Counsel parents of a neonate with critical aortic stenosis — OSCE

Communication framework

Acknowledge the shock and the fear directly. The parents have gone from a healthy newborn to an intensive care unit in three days, and their world has collapsed. Begin by sitting down, making eye contact, and acknowledging their fear: "I know this is every parent's worst nightmare, and I want to explain what has happened and what we are going to do." Do not minimise the severity, but do not leave them without hope — the prognosis with appropriate treatment is good. ^[2]

Explain the diagnosis in plain language. Your baby was born with a narrowing in the main exit valve of the heart — the aortic valve. Before birth, the baby was fine because a blood vessel called the ductus allowed blood to bypass the narrowing. That vessel normally closes in the first few days of life, and when it closed, your baby's heart could not pump blood to the body properly. That is why your baby became so ill so quickly — it was not something that went wrong in the last day, it was there from birth, and we only saw it when the duct closed. ^{[2] [4]}

Explain the prostaglandin and the breathing tube. The medicine we are giving through the drip — prostaglandin — keeps that bypass vessel open so blood can reach your baby's body while we plan the fix. The breathing tube is there because that medicine can sometimes make babies forget to breathe, so we are breathing for your baby to keep them safe. Your baby is not in pain, and we will take the tube out as soon as the fix is done. ^[2]