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Winnipeg sonographer works to detect heart defects in babies before they are born

Ultrasound
Ultrasounds, like the one pictured above, can be key in the detection of congenital heart defects
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Watch Karen Letrouneau's presentation at TEDxManitoba

CBC profile of Karen Letrouneau

DON GOULET
Winnipeg Health Region
Published Wednesday, February 16, 2011

Imagine being told that your newborn baby has a congenital heart problem that needs immediate attention. Suddenly your life is turned upside down. You need to make decisions - quickly. Your baby must leave the province for heart surgery in a pediatric cardiac centre in Edmonton, Toronto or Chicago.

Unfortunately, every year some anxious parents have faced this reality, in part because of heart problems that went undetected before the baby was born.

Now, thanks to Karen Letourneau, Assistant Charge Sonographer in the Ultrasound Department at St. Boniface Hospital - part of the Winnipeg Regional Health Authority's Diagnostic Imaging Program - babies are being saved, not through high-tech, expensive interventions but rather through a simple, sustainable, low-cost training program that allows problems to be detected before they cause irreversible damage.

Ultrasound is a very common procedure for pregnant women, allowing sonographers to determine the health of the fetus by checking dozens of things, including the heart. As Letourneau scanned the abdomen of expectant mothers, she often experienced unease when looking at the tiny hearts - the size of a strawberry - not knowing if she was catching potential problems. While attending a conference in Montreal, Letourneau realized that her colleagues shared her unease.

This spurred Letourneau's interest. She read many scientific studies on the subject from professional journals across the globe. A common theme emerged: detecting congenital heart problems in the fetus needed to be improved. The challenge? How to do it.

On her own initiative, Letourneau sent a survey to all sonographers in Manitoba to find out if they did heart scans to detect abnormalities. The results confirmed her suspicion that most, like her, felt uncomfortable doing these scans. According to the survey results, only 50 per cent of developing babies in the womb were getting complete heart scans. It was clear that sonographers wanted and needed more training.

Armed with this information, Letourneau developed an education plan to teach sonographers how to better detect heart problems in the yet-to-be-born baby. "Depending on the position of the mother, some normal fetal hearts may appear abnormal, and some abnormal hearts may appear normal," says Letourneau. Her education plan would teach sonographers what to look for in fetal hearts and provide tips for getting a clear image of the tiny heart. "Early detection of problems allows physicians to better prepare for this baby's arrival and intervene as needed, before it is too late," she says.

Co-investigators Keith McDonald, Dr. Reeni Soni, Dr. Fern Karlicki, Dr. Randy Fransoo, Dr. Greg Reid, and the late Dr. Phil Hall helped Letourneau in her efforts.

Letourneau and her team received some funding from the Health Sciences Centre's Foundationto compare how many problem heart cases were picked up before and after her education plan was implemented. Some 100 sonographers in Manitoba, radiologists in the Region's pediatric cardiac sub-program, the obstetricians and gynecologists and nurse sonographers from the two fetal assessment units at both Health Sciences Centre andSt. Boniface Hospital agreed to sign on to her experiment. The participants committed to attending all education sessions and follow the checklist for every pregnancy ultrasound procedure. Karen offered her training free of charge.

The results are very promising. Based on the information Letourneau and her team gathered, four to six babies a year in Manitoba died because of undiagnosed heart defects before the checklist and training were provided. Since the checklist was established, no babies scanned have died because of undiagnosed heart problems.

Letourneau's research is not yet complete, but journals are eager to publish it based on the results so far. She is passionate about her work: "I want to make sure that everything that can be done to save these babies is being done. My dream is to have ultrasound facilities across Canada and the U.S., even the world use this knowledge to benefit babies and their families."

Letourneau was a featured speaker at TEDxManitoba on February 15 to talk about her research. TEDxManitoba brings together innovative and fascinating speakers from the fields of health, business and technology to spark discussion and spread ideas in an atmosphere of sharing.

Don Goulet is a communications advisor with St. Boniface Hospital.

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