Checkup should precede
baby’s flight

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By Nelson Daranciang
ndaranciang@starbulletin.com

The death earlier this summer of a 1-month-old boy aboard a flight to Hawaii from Alaska serves as an unfortunate reminder of the importance of having infants undergo a complete physical exam, especially if they will be traveling by air, says a local doctor.

The boy had a heart defect his 20-year-old mother was not aware of, said Dr. Bani Win, who recently retired from the Honolulu medical examiner's office.

The defect, patent ductus arteriosus (PDA), would have been detected as a heart murmur during a physical, Win said.

"It's not hard to spot," said Dr. Venkataraman Baldaraman, a neonatologist at Kapiolani Medical Center.

It is generally OK for babies 1 month old or younger to travel aboard airplanes, Baldaraman said, but he advises parents to have their children undergo a physical examination before flying. Such examinations are usually done two weeks after birth.

Win performed the autopsy after the June 3 flight and determined the boy died of asphyxia.

He said the lower air pressure in the airplane at altitude worsened the boy's condition, preventing his heart from getting oxygen-rich blood from his lungs.

Before a child is born, it gets its oxygen from its mother. So a valve in the baby's heart, which connects the pulmonary artery and the aorta, allows the baby's blood to bypass its lungs.

In 80 percent of the babies born at full term, the valve closes within 30 minutes of the baby taking its first breath of air, the rest within two to three days, Baldaraman said.

But in about one in 10,000 births, the valve does not close, which could cause the flow of blood to back up, he said. This happens more often in babies born prematurely. Win said the boy's blood backed up into his lungs during the flight.

When the defect is detected, doctors close the valve through either drugs or surgery.

But even if the boy's condition had been known, he may still have been allowed to fly without drug treatment or surgery, Baldaraman said.

"Travel would have been discouraged. But we would really not anticipate this result just from the PDA. It's very unusual," Baldaraman said.