Historic surgical birth last year a giant leap for Children’s Hospital

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This article was published 22/12/2017 (3192 days ago), so information in it may no longer be current.

At age one, Lily Kehler and her slightly crooked smile can be counted on to run to the back door when visitors come knocking. Friendly and outgoing, she’s used to meeting strangers.

Maybe that’s not so odd.

But her eyes offer something unexpected. This toddler has a level gaze, the kind of adult look you’d get from someone after hardship. It’s striking. Along with the smile, it’s also totally charming.

Meet Children’s Hospital’s miracle baby, born Dec. 13, 2016, by a modified caesarean section, where doctors didn’t clamp the umbilical cord until they got an air tube past a grapefruit size lump on her neck. The lump meant Lily couldn’t take that crucial first breath on her own.

To get her there, doctors had to balance Lily on the edge of birth, keeping her half in and half out of the womb for nearly 15 minutes, her head and shoulders exposed, her bottom half still inside her mother Ashton, umbilical cord intact.

“In a normal C-section, we’d give the mother an anesthetic, but we want the baby to be awake and vigorous and ready to take the first breath,” pediatric otolaryngologist Darren Leitao recounted a year later. He agreed to tell the story on behalf of the team of doctors and nurses who performed the work.

“In this situation we didn’t want the baby to take the first breath until the airway was safe and that meant giving the mom a deeper anesthetic to ensure she and the baby were asleep,” he said.

Leitao went on to describe an operation performed more commonly at major children’s hospitals such as Sick Kids in Toronto. In fact, a look at current medical literature showed the kind of cyst Lily had is extremely rare; one American centre cited just six cases over an eight-year period and noted two babies died.

Delivering a baby simultaneously as an airway is opened without a tracheotomy means fooling the uterus into thinking the infant is still in the womb.

“When a baby is born, the body’s natural response is to contract blood vessels in preparation for the cord and placenta separating. We had to try to stop all those things, all those normal body processes, because we wanted that blood to keep going to the baby,” Leitao said.

It took two surgical teams to monitor the mom and another two for the baby to pull it off, filling the womb with warm saline solution so the uterus won’t contract.

“It was almost like (the movie) Indiana Jones, where we had to take the idol but replace it with a rock, to trick the body into thinking there’s still something in the womb,” Leitao said.

The medical teams — led by Leitao, for the baby’s neck surgery, obstetrician Carol Schneider, neonatologist Michael Narvey and anesthesiologist Leanne Docking — ran through practice runs on a mannequin, charting every possible complication and planning out logistics so the four teams, about 20 people, could float around the equipment in the operating room and perform the surgeries on mother and child.

Think of pathways to the table as spokes on a wheel.

“Surgery isn’t about doing the one procedure right. It’s about if things go wrong, do you know what your plan B’s and C’s are, and are you prepared for those things to happen in split-seconds?” Leitao said.

The surgery was completed in 14 minutes, but it took more than 14 hours to plan it out.

“This was one of those cases where you wonder what you would do,” he said. “Lots of centres do it but usually we think of it for other centres. We don’t give enough credit to our hospital, that we do cutting-edge stuff and we have the expertise to do these kinds of surgeries.”

Lily was born without complications, but remained in the hospital and underwent two more major surgeries on the lump, called a congenital cervical teratoma. It was removed, without interfering much with a network of nerves through the neck that control everything from swallowing to smiling.

Much later, the hospital quietly posted a video on YouTube describing the surgery as a first for Manitoba.

The reason Lily’s smile is a little crooked is there was some minor nerve damage; she may grow out of it, but if that doesn’t happen, Leitao said doctors can probably help her.

“We expect her to eat and drink and breathe, laugh and smile and do all those things. If there are some subtle things she has, we’ll see it over time and work to make sure she has the life mom and dad both want for her,” he said.

That life is being lived with Ashton, her dad Jordan and her three-year-old sister Aria in their small Elmwood home. The family is close, and Ashton gets help from her mother and grandmother. She thinks it’s cool to be part of the hospital’s history.

She remembers the fear she felt when doctors first diagnosed the cyst on Lily’s neck; it showed up on an ultrasound about halfway into her pregnancy. And she recalls being shocked when she saw her sedated baby girl hooked up to machines in intensive care after the birth. But she also said she had confidence in the doctors.

“She’s catching up with all her milestones,” Ashton said as Lily and Aria played nearby. “She’s eating most of her food by mouth now. She was late in crawling, but she’s on the move to start walking and she’s just about to talk. She doesn’t drink. She has a feeding tube for her milk overnight. And she has to have plastic surgery to remove the skin on her neck.

“Then hopefully, this will all be the past.”

alexandra.paul@freepress.mb.ca