When a mother brought her newborn to the emergency department, he’d already been throwing up for several days. She’d been to the pediatrician the day earlier, but now he wouldn’t stop vomiting and was looking pale and lethargic.
Dr. Ashley Davis
The four-week old baby boy was admitted to St. George Regional Hospital. Pediatric hospitalist Ashley Davis, MD, ordered an ultrasound, which showed the infant had a pyloric stenosis, a swelling of the pylorus—a muscle between the stomach and the intestines—that causes severe vomiting.
Dr. Davis reached out to general surgeon John Sutherland, MD, to see if he’d perform the surgery to treat the condition. Otherwise, they’d need to transfer the patient to Primary Children’s Hospital in Salt Lake City.
“He didn’t do this particular surgery often,” Dr. Davis says. “But he said, ‘If you’ll manage the medical part of it, I’ll manage the procedures.’ He agreed to do it. The next morning he performed the procedure with no complications.”
“The last time I treated pyloric stenosis was at a children’s hospital,” Dr. Sutherland says. “For an adult hospital to pick it up, work it up, diagnose it, and treat it—it went just as smoothly as it did in a children’s hospital. I think everyone did a good job identifying it and getting it taken care of.”
Dr. John Sutherland
The baby’s mother was grateful the surgery could be done locally because they didn’t have to travel and the local physicians could help her baby quickly.
“Let’s say we had to take him up to Salt Lake,” she says. “I didn’t know how I was going to do it. He wouldn’t stop throwing up. It would’ve been hard.”
Keeping a patient like this close to home is much easier on the patient and the family because their support system is nearby and there isn’t the added burden of travel, says Dr. Davis. But his first consideration is always what’s best for the patient.
“My primary thought is with the patient and after that do they meet the criteria for staying here,” Dr. Davis says. “The best physician is the one who honors the limitations. If it’s possible they need a higher level of care, I’d rather have that happen in a place that can handle it rapidly.”
Dr. Sutherland credits Dr. Davis for medically preparing the patient for the surgery.
“They gave him fluids in an IV,” the mother says. “Also he couldn’t eat anything. They told us to stop giving him the formula. We were just keeping him calm with the grape Pedialyte.”
“I can do the surgery—that’s pretty easy, but resuscitating the patient and making sure their metabolic status is adequate and safe for surgery is the more critical and more difficult aspect of this,” Dr. Sutherland says. “Having not done that in quite a few years, I relied on Dr. Davis to take care of that, and he was gracious enough to say he’d manage all that—all the medical aspects to resuscitation and also manage the post-op feedings.”
“When these infants wake up from surgery, they’re starving,” Dr. Davis says.
He consulted with the surgery unit at Primary Children’s to follow their feeding protocol for an infant post-surgery, which was to give up to a quarter of what the patient would eat and gradually increase that.
“He’s doing good now,” the mother says of her son. “He’s eating, and he’s gaining weight. He hasn’t been throwing up.”
“Between the two of us working together, I think the patient did really well and got out of the hospital in pretty quick fashion,” Dr. Sutherland says.
“The nurses, anesthesia staff, and all the other staff, and physicians in the ER who helped give the care needed were very important, and the care was excellent,” Dr. Davis says. “We couldn’t have done it here in St. George without the nursing care provided.”