Original airdate: 12/7/2004
epidemic strikes the maternity ward at PPTH. Several babies become
seriously ill, and the team has little time to determine the cause.
Patient: Maxine Hartig, Baby Boy Chen-Lupino, Baby Boy Howsam, Baby Girl Perry, and two others.
Initial symptoms: high fever, seizure
Hartigs are holding their newborn daughter, trying to decide on a name,
when she spits up. The parents become alarmed and call the obstetrician
in to look at her. He notes that she is lethargic and feels hot. The
baby begins to seize, and the OB calls for the crash cart and Ativan.
is loafing in the OB/GYN lounge when he hears the obstetrician talking
about the case with another OB. Baby Girl Hartig has been diagnosed
with a bowel obstruction and is under observation. House is intrigued,
and investigates. He finds Baby Boy Howsam in the NICU. This child has
a fever of unknown origin, 101 and rising.
believes an infection is spreading through the maternity ward. He notes
that the two babies shared a delivery room, and their rooms were next
to each other, making transmission possible. Wilson points out that the
Hartig baby has a bowel obstruction, but House says the baby's x-ray
has a normal gas pattern, showing air in the colon, eliminating the
possibility of a blockage.
House demands that the maternity ward
be shut down, but Cuddy refuses, on the grounds that two sick babies
does not qualify as an "epidemic," and that House is just seeing what
he wants to see because the alternative is uninteresting. House
rounds up the Doclings to search for more sick babies. They find none
on the second floor, but Baby Boy Chen-Lupino on the third floor has
developed a sudden fever. A fourth baby, Baby Girl Perry, is also
showing early symptoms. Cuddy sets a team of med students to swab the
maternity ward while House and his team begin the differential
The babies all have fevers and low blood pressure.
They rule out parasites, as the infection is speading too quicky.
A viral infection is considered, but Cameron thinks the babies are too
sick, and notes the blood tests showed no lymphocytosis. Foreman agrees
because they're not responding to the antivirals, acyclovir and
ribavirin, and if it is a virus that doesn't normally respond to those
medications, they don't have time to find it.
They decide the
children must have a resistant bacterial infection, since
broad-spectrum antibiotics are having no effect. Foreman suggests
MRSA and H Flu as possibilities, Cameron thinks it could be
Pseudomonas, and Chase suggests VRE. House orders vancomycin for
MRSA and aztreonam for the others, and MRIs to look for abscesses or
The Hartig and Chen-Lupino babies develop
kidney failure, which they attribute to the antibiotics as the urine
tests show no casts. Since both drugs can cause kidney failure and they
don't know which infection the babies have, House wants to take one
baby off vancomycin and the other off aztreonam.
Doclings, Cuddy, and the hospital lawyer view this as an unethical
experiment, though Cuddy allows it, since the alternative is to allow
the babies to die of the infection, and two more babies are now ill.
Foreman explains to the Hartigs that they think the baby has MRSA, and
they are taking her off the aztreonam. Cameron tells Judy and Kim the
baby probably has Pseudomonas, so they are taking him off vancomycin.
after, the Chen-Lupino baby's blood pressure drops precipitously. The
baby is given Levophed and pressors, but his BP continues to drop, and
he develops v-fib. Chase delivers several shocks, but the child dies.
House concludes that the aztreonam is ineffective, and orders
vancomycin for the remaining babies He tells Cameron to tell the
Chen-Lupinos that their baby probably saved five lives.
ethical dilemma is rendered moot when Chase informs House that the
Hartig baby is continuing to decline. The vancomycin isn't working,
either, so they're back at square one.
Foreman suggests theya re dealing with a superbug. Chase thinks the Howsam baby's skin rash could be scalded-skin syndrome, which would indicate VRSA, though Cuddy says there has only ever been two cases in the United States.
House launches into a rant about the practice of overprescibing
antibiotics, but changes his line of thinking when he remebers how low
the baby's blood pressure was before his death, even with three
pressors. Wilson speculates the baby had heart damage. House sends the
team home, as there is nothing more they can do, and performs an
autopsy on Baby Boy Chen-Lupino.
autopsy revealed fibrosis and lymphocytic infiltrates in the boy's
myocardium, though there was no sign in earlier blood tests. They
conclude that the infection must be viral. The process of finding the
virus is daunting as there are thousands of possibilities
and limited time. Chase also points out that if they take vials of
blood from the babies, rather than stick-tests, they can only take five
or six without exsanguinating the infants.
divides the white board into yes/no columns, and separate the
possibilities based on the symptoms and effects of the medications
they've tried. Herpes viruses 1 and 2, adenovirus, toxoplasmosis,
rubella, TORCH syndrome, paramyxoviridae, and a number of others are added to the "no" column.
"yes" column consists of CMV, Echo 11, influenza A, Coxsackie,
rotavirus, Epstein-Barr, Parvovirus B19, and RSV. The Doclings draw the
blood, though Chase feels that eight vials is "pushing it." Wilson
heads off to research which antivirals are effective against the eight
viruses, and Cuddy draws blood from the last remaining baby at the
hospital who was unaffected by the infection.
the sick babies tested positive for echovirus 11, CMV, and parvovirus
B19. The healthy baby tests positive for echovirus 11 and CMV
also, which Foreman thinks is odd. House realizes that the babies have
their mothers' antibodies, so if the mothers had had any of these
infections in the past, her antibodies would be passed to the newborns,
rendering them immune as well.
of the mothers' blood reveals the culprit to be echovirus 11. Cameron
tells the Hartigs that while the virus can cause flu-like symptoms and
diarrhea in adults, but can be deadly for newborns, and that the virus
is damaging her heart. The team acquires an experimental antiviral from
a company in Pennsylvania which has shown promise in laboratory
tests. After a tense period of waiting, the babies recover.
the maternity ward reopens, House continues to to seek the source of
the infection. Wilson urges him to wait for the results of testing
on stool samples that Cuddy got from the entire staff, but House is
adamant. He says the manner of transmission of enteroviruses is
fecal-oral or respiratory secretions, and the shedder must have been
showing symtpoms that Cuddy would have noticed. Wilson thinks
House's determination is "weird," but just after Wilson walks off,
House hears coughing.
An elderly hospital volunteer walks by
pushing a trolley and wiping her nose on her hand. The trolley contains
a basket of teddy bears, which she handed out to all the babies. House
has found the one person all the babies had in common.
agrees to deliver the baby of Jill, a clinic patient, so he can
continue to loaf in the OB/GYN lounge for five more months.
Diagnosis: Echovirus 11 infection
Physician's Desk Reference
Medical ethics: when the babies' kidneys fail
Cameron is unable to give bad news to the
babies' parents, even in response to direct questions, to the point
where Foreman, Wilson, and House question her professionalism. When the decision is made to
discontinue one of the antibiotics, Foreman tells the Hartigs that the
baby is gravely ill, and they don't know of she will survive. He does
so gently and with tact. Cameron, however, does not give the
Chen-Lupinos the full truth about how sick their baby is. When
Wilson calls her out for it, she claims the poor women will not care
what she said today if their baby dies tomorrow, and it is better to
give them hope.
When the Chen-Lupino boy dies, House tells Cameron
to inform the parents. She tries to get out of it, but House insists.
She appraoches the parents, but freezes, saying nothing. Wilson
delivers the news for her.
needed a good, hard slap. She soft-pedaled the baby's condition,
leaving the mothers unprepared for his death. When she clammed up
in front of the parents, Wilson did her no favor by delivering the bad
news for her. They most certainly will remember what their doctor said to them before their baby's death.
House performs the autopsy on the baby with surprising tenderness, but you'd think a pathologist would be doing that.
Cameron consistently pronounces vancomycin as "vanco-mya-cin." It's nitpicky, but I'm saying.
Either House's office has moved itself to the second floor, or the set
dresser forgot to change the sign by the elevator. In the scene where
Jill drags Charlie to the hospital, the directory by the elevators is
Oops: When House tells the OB he's delivering a baby in late
March, the OB replies, "That's five months from now." House gives the
date as December 2. Jill is four months along, so she will be giving
birth in five months, but it won't be March.
I wonder if they
told the teddy bear lady what happened. If she knew her sniffles caused
a baby's death, she would probably feel like absolute crap for the rest
of her life.
Blonde NICU nurse
Brunette NICU nurse
Baby Boy Limpert