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Saved by a Cool-Cap

Thanks to Advanced Technology, a Struggling Newborn Survives and Thrives

Jack Ruffles, son of Matt and Marisa
Ruffles, is an active, healthy child
despite severe medical problems
when he was born.

Today, Jack Ruffles is your typical toddler, so you would never know he was born with a barely functioning heart. "He was essentially stillborn," his mother, Marisa Ruffles, says. Jack thrives today thanks to fast-acting doctors and a remarkable medical device called a Cool-Cap that is available only at elite neonatal intensive care units, such as the one at Maria Fareri Children's Hospital at Westchester Medical Center.

On March 17, 2008, after a normal pregnancy, Marisa went into labor with her and husband Matt's first child. Her contractions started coming too fast, so her doctor told her to head to her local hospital, where she was hooked up to a fetal monitor. It showed that Jack's heart rate was far too low. "As soon as the monitor was on, the nurse started calling people; then there were 12 doctors in the room and I was saying goodbye to Matt," recalls Marisa, who was rushed into surgery for an emergency cesarean section. "Jack was born 30 minutes after we arrived at the hospital — that's how fast they acted."

Jack's Struggle
Jack was a full-term, 8-pound, 10-ounce baby, but his Apgar scores—measurements of a newborn's heart rate, respiration, skin color, reflexes and muscle tone—totaled just 1 out of a possible 10 at birth, and 0 at both five and 10 minutes later. (The higher the score, the better — a five-minute Apgar of 7 to 10 is considered normal.) "That means his heart rate was undetectable or extremely low for the first 10 minutes of life, in spite of the full resuscitative efforts of the neonatal team at that hospital," says Lance A. Parton, M.D., Associate Director of the Level IV Regional Neonatal Intensive Care Unit (RNICU) at Maria Fareri Children’s Hospital, the most sophisticated unit of its kind in the region.

Marisa, still groggy from the cesarean section anesthesia, got to see Jack for just a moment—"that's when I learned he was a boy," she says—before he was whisked by helicopter to Maria Fareri Children's Hospital with Matt. As she came to, she was told that for unknown reasons she had suffered a placental abruption, a separation of the placenta from the uterus, which had caused Jack’s heart failure. At 8 p.m., just eight hours after her C-section, she was discharged from the local hospital and driven by her sister to Maria Fareri Children's Hospital.

By that time, Jack's Cool-Cap had already been put in position. Approved by the Food and Drug Administration about four years ago, the Cool-Cap is literally a cap that sits on the newborn’s head. Cold water circulates through it, and the chill slows down brain activity. "Because Jack's heart had stopped, his brain wasn't getting oxygen, and that can cause the death of brain cells," Dr. Parton explains. "The brain gets damaged because those cells keep 'firing'— communicating with other cells—even without oxygen, so they burn out and die. Cooling these cells for 72 hours slows their firing."

A Very Cool Cap
The Cool-Cap cools the baby's scalp to about 50 degrees Fahrenheit. But research in similar cases has shown that cooling must begin within six hours of birth, or brain damage may not be reversible. And cooling provides no further benefit after 72 hours.

Fortunately, Jack's heart was structurally normal, but during these first days the RNICU team had to address his heart rhythm and breathing problems. He was treated with highfrequency jet ventilation for the first nine days of life. "The jet ventilator breathes 420 times a minute, where newborns typically breathe 40 to 60 times per minute," says Dr. Parton. Jack needed inhaled nitric oxide for 12 days to open his constricted pulmonary blood vessels to get more oxygen into his bloodstream. He also required medications to help his heart pump more efficiently and to treat seizures, plus blood transfusions to support his strained system. "For a big, full-term baby, he was really sick," says Dr. Parton.

Marisa was still recovering from her own surgery, but "I was so caught up in Jack, that wasn’t registering with me," she says. At first, they were preparing for the worst. "Matt was told he might not make it," she says. But after the threeday Cool-Cap period, Jack responded magnificently. "I thought we'd be in the hospital six months, but every day was better than the day before," Marisa remembers. Jack was discharged on April 7, three weeks—not six months—after his birth. His biggest risk was for some kind of brain or developmental damage. But to date, all his tests have been normal and he has reached all the developmental markers for a boy his age.

"He's perfect," says Marisa.


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