Asking the right question
by Beverly Merz
Maureen Carrier, RN, had seen "blue babies," but she never thought she'd have one. Last November, Carrier, a nurse in Children's Hospital Boston's Department of Radiology, was feeding her 5-day-old daughter, Brenna, when the baby choked, gagged and went blue. Alarming as it was, the episode was brief. As soon as Carrier turned the baby, she
started to breathe again.
Brenna had suffered an ALTE, or "apparent life-threatening event," the first of several she would experience in the weeks to come. Underweight and feeding poorly, Brenna was hospitalized for pneumonia at her local hospital on Christmas Eve and transferred to Children's three weeks later.
On January 16, while most of New England was glued to the Patriots' playoff game, Carrier's colleague, Mary Horn RN, MS, RRT, was monitoring Brenna's breathing as she fed. Horn, a surgical clinical nurse specialist trained in respiratory therapy, wasn't on duty that Sunday night, but went to Children's when a friend told her Brenna was hospitalized. She knew she could help.
Horn had seen quite a few babies like Brenna, and had noticed that most of them seemed to have small jaws. Measurements confirmed her suspicions, and Horn guessed that during feeding the tongue might fall back, further obstructing the already small airway. She changed the nipple size on Brenna's bottle and taught Carrier and her husband, Don, a simple technique for feeding Brenna—thumb and three fingers grasping the bottle, pinkie finger propped under the baby's chin. Reducing nipple size made the flow from the bottle more manageable; tugging the chin forward brought the tongue back up.
Several years ago she had shared her observation with Martha Curley, RN, PhD, FAAN, director of Cardiovascular and Critical Care Nursing Research, who suggested that Horn conduct a formal experiment. But Horn found that prospect daunting. Unlike physicians, nurses can't rotate off duty to conduct a study. Moreover, Horn had only cursory training in research methodology and scientific writing and hadn't conducted a formal scientific experiment since her master's thesis.
But help was available. A grant from the Thoracic Foundation, an organization that funds initiatives to improve the care of patients with respiratory disease, gave Horn a one-day-a-week "research sabbatical" and paid the transportation costs for families participating in the study. Curley mentored Horn, helping her design the study, offering advice on patient recruitment and partnering with her in writing up the results.
It took almost three years to enroll 25 infants who had suffered at least one ALTE, plus 50 controls—infants similar in age and weight but who hadn't had an ALTE. Horn found that the ALTE babies had significantly smaller mandibles, or jawbones, than the controls. Her study suggests that small jaw size can be used to identify infants at risk for an ALTE so parents can learn techniques to prevent it.
Horn submitted an abstract of her study to the American Thoracic Society’Äîthe field's most prestigious organization. Of 5,200 submissions, it was one of only 23 actively promoted to the media at the Society's international conference last May. "Seeing Mary present her study was as gratifying as anything I've ever done," says Curley, who has accumulated a host of accolades for her own research.
Patty Hickey, RN, MS, MBA, vice president of Cardiovascular and Critical Care Services, cites Horn's research as a prime example of how nurses transform patient care. "Nurses have the expertise to ask the questions that drive research," she explains.
Don Carrier is grateful that Horn asked the question, "Do small jaws increase the risk of ALTE?" Now the proud dad of a healthy, energetic 8-month-old, he has coined a term for the feeding technique he practices religiously. "Since we have been 'Horning,' Brenna has really taken off," he says. "Just look at her!"