room, where a doctor again found nothing wrong with the baby's heart or breathing.

But the finding that prompted Fischer's call showed the problem was not a false alarm. "It was quite concerning to me," she recalled. Without prompt treatment, she worried, the baby might die.

Only weeks later did Kahler discover that two things she had observed in the first days of her son's life were probably subtle clues to his undiagnosed condition.

'Like a little beet'

James was born nearly a month early, on May 29, 2009, and spent the first eight days of his life in a neonatal intensive care unit being treated for jaundice as well as apnea of prematurity, a common and usually temporary condition in preterm babies.

This form of apnea is characterized by slowed or stopped breathing and is usually not a problem unless the episodes last longer than 20 seconds. Most preemies outgrow it, but in some cases apnea can indicate a heart or lung abnormality or an infection. As a result, some infants are sent home on an apnea monitor, which tracks breathing.

But false alarms are common with these devices, according to the American Academy of Pediatrics, and can be triggered by the baby's movements or incorrectly placed equipment. Parents are told not to assume the alarms are false but to check the baby, looking particularly for a bluish cast to the lips and a slowed heart rate, which mean the infant is not getting enough oxygen.

James was sent home on a monitor as a precaution. His mother said she immediately noticed that he was different from his brother, who is nearly four years older: He slept almost all the time and his skin tone was very red, "like a little beet."

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