‘‘stronger’’ than the baby who expired the previous

year and ‘‘wanted to live.’’At that time, the baby was

transferred to our hospital, a family-centered plan of

care was developed, and consults were requested

from social services, nutrition, genetics, dermatol-

ogy, ophthalmology, ENT, and speech therapy.

Networking with a world-renowned specialist for

ichthyosis provided additional support.

In 2005, adenosine triphosphate-binding cassette

A12 (ABCA12) was found to be the defective gene

associated with HI (Akiyama, 2006) making it pos-

sible for diagnosis by chorionic villus or amniotic

£uid sampling. This provides opportunities to assist

families with decision making and preparation for

the birth of a child with a high probability for mortal-

ity and morbidity. Nine months since her birth, our

baby girl is a growing developing child who receives

ongoing care at our neighboring children’s hospital.

Although the patient’s family is migrant, the mother

is staying in our area year round so she can access

the care her baby needs. Our team has learned

valuable lessons about the importance of a dy-

namic family-centered plan of care that meets the

changing needs of the patient.

Future possibilities include DNA testing from

maternal circulation and even preimplantation di-

agnostic testing. Research has begun to develop

corrective gene therapy for patients with HI (Aki-

yama, 2006).

REFERENCESAkiyama, M. (2006). Pathomechanisms of harlequin ichthyosis and ABCA

transporters in human diseases. Archives in Dermatology, 142(7),

914-918.

Makhopadhyay, S., & Agarwal, R. (2006). Harlequin ichthyosis. Indian

Journal of Pediatrics, 73, 351-352.

No Barriers Exist: Providing Care for the

Fetus With Complex Cardiac Anomalies in

the Most Appropriate Setting

Poster Presentation

The Association of Perioperative Registered

Nurses has reported that the perioperative set-

ting is one of the most potentially hazardous of all

clinical settings. When addressing the obstetric

(OB) patient in the operative setting the OB team

must remember that there is not one patient but

two distinct patients. Typically, a Cesarean delivery

in our Level III unit that involves a healthy mother

with a fetus with known anomalies can be success-

fully performed without a¡ecting neonatal

outcomes. Evenmost fetal structural cardiac

anomalies that are estimated to occur in 8 of 1,000

births can be stabilized in our Level III unit prior to

transfer to a pediatric hospital specializing in cardi-

ac surgery. We have experience in delivering

neonates with known structural cardiac anomalies

who arrive at our hospital from Europe and the Uni-

ted States for follow-up cardiac surgery at our local

pediatric hospital. However, some neonates with

structural cardiac anomalies such as hypoplastic

left heart syndrome (HLHS) and a narrowed ductus

arteriosus will develop life-threatening shock prior

to transfer to a pediatric cardiac center.

Our OB unit was faced with the challenge and re-

sponded to the special needs of a neonate with

HLHS and a narrowed ductus arteriosus. Using a

multidisciplinary approach, a team from obstetrics,

perinatology, and neonatal cardiac surgery made

the decision to deliver the neonate in the most ap-

propriate setting. The most appropriate setting was

a planned Cesarean delivery at a pediatric cardiac

center. Combining the knowledge and expertise of

the OB team and the pediatric cardiac team, the

¢rst coordinated and successful Cesarean delivery

occurred at a local and renowned pediatric cardiac

center. The presentation will also address legal

issues that are of little concern to either health

care provider team but are a valid barrier when pro-

viding health care outside of one’s own health care

institution.

Lisa M. Romano, BSN, RN,

CPN, Pediatric and Adolescent

Maternity, Christiana Care

Health System, Newark, DE

Newborn Care

Dawn Johnson, BSN, RNC,

Labor and Delivery, Christiana

Care Health System, Newark,

DE

Joyce Gregg Swisher, RN,

Labor and Delivery, Christiana

Care Health System, Newark,

DE

Newborn Care

JOGNN 2010; Vol. 39, Supplement 1 S133

Johnson, D, Swisher, J G C A S E S T U D I E S

Proceedings of the 2010 AWHONN Annual Convention