The birth of a healthy baby boy last week was not an unusual event at Hadassah, but somewhat unusual – and a cause for great celebration – for his mother, father and siblings. Thanks to Hadassah's medical and research team led by Prof. Azaria Rein, Head of the Pediatric Cardiology Unit, the newest addition to their family was born with a healthy heart like his six-year-old brother, but unlike their eight-year-old brother who had a pacemaker implanted immediately after he was born.
The oldest boy was born with extreme heart failure because their mother suffers from Lupus, a condition that produces antibodies that attack the autoimmune system. During pregnancy these antibodies can cause fetal heart failure by attacking the fetal heart tissue and blocking the blood flow between the fetal heart’s natural pacemaker in the atria and the heart’s pumping chambers. Fetuses with this condition have a very high morbidity and mortality rate.
It all began in 1998, when a 32-year-woman from Jerusalem with Lupus was referred to Hadassah in her 34th week of pregnancy. Her fetus had a severely low heart rate and required immediate attention. Fetal echocardiography, ultrasound of the fetal heart, revealed that the fetus had a very low heart rate – 40 beats a minute rather than 160 – that was causing nearly total heart failure.
At that time, surviving newborns received a pacemaker immediately after birth to correct the condition. Prof. Rein and a team of Hadassah physicians decided that delivering the baby by Caesarian section and immediately attaching an external pacemaker was the best solution. And so it was – then. The baby boy was delivered, the pacemaker connected and his heartbeat jumped to 120 beats a minute. Eventually, a permanent pacemaker was implanted in the baby’s chest and he went home 10 days later in perfect health.
The parents decided to hold off on having more children because there was a high probability that another pregnancy could result in another baby with similar condition, which it later did, but with completely different results.
The first child was born eight years ago just before Hadassah's Pediatric Cardiology Research team completed their invention of the fetal kinetocardiogram. A novel methodology at the time, modeled on an adult ECG, it enables physicians to analyze the fetal heart rate and blood flow. Their new methodology could detect many conditions, including early changes in fetal heart conduction associated with Lupus.
In 2000, the doctors told the mother that, based on their research, they were able to detect early heart blockage in the fetus and treat it before it became irreversible. When she became pregnant again, the fetal heart condition was monitored from the 14th week of gestation. At 18 weeks, the first sign of heart blockage was detected. This was immediately treated with medication and the fetal heart conduction returned to normal in a few days. A few months later, she delivered a normal baby boy, with a normal heart and no need for a pacemaker. This was the first time prenatal therapy prevented a life threatening condition from developing. The Hadassah findings were published in the prestigious medical journal Circulation in 2001.
Recently, this extraordinary story was repeated when the woman became pregnant again and carried another fetus with the same condition. She and her fetus received the same monitoring and intervention. Last week, she delivered another healthy baby boy.
This is the only case of repeated treatment and prevention of complete fetal heart blockage that has ever been reported. Prof. Rein and his colleagues, gynecologist Dr. Uri Elhalal, pediatric cardiologists Dr. Zeev Perles and Dr. Gavri Sagui, and Lupus specialist Dr. Dror Mevorach – among others – conducted the basic research, which evolved into clinical research and resulted in a direct clinical application with an extraordinary outcome.