Groundbreaking procedure saves life of SA baby born with organs compressing his lungs

Ignus Greyling and his parents on the day of his discharge after three months in hospital. Picture: Supplied.

Ignus Greyling and his parents on the day of his discharge after three months in hospital. Picture: Supplied.

Published Jul 19, 2021

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JOHANNESBURG - When Nadia Greyling and her husband heard their newborn son cry for the first time, they nodded at each other in happiness as the sound melted their hearts.

However, what they didn’t know at the time was the roller-coaster ride they would go on as a result of baby Ignus’s health problems.

Listening to his little cries as he familiarised himself with the world for the first time after being born, they didn’t know that a team of 10 doctors and numerous nursing staff would have to race against time to save his life with a procedure that had never been performed on someone his age and whose success could not be guaranteed.

Three months later, however, baby Ignus has made a full recovery. The days of his worried parents looking at numerous IV lines going in and out his tiny body are a thing of the past, and the couple is now ready to enjoy being with their second-born child whose introduction to the world was a painful one.

Ignus was born on April 15 and almost immediately a paediatrician found that he was not breathing as he should.

He was then rushed to the hospital’s neonatal intensive care unit for observation.

Later, he was intubated and put on a ventilator to support his breathing - the first of many “lifelines” that would help sustain him in the fight to save him over the coming weeks.

It was at this point that Ignus’ parents were given the news that shattered their happiness that had been brought about by his birth.

“Neonatologist Dr Klaas Mnisi explained to us that Ignus had something called a congenital diaphragmatic hernia (CDH).

“Inside my baby’s body, there was a large hole in the muscle that separates the chest from the abdomen, allowing his abdominal organs to push through the muscle and compress his lungs.

“The overall chance of survival for Ignus, all things considered, was extremely low, if not non-existent,” Greyling recalls.

Dr Ashley Jeevarathnum, a paediatric pulmonologist at Netcare Clinton Hospital in Alberton, said Ignus did not respond to the initial therapeutic measures as hoped.

“The pressures in his lung were exceptionally high, a condition known as pulmonary hypertension and all life and respiratory support measures had failed.

“For any chance of saving his life, the therapy had to be escalated to extracorporeal membrane oxygenation (ECMO) life support.”

ECMO, he explained, is a highly specialised process where a machine artificially performs the functions of the heart and lungs. In Ignus’ case, it had to function for 24 hours a day over 12 days.

“Although ECMO is well established in adult care in South Africa and is a very good therapeutic strategy, it comes with huge risks for a neonate, or newborn baby. ECMO for a neonate with CDH is internationally known to be notoriously difficult, however it was the best option available to support his vital functions and get him well enough for surgery,” said Jeevarathnum.

Greyling said Jeevarathnum called her and her husband together with Ignus’ team of specialists and explained that their baby was not doing well and needed to be put on ECMO to help give his lungs a chance to rest before he would be ready for surgery.

“At that moment, it felt as if someone had pulled the whole world out from under my feet, but we were desperate to give Ignus a chance,” recalled Greyling.

A team of 10 doctors then proceeded with the delicate procedure to insert the ECMO cannula into Ignus’s tiny chest.

From there it was a waiting game for both the parents and medical staff, who didn’t know if the procedure would work on a neonate.

Greyling remembers that anxious time vividly.

“At one stage I counted eight or nine lifelines connected to his little body, anything from drips, the ECMO machine itself, haemodialysis, a ventilator with nitric oxide and an oscillator. Every move that Dr Ashley (Jeevarathnum) made was carefully calculated and discussed with a team that was highly qualified in areas that I can’t even pronounce,” Greyling said.

Paediatric ICU nurse Sister Khanyi Ngobese, who has 36 years’ nursing experience locally and abroad, said nursing Ignus required everyone to “think 10 steps ahead”.

“I think the ICU nurses found ECMO a bit overwhelming at first, as they had no previous experience with the process, but I was so proud of how they embraced it,” she said.

After almost two weeks on ECMO, the specialists agreed that Ignus was in a better condition for the surgery to repair the hole in his diaphragm that would keep his abdominal organs, including his intestines, liver and spleen, in their correct anatomical position to relieve the pressure on his lungs.

Paediatric surgeon Dr Charles Carapinha then performed the crucial operation to correct the life-threatening CDH.

“Ignus’s lungs and their blood vessels were under severe pressure due to his abdominal organs pushing through the large hole in his diaphragm.

“During the operation, a special patch of collagen was used to close the hole in his diaphragm as this creates a biological seal that is as natural as possible for a growing baby.

“Throughout, Ignus’s parents were very much at the centre of the team. They were fully informed of the potential risks involved at each stage, transparently and objectively.

“To my knowledge, Ignus is the first baby born with CDH in South Africa, that has completed ECMO and subsequently went on to have a successful diaphragmatic hernia repair. He has tolerated the procedure well, and his progress has been remarkable.”

According to Jeevarathnum, Ignus’s experience has raised the bar for South African neonatal care.

“His story has showed that we can reach international standards of medical care for our children and achieve good outcomes even for highly compromised babies.

“These world-class interventions are available in our country, and with the collective efforts of a dedicated multi-disciplinary team, Ignus’s excellent recovery has proved what is possible.

“Not only has Ignus survived, but all indications are that he is physically well and neurologically sound. This is an absolute miracle,” he said.

IOL

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