Marvel of foetal surgery

But for modern medicine, little Ethan Leibbrandt " who took centre stage at a reunion last week " would have died. Making a fuss of him were, from left, his dad, Dean, his big sister, Amber, proud mother Vanessa, foetal specialist Dr Ismail Bhorat and paediatrician and neonatologist Dr Japie Roos. Picture: Puri Devjee

But for modern medicine, little Ethan Leibbrandt " who took centre stage at a reunion last week " would have died. Making a fuss of him were, from left, his dad, Dean, his big sister, Amber, proud mother Vanessa, foetal specialist Dr Ismail Bhorat and paediatrician and neonatologist Dr Japie Roos. Picture: Puri Devjee

Published Oct 16, 2014

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Durban -

Vanessa and Dean Leibbrandt just could not believe it when foetal specialist Dr Ismail Bhorat told them their unborn baby had a rare lung condition.

Having already lost a daughter just 19 hours after she was born with a rare kidney condition, they had dreaded hearing that their next baby had the same problem.

Now, however, the Glenashley couple were being told their unborn child – a son – had an entirely different life-threatening condition: pulmonary sequestration.

“What the hell are you talking about?” the shocked father asked.

The Leibbrandts soon learnt that it was a rare congenital malformation: that a benign tumour – a solid lump of tissue – had developed on the baby’s right lung, with its own independent blood supply from the aorta.

The problem was that it was occupying part of the lung space.

“They were devastated, especially in light of their past history,” recalled Bhorat, who assured them that he would follow the foetus closely to detect any compromise.

However, the prognosis was guarded because of the tumour.

The couple, who have a daughter, Amber, 4, were told the heartbreaking news when the mom-to-be was 19 weeks pregnant.

She had already had the traumatic experience of losing her daughter, whom they named Jayde.

It had been a perfect pregnancy with no issues at all.

But Jayde had breathing difficulties at birth and tests found that her kidneys were enlarged and were full of cysts, as were her lungs.

Her death at just 19 hours was totally unexpected, and in view of that history, Leibbrandt’s gynaecologist and obstetrician, Dr David Attwood Smith, referred Leibbrandt to Bhorat for the next pregnancy.

The chances of developing the tumour were put at one in 10 000.

Then after the expectant mom went for her 32-week scan, disaster struck.

By now the tumour was taking up 50 percent of the lung space, pushing the foetus’s heart to one side. On top of that, there was another rare complication.

The tumour was causing a massive pleural effusion (fluid on the lungs), resulting in a form of cardiac failure.

Leibbrandt was also developing a “mirror” syndrome, which Bhorat explained was “a maternal manifestation of what was going on with the foetus”.

Most unborn babies die at this stage.

But a special foetal surgical team – Bhorat, Dr Samad Shaik, Dr Abdul Gafoor-Shaik, paediatric surgeons, and Attwood Smith – decided that this was a case where they could intervene.

They decided to put in a thoraco-amniotic shunt, similar to those inserted in a few other local patients before they were also born, to drain out the fluid.

The first procedure by the same team in Durban had made South African medical history in 2012.

It called for the same pinhole surgery and involved inserting an 18cm needle through the mother’s stomach and uterine wall, then through the baby’s ribs and into his chest cavity to drain out the fluid via his mother’s amniotic fluid.

The shunt had to be inserted down through the needle to continue draining out fluid, with the needle then withdrawn, and leaving the shunt in place to continue its life-saving work until the baby was born by Caesarean section.

Then it would be clamped off just before he was born.

“I was absolutely terrified as I knew it had only been done a few times before.

“I knew I could go into premature labour and that even when the shunt was in place, the baby could pull it out,” Leibbrandt said.

But the operation at Netcare’s Parklands Hospital was a success with the fluid in the lungs draining away and the heart issues resolved.

However, the tumour was still taking up half the lung space, preventing it expanding.

The next few weeks proved nerve-racking for the Leibbrandts. “We should have been happy, but we were cautious. It was a very stressful, unpleasant time,” they said.

The doctors managed to take their patient up to 38 weeks – then decided the time had come for the parents to meet their son, to be named Ethan.

But before the 3.3kg baby could be helped into the world in July, he was not breathing properly because of the tumour and had to be intensively ventilated and resuscitated.

“As we already knew the reason why he was struggling, there was no time delay in resolving it,” Bhorat said.

A few hours after his birth, Ethan returned to the operating theatre to have the tumour removed and immediately began to make a remarkable recovery.

Ethan spent almost a month in the neonatal ICU ward at Parklands Hospital and finally went home on his father’s 38th birthday. His proud 34-year-old mother says that Ethan is “perfect with no issues. He is just like any other baby, except he has a couple of scars”.

The family met up again with Bhorat and their paediatrician/ neonatologist, Dr Japie Roos, the other day and Bhorat said it was “amazing” to see the thriving little boy, now 11 weeks old.

“It was a difficult case. If we had not taken action, he would not have made it.

“The success was the result of hi-tech early foetal diagnostics, fetal therapy and immediate neonatal surgery. This type of work really has its roots in our preceding foetal therapy experience.”

Roos said the foetal surgery team were the “glory boys”, adding that but for the team, there would be no baby.

“If you make a primary mistake, that’s the end of it.”

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