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Update on the Toddler Who Survived Sub-Zero Temperature

An update on an amazing story we first reported on Monday, February 26: On Friday, February 23, 13-month-old Erika Nordby wandered into sub-zero temperatures in only a diaper. She had become so cold in the time it took her mom to find her that her heart had stopped beating for nearly 2 hours. But doctors managed to revive her. For an update on her condition, we turn to Dr. Alf Conradi, director of the pediatric Intensive Care Unit at Stollery Children's Health Center in Edmonton, Alberta, Canada.

How is Erika's condition?

"Erika overnight has become afebral. On the 28th, she developed a fever, and yesterday infectious disease specialists saw her and she started on an antibiotic. She had an infection in her blood and today she is without fever and looks good. With respect to her frostbite injuries, the plastic surgeons continue to follow her, and I think they're quite pleased with the improvement in her hands. But the condition of the feet is still unknown. We will be watching her for a few more weeks. It may mean eventually removing some of the damaged tissue, but whether it means amputation of some portions of her feet is unknown. She is interacting with her mom, doing the appropriate things. She had a CT scan of her head as a precaution, but that result is not available. The assumption is that it will be normal because her behavior is normal. The long-term for this little girl--though she appears normal--there is a possibility that there may be some subtle injury to the brain that may affect her development in the future. It could mean possible learning disabilities. If the brain gets any damage, there can be a subtle block in the ability to learn.

"Fortunately, if those blocks are detected in a timely fashion, we can take steps to circumvent those problems, rather than having the child fall back. With the appropriate teaching, some of those difficulties can be overcome. It's still our hope that she has no difficulties."

There are accounts of donations. How much has been raised for Erika's care?

"I don't know the quantity, but there have been numerous donations to the health foundation and those donations have been directed to Erika, and some to the pediatric ICU. They've from all over the world. People have called in and offered suggestions on how to care for Erika. One amusing one was to warm her with automotive oil."

What has the effect been on the hospital staff?

"I think it's been a very positive thing in that suddenly--you know we work day in, day out in the pediatric ICU. We have incredibly complex children's ailments come our way, and we often marvel at how some of these kids overcome the odds. We almost make the assumption that this is how it is, and we sort of lose sight at some of the marvel behind this. Until suddenly, we have a child come along and recover in a more extreme way--it makes us realize that something really special has happened here, but ot only here, it happens on a regular basis to critically ill children. It reinforces a sense of pride to what we as a healthcare team do. It makes us proud.

"My colleague said that it's been a humbling experience, and after he used that word, there's been some introspection, and it's become clear to us, and I think this was something we considered, the importance of hope. This little girl came in dead to external appearances, and based on a slim chance that she could recover, in other words hope, the paramedics worked on her, then the ER team, even though a chance of survival was small. Hope, as has the contribution of other aspects that we have no control over-- spirituality and faith--make a difference."

Is her recovery inexplicable?

"I would say it was a one in a million chance. There are four to six recorded cases like this in pediatric literature. With such profound hypothermia, for her to have no heartbeat for in excess of 2 hours, and then in suca dramatic fashion and such a short period of time to recover fully, really is extraordinary. Is it impossible? No. We know that such cases have occurred. Was it probable? No. Far from it."

Is this a case that the hospital can learn from to help in a similar situation?

"I would hope that the medical side of it, from the moment the paramedics arrived, I would like to think we would be able to reproduce the performance, but a lot had to do with what happened to Erika when she went outside. Her cells had to be protected in just the right way, to match the slowdown in her circulation, as the oxygen slowed down, so there was optimal matching. Likewise, again the mother finding her in a timely fashion was paramount. But the re-warming process also had to optimally match the recovery of the cells, especially the brain--the brain being the most demanding for oxygen. It's just one of those situations where all the factors came together just right.

"The main issue now is the ongoing frostbite injury, and the plastic surgeons say she'll have to be monitored in the hospital for at least 3 weeks. If she needs amputation or tissue removed, she'll have to be here longer. Thereafter, she will be transferred to a rehabilitation hospital to recover.

"We've been very appreciative of the world's interest in this story. The phone calls, emails and faxes that have come from all over have been overwhelming."

Background Information on the Toddler

The toddler's mother on Tuesday, February 27, described for the first time discovering her daughter, Erika, who had wandered outdoors in Edmonton, Alberta, wearing only a diaper during sub-zero temperatures Friday night while her mother and her 2-year-old sister slept. The baby was found around 3 AM Saturday morning, her hands curled underneath her body. "I picked her up and she was rozen. It was the worst feeling ever. She was stiff in my arms," said Erika's mother, Nordby, 26.

Nordby said she wrapped Erika in a pink blanket and rocked her until an ambulance arrived. She watched the paramedics working, she said, and "all of a sudden one of them said, 'We got a pulse. Let's move her."'

Officials at the Stollery Children's Health Center in Edmonton said Erika was moved Tuesday from the intensive pediatric unit to a regular hospital room.

Dr. Alf Conradi, director of the hospital's pediatric unit, told reporters earlier that the baby was interacting with her mother and being playful. She uttered a few words like "mom" and "down." Conradi said two outstanding concerns remained. Frostbite in the baby's toes and fingers was being continually assessed.

It will take a few weeks before they will be able to know if some of her toes and fingers require amputation. Also, it is difficult to tell at this stage if the baby will suffer any serious brain complications in the future.

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