Quick-acting parents use CPR to save baby's life

Page Dowdy/Chesterfield Observer Krissy and Alby Natalini IV with their happy and healthy 11-month-old daughter, Leila.

Leila Natalini chatters playfully in the background - not the sound you would expect from an 11-month-old girl who went into cardiac arrest when she was three days old. Considered brain-dead and taken off life support several days later, the doctors predicted Leila would have severe cerebral palsy and major neurological defects, if she lived.

On Feb. 19 last year, Leila, weighing 5 pounds 8 ounces, entered the world at CJW Medical Center's Chippenham campus, 15 months after older brother Albert "Alby" Natalini V. Given a clean bill of health, Leila journeyed three days later with parents Krissy and Alby Natalini IV to their Hampton Park home.

Exhausted from childbirth and breastfeeding every 30 minutes like clockwork, Krissy took a nap at 10:30 p.m. that evening. At 1 a.m. she awoke, sensing something was not right.

Leila appeared to be asleep next to her in the living room, but peering closer, Krissy says, "She looked pale and playdough-colored." When she picked her up, Leila's head and arms immediately flung back like a rag doll.

Krissy's instinct told her not to shake Leila, so she desperately uttered, "Wake up." She placed her fingers near Leila's mouth and watched her chest for signs of breathing. "She wasn't blue, but I thought she was dead."

Krissy cried out to her husband, who took one look at Leila and quickly brought her into the kitchen and raised her limp body under the light to get a better look. Krissy dialed 9-1-1 while Leila remained completely unresponsive.

CPR training was crucial

When their son was born, the Natalinis became CPR-certified. "If we hadn't had the training, I don't think we could have done it," Krissy supposes. Although the 9-1-1 dispatcher effectively guided them through CPR, Krissy wonders how much longer it would have taken if they did not have CPR training.

Alby laid Leila's body on the living room floor and confirmed that she had no pulse. As Krissy relayed to Alby the number of compressions and breaths to give, the dispatcher asked them to count aloud so she could hear them. The dispatcher urged Alby to press faster. What felt like an hour for Krissy was actually about 10 to 13 minutes of continual CPR by Alby.

The police were the first to arrive. They observed Alby's efforts and told him to continue. Later, she learned that it would have been too time consuming and risky for them to take over. Soon after, the Manchester Volunteer Fire & Rescue Squad arrived along with firefighters from Clover Hill Station 7.

Leila had flat-lined, meaning she had no heart activity, and defibrillation would not have helped her. Two firefighters were certified in advanced life support, and they abandoned their truck to ride in the back of the ambulance with Leila.

Alby hastily alerted his sleeping mother to take care of little Alby, and he drove Krissy and himself to St. Francis Medical Center. Because St. Francis does not have a pediatric intensive care unit, it has a team of on-call pediatric intensivists.

Dr. Sarah Gay was the lead physician. Krissy watched about 10 practitioners assemble around Leila in the emergency room. They restarted her heart and placed her on life support, but the prognosis did not look good, Dr. Gay professed.

They could do no more for Leila at St. Francis, so they transported her to St. Mary's Hospital in Richmond in a Hummer-style emergency services transport vehicle, Krissy describes. She rode in the backseat and watched through the glass partition while her daughter flat-lined again, and they resuscitated her during the trip.

When they arrived in the pediatric ICU, an experimental process called therapeutic hypothermia was used to cool the body and minimize brain damage. "It virtually looked like she was wrapped in cold gel packs," Krissy says.

The idea is to slow down the metabolism and decrease the blood flow to the brain, medical sources state. "Because of Leila, this method is standard procedure at Bon Secours," she claims.

The technique is now also being used at CJW Medical Center (see story on page 11).

Desperate hours

The next three days were excruciating. The doctors sedated Leila with phenobarbital to let her brain recover. Two days after the barbiturate wore off, an electroencephalogram (EEG), which measures brain activity, showed no signs of life, and she wasn't responding to any stimuli, such as light. By day four, the outlook was bleak. The Natalinis were told Leila would not wake up. The nurses called in the family and presented a pink outfit for her burial.

Leila was in danger of losing her limbs and suffering organ damage if they kept her on blood pressure medicine, Krissy relays. The Natalinis agreed to wean her from life support. They did not sign a "do not resuscitate" order, but told medical personnel they did not want them to do chest compressions if Leila's heart failed.

Despite the lack of brain activity, an electrocardiogram (ECG) revealed her heart was normal. Even off life support, Leila showed some movement, which the doctors believed was due to nerve spasms.

On day five, Leila finally opened her eyes. "They were glassed over and rolled into the back of her head," Krissy conveys. "We believed in her strength and will to live. We looked beyond that glazed look and imagined the bright eyes and smile of the baby we were going to take home from the hospital."

Sure enough, on March 14, 21 days after being clinically dead, Leila went home, albeit with an oxygen tank, feeding tube, pulse oximeter (a device that measures the level of oxygen in the blood) and suction catheter. Doctors proclaimed she would need a tracheotomy in order to be fed. Within one to two months, the Natalinis weaned her off the machines. She started making motor and verbal strides, such as rolling over and saying "mama" and "dada."

"It was as if the brain completely regenerated itself," Krissy remarks.

An occupational therapist visits Leila every two weeks, and she sees a pediatric neurologist every six months. "Other than some muscle tone issues with her legs, she shows no longterm effects," reports Krissy.

She believes the rapid CPR and cooling treatment were crucial in Leila's comeback.

"We don't know enough about the brain," she adds.

Cardiac arrest has a slim survival rate, but Leila's case shows hope. In his 13 years on the squad, Lt. Frank Kinnier from Chesterfield Fire and EMS who delivered mouth-to-mouth that night said he has never seen a baby survive cardiac arrest.

Krissy encourages others to get CPR training. "It made a difference.

"The biggest lesson I learned was to take every moment at a time," adds Krissy.

She laments that if she had known what was in store, she would have nurtured and held Leila more those first three days after she was born. "As awful as it was, I took all the negative and turned it into a positive."

Alby received the Chesterfield Fire & EMS "Life Save" award on Oct. 7 last year, along with the firefighters, EMS staff and 911 dispatcher that responded.

Krissy has invited them all to Leila's upcoming one-year birthday party. She recalls how the firefighters left their truck in the street that night. She told them to bring the fire truck, but this time they won't have to leave it.