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When a two-month-old baby’s chest infection suddenly turned serious, his mother remembers the horror of realising her son was not breathing properly and was slipping in and out of consciousness.

“I knew we had to try to keep him awake. He needed urgent medical care, and so I drove with Nkateko on my lap to the emergency department at Netcare Waterfall City Hospital. I don’t remember parking the car – I just rushed him inside and they immediately put him on oxygen,” recalls Nthabiseng Mlangeni.

Nkateko was first admitted to the paediatric unit and his mother was able to remain with her son, rooming in with him. After several days in the hospital, Nkateko was again struggling to breathe, despite medication and physiotherapy to help clear mucus from his lungs. Doctors transferred Nkateko, whose name means ‘Blessing’, to the paediatric intensive care unit (PICU) under the care of paediatric intensivist Dr Palesa Monyake.

“In the PICU, they started him on high flow oxygen and Dr Monyake explained the unfamiliar environment to us, the treatment Nkateko was receiving and how they were monitoring his condition every minute. It was the hardest thing to have to leave my two-month-old baby and go home because parents can’t room in with their children in the high care environment,” Nthabiseng recalls.

“I did not sleep at all that night, between worrying about Nkateko and anxiously expecting a call from the hospital at any moment. It was one of many sleepless nights for us in the weeks ahead, but we came to trust the PICU team implicitly.”

Baby Nkateko Rivisi has made a strong recovery after a life-threatening respiratory infection, requiring extracorporeal membrane oxygenation (ECMO), an advanced form of life support in which specialised equipment artificially performs the functions of the heart and lungs, giving them a chance to heal.

 

Dr Palesa Monyake, a paediatric intensivist practising at Netcare Waterfall City Hospital, is pictured with members of the paediatric intensive care unit (PICU) team, (standing left) registered nurse (RN) Nonhle Mdluli and enrolled nurse (EN) Faith Molepo, as well as the hospital’s HR manager Sonto Makhanya.

 

The nightshift PICU team who cared for Nkateko at Netcare Waterfall City Hospital included RN Hlengiwe Msibi, EN Tholakele Dhladhla, RN Nothando Selepe and PICU manager Sr Jabulile Nxumalo.

 

The next day, Nkateko’s vital statistics suddenly dropped further, requiring the baby boy to be placed on a ventilator, then on an oscillator to support his breathing.

“He started to swell up in response to the infection, and it was extremely frightening for us as parents to see all these tubes sticking out of our baby. Our families here in Gauteng and other relatives travelled from different provinces to support us. We knew it was a very serious situation, and we prayed constantly,” Nthabiseng says.

Dr Monyake says Nkateko was one of several children admitted to the PICU requiring critical care for respiratory syncytial virus (RSV) so far this year.

“Babies’ immune systems have not had the time to build up resistance to the many common germs such as RSV that generally would not cause serious illness among older children or adults,” she says.

“It is rare to put a child on ECMO, however, this RSV season has been particularly brutal, and we are grateful this lifesaving option is available for our patients who are in the critical situation that Nkateko faced,” she says.

Cardiothoracic surgeon Dr Sharmel Bhika explains that extracorporeal membrane oxygenation (ECMO) is a form of life support in which specialised equipment artificially performs the functions of the heart and lungs, giving them a chance to heal. Yet, ECMO is only considered in life-threatening circumstances for such young children.

“ECMO provides a valuable lifeline when other forms of ventilation are no longer proving effective, and without this intervention, Nkateko may not be with us today.
“Nkateko required maximum mechanical ventilatory support and was not reaching targets for adequate oxygenation. ECMO was a clear indication in Nkateko’s case with his rapid deterioration and increased demand on mechanical ventilatory support,” Dr Bhika says.

Extracorporeal life support (ECLS also known as ECMO) is achieved by draining venous blood, removing the carbon dioxide (CO2) and introducing oxygen (O2) through an artificial lung, or oxygenator, and returning the blood to the circulation via a vein or, as in Nkateko’s case, via an artery known as veno-arterial ECMO.

“Nkateko was placed on veno-arterial ECMO, so cannulas were surgically placed in his internal jugular vein to drain blood from his heart, and return oxygenated blood via his carotid artery. This therapy allowed his lungs to rest and recover, while supporting his heart. The ECMO circuit also provides the patient the opportunity to be dialysed effectively so that his fluid balances are managed optimally during this critical time,” Dr Bhika explains.

Nthabiseng says, “At that stage, it seemed like Nkateko was getting worse, and we just wanted him to get better. We needed to decide in extreme circumstances, and we spent an hour asking questions about ECMO, and they explained all the risks, and that he would need a surgical procedure to insert a cannula to connect the system to his heart.

“It was such an anxious time for us, and although I felt like I was at breaking point, we remained prayerful. We also found comfort and support from the nurses and the unit manager Sister Jabulile Nxumalo. Every nurse who looked after Nkateko did so with so much care, and they really supported us. The doctors, especially Dr Monyake who was so supportive and prayed with us every step of the way, and the ECMO doctors who ensured that we were updated throughout the process, and the families of other children who were also being cared for in the PICU,” Nthabiseng says.

The baby boy showed remarkable resilience as he fought for survival.

“Under the constant care of specially trained PICU nurses, Nkateko gradually improved enough that we could consider transitioning off ECMO after three weeks and back onto conventional ventilation,” Dr Bhika says.

Dr Monyake adds, “This little boy had us so worried, it was an emotional rollercoaster, but his parents were amazing, they remained positive and drew strength from their faith.”

“On Mother’s Day, finally, they could take Nkateko off ECMO. I was nervous, but it was the greatest Mother’s Day gift to know he was making some progress. That day we were so excited that we arrived at the hospital three hours before visiting time – I even managed to eat something for the first time in weeks at the hospital coffee shop,” she says.

“My husband supported me with his positivity throughout. By spending time at our son’s bedside and speaking to him, we felt we were helping to breathe life into Nkateko, telling him ‘We are taking you home soon’,” Nthabiseng says.

At last, Nkateko no longer needed the ventilator, and his relieved parents could hold him in their arms again. “We heard him cry out for the first time in a month and a half, and the tears of relief were streaming down my face; by the grace of God, he was getting better,” she says.

Nkateko’s father, Tiyani Rivisi, thanked all the specialists, nurses, and allied healthcare practitioners who were part of the team caring for their son at Netcare Waterfall City Hospital.
“When Nkateko was hospitalised with RSV and required ECMO, our world was turned upside down. But, amid uncertainty, we found strength in each other, my parents, siblings, in-laws and our faith. My wife and I were each other's pillars, supporting and praying together,” Tiyani says.

“We feel blessed as a family to have Nkateko back home with us, and he has been doing so well since he was discharged towards the end of May. The outpouring of love and support from our family and in-laws was overwhelming, and we're grateful for their presence. The medical team's expertise and care were instrumental in Nkateko's recovery. This experience taught us that even in darkness, there's hope. We're thankful for Nkateko's resilience and the lessons we've learned along the way."

“He is now five months old, and he’s so active and so hungry, it’s almost like he is making up for lost time,” Nthabiseng concludes.

Ends.

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