Baby Lake: Saved Before Birth

In a first-of-its-kind surgery, a baby who would not have survived a traditional delivery receives life-saving fetal surgery.

“We were 20 weeks pregnant and we had just our regular check-up ultrasound,” Savannah Perry told Ivanhoe.

Every expectant mother’s greatest fear is when a problem appears during an otherwise normal pregnancy.

“We didn’t even know if she was going to survive. They did another ultrasound about a week later and at that time they said it looked like there was a cyst inside of her lung,” Savannah said.

A non-cancerous, benign cyst was growing next to her unborn baby’s left lung. 

“I think there was a significant risk once she was delivered. She was fine in utero, but once she was delivered, we were asking the lungs to support her.  It just wouldn’t have worked.  So, we knew we had to come up with a separate strategy,” Dr. Timothy Crombleholme, Fetal Surgeon, Surgeon-In-Chief, Children’s Hospital Colorado, told Ivanhoe.

The strategy—at 36 weeks, half delivered, and still attached to the placenta, doctors at Children’s Hospital of Colorado removed the cyst before delivering the baby. 

“By the time Lake was delivered, her left lung was touching her right chest wall.  It had phenomenally increased in size and had compressed the right lung,” Dr. Croblemholme said.

“She is doing amazing. She is learning to walk. She walks around furniture now. She loves anywhere she is not supposed to be,” Savannah said.

Baby Lake is now 11 months old and her left lung has almost returned to its normal size. Doctors believe she will make a full recovery and be just like any other kid as she grows up.

 

BACKGROUND: The lungs are the most crucial organs in a person’s body. Of all of the body’s organs, the lungs are the last to develop and are not completely finished until after birth. The lungs have the largest number of health problems in babies and young children that include asthma, viral, and bacterial infections. Unborn babies do not have a need for lung development because they rely on the placenta to transfer carbon dioxide and oxygen. After a baby is born, the chest cavity expands and takes in air. (Source: http://www.healthline.com/galecontent/lung-development-and-breathing-disorders)

FETAL SURGERY:  Doctors at Colorado Fetal Care Center performed a life-saving surgery on baby, Lake Annabelle Hall while she was still in the womb! While mother, Savannah was 30 weeks pregnant, a team of 43 doctors and nurses operated on her unborn baby to remove a cyst that developed in her left lung. If the cyst was not removed before birth, Lake would not have survived. Doctors decided to conduct the surgery by performing a cesarean section that entailed pulling the baby halfway out of the womb, but leaving her connected to the umbilical cord to serve as life support. The procedure lasted roughly 20 minutes and created a healthy start to baby, Lake’s life. (Source: http://news.yahoo.com/baby-lake-doing-fine-5-months-exit-procedure-091820579.html)

EXAMPLES: Unborn babies have been found to develop abnormal cysts and tumors in different regions in the body across the country. A first-of-its-kind surgery was performed last year in Miami, Florida. Baby Lyna Gonzalez was the first to have surgery while in the womb due to a benign tumor on her lips the size of a tennis ball. Another case in Mequon, Wisconsin detailed a procedure that involved the removal of a macro-cyst the size of an orange in the baby’s chest. This procedure was also done in the womb before baby, Elijah Leffingwell was born. (Source: http://www.lifenews.com/2012/06/21/worlds-first-surgery-removes-tumor-from-unborn-babys-lips/ and http://www.lifesitenews.com/news/in-utero-surgery-saves-20-week-unborn-baby-with-cyst-the-size-of-an-orange)

Timothy Crombleholme, MD, Surgeon-in-Chief, Children’s Hospital Colorado and the Director of the Colorado Fetal Care Center and Colorado Institute of Maternal and Fetal Health, talks about a life-saving surgery for fetuses.

Tell us about baby Lake; how serious was her condition?

Dr. Crombleholme:Well when we first met baby Lake understand that Savannah was earlier in the pregnancy. And she was really referred because Lake had an echogenic area in her left upper lobe. During the course of her evaluation however, we also noted that she had a small cystic structure sitting right where the trachea bifurcates into left and right main stem bronchi. And we set up a plan for follow-up and it wasn’t too long on the follow-up ultrasound we saw the left lung was now significantly hyper-expanded. What happened was that this small bronchogenic cyst had actually increased in size several fold and had now completely obstructed the left main stem bronchus right at that bifurcation.

How great of a risk was the fetus at that point in time?

Dr. Crombleholme: The big thing was that we weren’t going to have a stable airway and we were not going to have a way to safely ventilate the baby. If you think about it from the neonatal perspective once the baby was delivered every breath that the baby would take would trap air in this hyper expanded lobe. And by the time Lake was delivered her left lung was touching her right chest wall. It had phenomenally increased in size and compressed the right lung. And so there wouldn’t have been a way to functionally ventilate Lake if we were to just deliver her in a conventional way.

So literally baby Lake wouldn’t have been with us today.

Dr. Crombleholme: I think with a conventional delivery that’s probably true.

How much at risk was the baby during the operation itself?

Dr. Crombleholme: Well actually not at great risk. The EXIT (ex-utero intrapartum treatment) procedure on baby Lake was performed by a very experienced team. We have a set of anesthesiologists for mom, and we have a set of anesthesiologists for baby. We have a surgical team, an obstetrical team, nursing team, and neonatal teams all available for both patients.

It was not a risky procedure?

Dr. Crombleholme: Well there always are potential risks, but we have enough experience to really mitigate those risks and prevent them from being a problem. And there are both fetal risks and neonatal risks for Lake, but there are also maternal risks for mom. It’s one of those rare instances in medicine where you have the mom who derives no direct benefit from this kind of intervention but assumes all of the risks and the baby who has everything to gain and nothing to lose by taking this course.

Is this a first of its kind or has this been done before?

Dr. Crombleholme: Not for this specific indication. We have a lot of experience with EXIT procedures and EXIT procedures have done to exit airway, exit to resection. But there’s never been a case recorded with this kind of presentation with a bronchogenic cyst and this hyper-inflation of a unilateral lung that so compromised the airway.

When you say EXIT procedure what does that mean?

Dr. Crombleholme: An EXIT is an ex-utero intrapartum treatment. It’s an operation that’s designed to be performed during delivery. So while mom is deeply anesthetized we open up her abdomen, open up the uterus with specialized stapling devices so there’s no bleeding from the uterine wall. And we can partially deliver the baby and because the uterus is completely flaccid it preserves utero placental gas exchange. So we literally have the placenta support the baby and were not asking the baby’s lungs to take over which is exactly what would happen once we clamp the cord. So the baby is making an exit from the womb and we utilize the placenta to support the baby while we’re doing the operation.

How is baby Lake today?

Dr. Crombleholme: Awesome. She’s just great and you would never know she had anything wrong. We had concerns that not only would the bronchogenic cyst compress the airway and cause this massive lung expansion but we were concerned that it might have caused tracheobronchial malacia or softening of the airway that would have caused airway collapse. And fortunately none of that has turned out to be the case and on follow-up CT scans her lung is gradually coming back to normal size, her airway is perfectly fine, and she’s just a beautiful little baby.

How long has the surgery been going on?

Dr. Crombleholme: Since 1981.

 

FOR MORE INFORMATION, PLEASE CONTACT:

Mary Beth Martin, RN
Executive Director

Colorado Institute of Maternal & Fetal Health

Children's Hospital Colorado, University of Colorado Hospital

(720) 777-4269


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