situs inversus in the newborn, kind of long

Jolie, BSN · Sep 24, 2007

situs inversus, kinda long sorry permalink
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This was posted under cardiac nursing, but as I haven't received a response as of yet I thought I would move it this forum Thanks for reading it.
Hi,
My name is Penny and I have been an LPN for 10 years. I am to be a first time grandmother in Dec. 2007. My daughter is 35 yrs. old and this is her first child. On Thursday, 9-20-07 we found out her little baby girl has situs inversus with levocardia. i am not sure if this is the correct forum to put this in, so please bear with me.
Even though I have been in the medical profession for 10 years, I am not familiar with this condition. I have researched on-line, but most all of the info is aimed for doctors. I do know a little more about this since I've researched, but don't feel as if I can ask compentent questions when we return for another ultrasound. If anyone has any information, knows of a support system, or anything that may be of use to us please let me know.
I am aware situs inversus with levocardia is a condition in which the visceral organs are in reverse order and the heart is located to the left. The perinatalogist said the baby was mirror image from the diaphragm down. This is a very rare condition and I need info. Please let me hear from you. Thanks, Penny

First of all, congratulations on becoming a grandmother (soon)!

In 11 years of NICU and OB, I cared for only one baby with the condition you describe. She was one of a set of fraternal twins who were born prematurely. Her admission to the NICU, as with her sister, was due to prematurity, not the situs inversus. She experienced some mild respiratory distress at birth, and progressed, along with her sister, to DC without incident. I don't recall her condition being anything more than a curiousity in terms of her health at that age.

I'll be curious to see what kind of input you get here. There is a poster on the PICU forum, janfrn, who seems to have extensive knowledge of cardiac abnormalities and their treatment. Perhpas you could post there or PM her.

The only thing I would suggest is to ask for a neonatology referral so that you can be well-prepared should your grandbaby require NICU care at birth. If there is any question of the need for intensive care, it may be preferable for your daughter to deliver at a tertiary care center, rather than rely on neonatal transport, which would separate mom from her new baby.

Best of luck to you all. Please let us know when the baby arrives!

Pediatric Critical Care Columnist · Sep 24, 2007

I moved this thread over so that more attention could come its way.

As you say, situs inversus with levocardia is quite rare. Situs inversus refers tothe orientation of the viscera, and levocardia refers to the direction of the apex of the heart, i.e. pointing to the left. The condition is often an autosomal recessive trait. Approximately 95% of these kids have congenital heart defects of varying severity. When your daughter returns for her follow-up ultrasound, the radiologist should be asked if the baby's organs appear morphologically normal, with special emphasis on her heart. Ultrasound may not be definitive for anatomy so CT may also be included. The radiologist should be able to answer most questions you pose at the next appointment. If there are no anatomical defects, then your granddaughter should be okay. Any physician involved in her care will need to know that she's got situs inversus, because it will affect her physical exam and any diagnostics or surgical interventions she may need in the future. If there are cardiac anomalies, she will require surgical correction eventually, so Jolie's suggestion of a consult to neonatology is a good one. Your best information regarding her condition and future care needs will come from them.

There is another condition called heterotaxy, where the thoraco-abdominal anatomy is duplicated in a mirror image. Someone with left sided heterotaxy would then have two spleens, one on each side and usually a very tiny central liver, two bi-lobed lungs, a malformed heart and vasculature and so on. Right sided heterotaxy would leave them asplenic with a huge horseshoe liver, two tri-lobed lungs and a malformed heart. As you can see, this syndrome tends to be much more severe, and it has a significant mortality rate.

I've cared for kids with both of these conditions. The last little one I can remember with situs inversus was a gorgeous little girl post-op cardiac repair into whom I was attempting to place a small bowel feeding tube. She wasn't my patient, but because I'm one of the specially-trained RNs who can do blind placement of nasojejeunal tubes, I was involved that day. I didn't know she has situs inversus and neither did her relatively junior bedside nurse. To make a long story short, I tried to get the tube into the right place for about 2 hours without success before discovering that if I had positioned her on her LEFT side, there would have been no problem. Lesson learned. The next time I had supreme difficulty putting in an NJ tube, I pulled up the kid's x-rays to see which way his stomach pointed!

I very much hope that your granddaughter is otherwise fine, just a little "backwards" and that all goes well at delivery. I'll be thinking of you.

AliRae · Sep 24, 2007

Definitely not one of our patients, but one of our EMS techs has situs inversus with levocardia. Scared me to death shortly after I met him when he asked me to listen to his heart. All I could think was "Wow. Muffled heart tones there!" with my stethoscope where I THOUGHT his heart should b e.

He's got no issues because of it. Just enjoys giving the new kids a fright. :lol2:

nursepenny · Sep 24, 2007

Thanks for your response. Ihad not even thought of morphology. Duh, Me... I had not given thought to a neonatalogist, either. I did look up a pediatric cardiologist though, and found 2 in our area, (well actually about 2 hours away, but they would be at the hospital where the baby would be born). As soon as we return from the next ultrasound appt., I will post the results.

Again, Thanks for the input. Have a good day. Penny :nurse:

Kiwimid · Oct 2, 2007

my MIL has it. she only found out when they went to take out her gallbladder. shes fine , as your grand baby will be

EricJRN, MSN, RN · Oct 2, 2007

Recently discharged a situs inversus kid (but with dextrocardia). The baby did fine CV-wise, but this case was associated with a chromosomal abnormality that will likely cause developmental delays.

nursepenny · Oct 19, 2007

Just a short note to update you all on my grandbaby. We went to thew perinatalogist this past Wednesday and receives some excellent news. He said everything in aligned correctly. There were no major abnormalities noted. "Rainee" (grand daughter's name), will need to have an Echo after she is born, but that should fine. Everything else checks out okay. She weighed in at 3lbs. 13oz. , and continues to grow daily. I told my daughter the baby will weigh around 8 lbs. She thinks 7 lbs. 10 oz. lol

I am so thankful to all of you for the words of encouragement and prayers for Rainee. May God bless and keep you.......................Penny:roll

Pediatric Critical Care Columnist · Oct 22, 2007

I'm so relieved to hear that your granddaughter Rainee is growing and developing as she should. Now you've just got to be patient until she makes her debut! Best wishes.

mgalloLPN · Mar 30, 2008

I'd like to hear how everything turned out with the baby

nursepenny · Mar 31, 2008

I am so sorry for not updating before now. My granddaughter was born Dec. 7th, after a very long and hard labor for my daughter. They finally did a C-section. The baby was perfect in every way possible. She weighed 7lbs. 8 oz. and 21 1/2 inches long. The attending Peditrician said she saw no signs of situs inversus. An x-ray was done and verified all the organs were in the correct location. An echo was also performed and the baby's heart was perfect. I don't know how such a renowned Perinatalogist could have made such an error. Honestly, I think God had a hand in everything turning out as well as it did. I had asked people all across America to pray for my little bundle of joy and I truly believe this is what happened. I am a true believer and I trust God completely.

I harbor no ill feeling toward the Dr. who told us of this condition (even though he was wrong).

Rainee is now a very healthy 3 & 1/2 month old baby and very normal in all ways. She is completely on track for her age. And she is the light of my life. She has me wrapped around her little finger and she knows it..........lol

Thank you all for your concern, answers to my questions, and prayers. God bless.

:yelclap: :nurse:penny

mgalloLPN · Apr 6, 2008

I am so sorry for not updating before now. My granddaughter was born Dec. 7th, after a very long and hard labor for my daughter. They finally did a C-section. The baby was perfect in every way possible. She weighed 7lbs. 8 oz. and 21 1/2 inches long. The attending Peditrician said she saw no signs of situs inversus. An x-ray was done and verified all the organs were in the correct location. An echo was also performed and the baby's heart was perfect. I don't know how such a renowned Perinatalogist could have made such an error. Honestly, I think God had a hand in everything turning out as well as it did. I had asked people all across America to pray for my little bundle of joy and I truly believe this is what happened. I am a true believer and I trust God completely.
I harbor no ill feeling toward the Dr. who told us of this condition (even though he was wrong).
Rainee is now a very healthy 3 & 1/2 month old baby and very normal in all ways. She is completely on track for her age. And she is the light of my life. She has me wrapped around her little finger and she knows it..........lol
Thank you all for your concern, answers to my questions, and prayers. God bless.
:yelclap: :nurse:penny

Congrats! I am so glad everything turned out ok for you and your family!! :yeah: :redbeathe