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A few months into her pregnancy, Anisah Brown had a routine ultrasound that detected a large hole in her baby’s diaphragm. Her baby had been diagnosed with a congenital diaphragmatic hernia, or CDH. The hole would let the liver, stomach and other internal organs compress the lungs, leaving them little room to develop. Her doctor told her there was no hope. But that was before she came to the Cincinnati Fetal Center.
Anisah Brown: “They just were telling me that they had a balloon that they used overseas and that they had did it on a couple patients over there and a lot of babies made it and that I would be like the first person to get it over here so that kind of scared me cause I was like, Oh my goodness, but I’m like, I’ve got to try something.”
The Cincinnati Fetal Center is a collaboration among Cincinnati Children’s. Good Samaritan Hospital and the University of Cincinnati Medical Center. The fetal center is one of only five sites in the U.S. to be testing a new treatment for the most severe cases of CDH. Dr. Jose Peiro, a fetal surgeon, says the procedure uses a balloon to block a baby’s trachea during a mother’s pregnancy to promote the baby’s lung development.
Jose Peiro: “It’s a very tiny balloon, it’s detachable. So we need to place a big needle, about 3 mm, inside the amniotic cavity with a camera so we can see the nose, the mouth of the baby, and then go through the mouth, inside the larynx, through the vocal cords, into the trachea. That is challenging.”
Once inside the trachea, the surgeons insert a catheter with a balloon at the tip, inflate the balloon, and then remove the catheter, leaving the balloon behind to block the trachea while the placenta provides oxygen for the baby.
Dr. William Polzin, director of maternal/fetal medicine at the Cincinnati Fetal Center, managed Anisah’s care after the balloon had been placed:
William Polzin: “We were using medicine to stop her labor and then under ultrasound guidance were able to pass a needle into the neck of the fetus and into the balloon itself that was obstructing the airway. This allowed the balloon to deflate and for the lungs then to start to recover their ability to function normally at the time that the baby was born.”
On January 2 of 2017, Anisah gave birth to her son, Azare, and waited anxiously to see him for the first time.
Anisah Brown: “It was like five hours I had to wait, but I waited and waited. It was the best moment of my life actually.”
With current advancements, the prognosis for mild CDH is excellent. In severe cases, like Azare’s, the prognosis is about 50-50. Dr. Paul Kingma, neonatal director of the Cincinnati Fetal Center who took care of Azare after he was born, says the new procedure should improve on that.
Paul Kingma: “Their survival rates after they’re born go way up, and all the things that we monitor as far as their lung function, and how long they’re on the ventilator, how long they’re in the hospital, all those things improve significantly if they go through this procedure.”
Dr. Foong-Yen Lim, surgical director of the fetal center, says the study also should tell us whether the procedure reduces additional, life-altering medical issues that often occur today.
Foong-Yen Lim: “If these babies can grow up without significant other issues, then this procedure can be a good option to our future patients.”
After Azare was born, Dr. Lim closed the hole in his diaphragm. As for Anisa, she recently celebrated with Azare on his first birthday, thankful for the decision to be the first at the fetal center to enroll in the study. Together, they are looking forward to a bright future.
Anisah Brown: “He’s my blessing, that’s all I can say, he’s a blessing.”
20 мар 2018
