BOSTON - Two-week-old Sarah Savage is scheduled to go home today, April 7, after undergoing lifesaving surgery at Children's Hospital March 22 by a team from the Center for Fetal Diagnosis and Treatment at Children's Hospital to remove a large mass that was obstructing her airway. Without the diagnosis of the growth in utero and the collaborative intervention of the center's multidisciplinary specialists from Children's and Beth Israel Deaconess Medical Center, Sarah would not have survived.
John and Lucie Savage of Pembroke, Mass., learned during the 15th week of Lucie's pregnancy that the baby they were expecting had a growth in her chest. Lucie, who is a Neonatal Intensive Care Unit nurse at BIDMC, was referred to Deborah Levine, M.D., a BIDMC radiologist, Geoffrey Wong, M.D., a BIDMC high risk obstetrician, and Russell Jennings, M.D., director of the Center for Fetal Diagnosis and Treatment and assistant in Surgery at Children's Hospital Boston, for further tests and consultation.
At the 31st week of her pregnancy, Lucie developed excessive buildup of fluid in her uterus and it appeared that the baby's heart had shifted to the right. Utilizing a fast magnetic resonance (MR) sequence and ultrasound, Levine and her colleagues determined that Sarah had a mass that was blocking her left lung causing it to fill with fluid and push her heart toward her right chest. Further imaging showed the mass then started to block the entrance to the right lung. This caused both lungs to enlarge and push on the diaphragm.
The collaborative surgical team, at the 34th week of Lucie's pregnancy, performed an EXIT (ex-utero intrapartum treatment) procedure in the Children's Hospital operating room. The BIDMC obstetrics team, led by Wong, performed the modified caesarian section. This entailed partially removing the baby from the uterus, so that her head and shoulders were accessible to fetal surgeons but the rest of her body was still inside the uterus. The goal was for fetal surgeons to operate on Sarah while she was still attached to her mother's placenta. Maintaining maternal circulation (a mother essentially serves as a baby's heart and lungs until the umbilical cord is cut) meant that Sarah could be operated on without having to breathe on her own.
Jennings and the fetal surgery team performed a bronchocscopic exam and evaluated the mass while Sarah was on placental circulation. Since the mass was preventing the lungs from filling with air, Sarah had to be placed on an extracorporeal membrane oxygenation (ECMO) or heart/lung machine to keep her alive until she would be able to breathe on her own. The ECMO machine essentially took over for the placenta. ECMO is a form of cardiopulmonary bypass where blood is oxygenated outside of the patient's body. Wong and the obstetrical team fully delivered Sarah at this point. Jennings and the surgical team then removed the mass and reconstructed Sarah's trachea while she was on ECMO.
"Her airway was completely blocked," said Jennings. "If this child was delivered without surgical intervention, she would have died."
Lucie was transported back to BIDMC the day of the surgery to recover under the care of the hospital's obstetrical team and went home on Mon., March 27. On Sat., March 25, only four days after her surgery, Sarah was weaned off ECMO and put on a ventilator. She was taken off the ventilator on Tues., March 28 and has been learning to feed in Children's NICU since then.
"I always knew that everything was going to be fine," says Lucie Savage. "From the very beginning everyone at Beth Israel Deaconess and Children's have come together to make the best plan for my baby." With Lucie's expertise in neonatal care, Sarah is able to go home early, as her mother will be able to tend to her special needs.
The Center for Fetal Diagnosis and Treatment at Children's Hospital brings together the expertise of fetal surgeons, obstetricians, perinatologists, geneticists, ultrasonographers, and other surgical specialists from throughout the Harvard medical community. In addition to the collaborative effort between BIDMC and Children's in Sarah's operation, the center also has relationships with all Harvard-affiliated teaching hospitals including Partners HealthCare System's Brigham and Women's Hospital.
"This case is an extraordinary example of the good that results when top-notch providers and institutions collaborate on a serious health complication," says Benjamin Sachs, M.D., chairman, Department of Obstetrics and Gynecology at BIDMC. "A tremendous amount of work and coordination behind the scenes made this all possible."
The Center for Fetal Diagnosis and Treatment is one of only three fetal surgery centers in the world that offer comprehensive maternal and fetal care from diagnosis to delivery to follow-up. Fetal surgery is the best, and in many cases the only, way to treat some abnormalities that may be too late to correct at birth. The Center specializes in treating fetal tumors, like Sarah's, as well as other types of life-threatening lesions and obstructions that result in respiratory problems, congestive heart failure and kidney failure at birth. Another example is congenital diaphragmatic hernia, a condition that severely restricts lung development in the fetus. Children's surgeons are paving the way for new treatments for this anomaly as well as other life-threatening fetal diagnoses.
Beth Israel Deaconess Medical Center is a major patient care, research and teaching affiliate of Harvard Medical School and a founding member of CareGroup Healthcare System. BIDMC is the third largest recipient of National Institutes of Health research funding among independent U.S. teaching hospitals.
Children's Hospital Boston is the nation's premier pediatric medical center. Children's Hospital is the primary pediatric teaching affiliate of Harvard Medical School, home to the world's leading pediatric research enterprise, and the largest provider of health care to the children of Massachusetts.
NOTE: Video footage from this lifesaving operation and a MRI slide of the mass are available.