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This article is about the newborn in the Season 7 episode Unplanned Parenthood. For the young mother in the episode The Mistake, see Kayla McGinley. For the asexual patient in the Season 8 episode Better Half see Kayla (wife).
Kayla was born full term after an uneventful pregnancy. The mother appeared to be in good health throughout, although she was in her 40s and had given birth once before over 20 years ago. The mother had attended regular doctor visits during her pregnancy and all pre-birth examinations were normal. Labor lasted 12 hours, but otherwise went smoothly without complications.
When the mother gave birth, it was clear that Kayla was in serious distress. The obstetrics nurses immediately called for the NICU team and noted the newborn was hypoxic. The newborn was rushed to an incubator as the NICU team rushed into the room.
None of the doctors were able to resolve the newborn’s breathing problems and the case was referred to Dr. House. The newborn had been given a surfactant and her lungs appeared to be fully developed. The biological father, a sperm donor, had a history of asthma. Dr. House though the problem might be something outside her lungs. Dr. Foreman noted that the newborn’s heart appeared to be fine, but Dr. Chase noted her liver enzymes were elevated. Dr. House surmised that the liver may have failed and the normal proteins that the liver produces to keep blood plasma out of the lungs may be lacking. If the newborn had a liver problem that could be treated, it would resolve the problem in the lungs.
Dr. Taub did an ultrasound of the liver looking for a cyst or abcess. The newborn was oozing blood from the site of her intravenous line, which also indicated a liver problem. Dr. Foreman ordered a unit of blood. Dr. Taub found an ectogenic site, but it did not appear to have the thick walls typical of an abcess. Dr. Chase thought that the bile ducts appeared to be dilated. They confirmed intrahepatic dilated bile ducts, but the extrahepatic bile ducts were normal. There were no masses causing an obstruction. The most likely explanation was that the dilation was congenital and Dr. Chase suggested Caroli's syndrome which could only be corrected by surgery. The team objected due to the bleeding and liver problems, but Dr. House noted it was the only way to correct the problem.
Dr. Chase and Dr. Taub attempted to correct the issue surgically, but when they tried, the newborn’s blood pressure kept dropping precipitously. Not only did they have to abandon the surgery, the drop in blood pressure did not fit the diagnosis. Whatever the disease was, it was affecting her heart. Dr. Chase suggested tuberous sclerosis. Dr. Foreman thought it might be a vascular malformation in the liver. However, correcting a vascular malformation meant more surgery, and it was unlikely the newborn would survive a second surgery. Dr. Chase suggested treatment with steroids, an anti-angiogenesis agent and dopamine which might result in the malformed vessels closing off, which is what would be accomplished by surgery in any case. Dr. Foreman tried to get Dr. House’s approval, but he was not available. They decided to start the treatment.
The newborn’s pallor improved, a sign of improvement. She also started making noises. This appeared to confirm a vascular malformation that had been corrected by the treatment.
However, when they advised Dr. House, he rejected the diagnosis of a vascular malformation, despite not having worked on the case overnight. He noted that the patient’s ALT levels were three times normal, indicating too much liver damage to be explained by a vascular malformation. Dr. Foreman insisted the patient improved with treatment, but Dr. House was sure the patient would crash again.
Dr. House turned out to be right as the newborn started bleeding again. Dr. House wanted to focus on why the newborn improved and asked Dr. Taub to advise what treatments the newborn was given. Dr. Taub thought the steroids may have treated idiopathic hepatic fibrosis, but improvement on steroids didn’t explain the multiple dilated ducts. However, Dr. House remembered that the newborn had received a transfusion from its mother. He ordered a direct blood transfusion.
Once again, the newborn improved greatly, but Dr. House knew that the transfusion could not have cured the problem. However, he had no idea why the newborn improved with each transfusion from her mother.
Dr. Taub asked Dr. Cheng, the attending pediatrician in the NICU for assistance. She noted that the mother’s blood was either treating a specific disease, or it was normal blood which was replacing a deficiency. If it were a deficiency, the liver failure pointed to a lack of clotting factors, an enzyme or a vitamin. Dr. Cheng suggested giving the newborn a transfusion from another donor to see if any blood would work. Dr. Taub was the same blood type and volunteered.
The newborn got worse again with Dr. Taub’s transfusion and they decided to switch her back to her mother’s blood. He planned to do a liver biopsy. However, the biopsy clearly indicated a melanoma. They realized that the mother probably had a melanoma as well. Dr. Taub examined her and found a mole under the nail of her left index finger.
Dr. House realized that the mother’s melanoma had to have mestastizied in order to have affected the newborn. However, this would mean that the cancer was late stage, but the mother wasn’t showing any symptoms. There had to be something in the mother’s blood that was affecting the melanoma in both her body and the baby’s. Anti-melanoma antibodies would be the logical choice, but if the mother had them, the cancer would not have spread to the newborn. The realized some other type of antibody had to be at work, and the effect on the melanoma was merely a positive side effect. Dr. Taub noted scleraderma can create antibodies that affect cancer, and Dr. Chase suggested that Churg-Strauss syndrome or most other autoimmune diseases could as well. Dr. Cheng noted that infections that cause granulomas like tuberculosis did as well. Dr. House ordered tests for the autoimmune diseases.
Dr. Taub reassured the mother if it was an autoimmune disease, the treatment would be straightforward. However, all the tests for autoimmune diseases were negative. They decided to scan her for infections that cause granulomas next. However, the scan showed oat cell lung cancer. It was obvious the lung cancer antibodies were what was suppressing the melanoma.
Dr. Taub broke the news to the mother. It was treatable with surgery and chemotherapy. The newborn only needed chemotherapy. The mother asked about using her blood, but Dr. Taub told her that once the lung cancer was removed, she would stop producing the antibodies that were fighting the melanoma. The mother wanted to delay her surgery, but Dr. Foreman calculated it would take 8 to 9 days for the antibodies to completely eradicate the newborn’s melanoma. Although the lung cancer was unlikely to spread in that time, there was a severe risk of clotting. Dr. Taub admitted chemotherapy could affect the newborn’s brain or her development, but these were manageable risks, unlike the risk of clotting. However, the mother refused surgery and instructed the doctors to use her blood to treat her newborn.
The newborn started to improve again on the transfusion. However, as Dr. Foreman feared, the mother had a clot which resulted in a pulmonary embolism and her death. However, enough of the mother‘s blood was harvested that they had sufficient antibodies to treat the newborn. Her prognosis was excellent.