KZN’s first pinhole surgery baby is born

Breakthrough procedure opens new doors

Wednesday, July 11 2012

The baby boy whose life was saved by groundbreaking pinhole surgery performed on him while still in his mother’s womb, was born at the Netcare Umhlanga Hospital yesterday.

The baby, named Joel Hayden Ford, who was operated on when his mother was 31 weeks pregnant, was delivered via caesarean section at 38 weeks. According to the doctors involved in his delivery, he is “strong and healthy” and entered the world weighing 3,32 kilograms.

The pinhole surgery, which involved the insertion of a shunt to drain fluid that had been building up in the foetus’ chest, was performed at Netcare Parklands Hospital in Durban early in June by a team of specialists. It was the first time the life saving procedure has been undertaken in KwaZulu-Natal and possibly in the country, according to foetal specialist, Dr Ismail Bhorat.

Hayden and Tarryn Ford of uMhlanga said they were delighted at the birth of their third child. Hayden, a former Netcare 911 paramedic, said that until now babies with hydrothorax, as the condition is known, had a very poor prognosis. “Thanks to the outstanding doctors and the latest in medical technology and techniques we are able to celebrate the birth of our third child,” he added. “We are very grateful to everyone who was involved in caring for Tarryn and our miracle baby.”

According to Dr Bhorat, who practices at Netcare Umhlanga Hospital, hydrothorax involves the build-up of fluid between the layers of tissue that line the lungs and chest. The condition occurs in approximately one in 15 000 foetuses. The build-up of fluid places pressure on the baby’s chest cavity and can cause breathing problems and prevent the heart from pumping properly.

 “The condition inhibits the growth of the baby’s lungs and often causes cardiac failure, which leads to intrauterine demise,” he adds. “Indeed, no fewer than 90% of babies who develop the condition, die before birth. The medical team therefore had no hesitation in recommending the surgery to the Ford family.”

He says the pinhole surgery performed on the foetus was a complete success and allowed the baby’s lungs to expand immediately. The foetus’ heart, which before the surgery was displaced by the weight of the fluid, also quickly returned to its correct position.

Dr Bhorat points out that the procedure to treat the hydrothorax involves using ultrasound to remotely steer a needle through the mother’s abdomen and uterine wall and into the foetus’ chest cavity. He says the operation is very intricate and has to be undertaken with the greatest care. The needle is very sharp and the surgeon has to be sure to avoid nerves and organs while navigating. A special shunt was inserted to drain the fluid from the foetus’ lungs and was left in place so that it could continue draining the lungs until the baby’s birth.

The shunt was clamped as little Joel was removed from the womb during birth to ensure that he was not able to breathe in air through it. He was immediately ventilated after birth to encourage regular breathing. The shunt was completely removed today, according to Dr Bhorat.

“Hydrothorax is a very rare condition and yet, remarkably, we diagnosed two cases within just days of one another,” he observes. “We also surgically intervened on another foetus of 24 weeks, just six days after we operated on Joel. This operation was even more difficult as the foetus was smaller, but it was also a success and the foetus is now 31 weeks.”

Dr Carlos Hartmann, an obstetrician and gynaecologist who practices at Netcare Umhlanga Hospital, says the two operations offered the team invaluable experience and will enable the doctors to do similar procedures in the future. “Traditionally, medical conditions have always been difficult to treat in-utero,” he adds. “We were able to treat a condition that was previously considered untreatable. This procedure brings new hope to the moms whose babies develop hydrothorax.”

Dr Hartmann says the operations may also open other doors in in-utero surgery: “We expect we will now be able to treat certain other conditions in the uterus, especially those of the spinal cord such as spina biffida. A disorder such as this is best operated on early so that the damage it causes to the nervous system can be minimised. It therefore makes sense, where possible, to perform a procedure for spina biffida while the foetus is still in the womb.”

Dr Hartmann says the procedure to treat the hydrothorax is highly complex and best performed by a skilled multidisciplinary team of specialist doctors and nurses working in close collaboration. The two cases were handled by a team comprising Dr Hartmann; Dr Bhorat; paediatric surgeon, Dr Samad Shaik; and anaesthetist, Dr Mark van Staden. A number of other doctors were also on standby during the operations. “Everyone had a vital role to play and we could not have successfully completed the two procedures other than through a team effort”, says Dr Hartmann. “We look forward to collaborating on similar cases in the future.”

Netcare Umhlanga Hospital General Manager, Shaun Ryan, said he found it moving that the Ford family had chosen the facility as the place to have their “miracle baby” and wished them the very best for the future. “Our maternity staff strive to provide parents-to-be with the best possible birthing experience and we trust that the Ford family had another favourable encounter of the hospital. Their two other children were also born here.”

He said it was a “great honour” that doctors from the hospital participated in the two in-utero operations. “These procedures were truly an important milestone in the field of obstetrics and we salute the doctors and staff at Netcare who contributed to the success,” he added. “Our doctors have once again made the impossible possible and we thank them for the immense initiative they have shown in introducing this life saving treatment in KwaZulu-Natal.”  

Issued by : Martina Nicholson Associates (MNA) on behalf of Netcells Cryogenics
Contact : Martina Nicholson or Graeme Swinney or Clemmy Eccles
Telephone : (011) 469 3016
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