Fetal medical experts at the Cleveland Clinic acted quickly to save an unborn baby girl’s life after a massive lesion on her lung nearly killed her.
The Ohio hospital reported the baby girl now is thriving at home after her fetal surgery last year and birth in December.
“I’m expecting her to have a normal life,” said Dr. Darrell Cass, director of the Cleveland Clinic fetal surgery program.
The successful lung surgery on a 24-week unborn baby represents a new milestone in medicine, according to the hospital. Just a few other surgeries on unborn babies’ lungs have been performed across the world.
In the case of the baby girl, whose name the hospital did not release, the surgery saved her life.
Last year, an ultrasound detected problems with the unborn girl, and, at 22 weeks, four days gestation, she was diagnosed with a severe congenital lung (CLM) malformation, according to the hospital.
The condition can result in serious health problems, including swelling under the skin, hydrops, underdeveloped lungs, circulation problems, preterm birth, heart failure and even death. It poses serious risks to the mother, too, including preeclampsia, which can lead to death.
Cleveland Clinic fetal medicine specialists began by giving steroids to the unborn baby in the hopes of shrinking a large lesion on her right lung.
“The ideal [with steroids] would be to slow the lesion’s growth enough that you could postpone resection until after birth,” Cass said.
However, the drugs did not work, and the lesion continued to grow. According to the hospital, “imaging showed the CLM’s size increased from 5.1 centimeters to 7.7 centimeters during the next 10 days,” and the unborn baby began to show signs of heart failure.
Cass realized the unborn baby needed immediate intervention or she would die, and his medical team only had a few days to act.
“This mass was occupying about five-sixths of the thoracic chamber and there was very little space left for the rest of the organs to function,” he said. “The fetus’s heart was being impaired and was showing early signs of failure.”
The doctors decided to try fetal lung surgery, and the baby’s family agreed. At 24 weeks of pregnancy, the unborn baby girl and her mother underwent surgery at the Cleveland Clinic, surrounded by a team of doctors and nurses.
First, surgeons made an incision into the mother’s uterus and removed some of the amniotic fluid. Then, Cass brought the baby’s arm through the opening and inserted an IV. A photo from the hospital shows the girl’s tiny hand resting against Cass’s finger as he prepares to insert the needle.
A heart surgeon and anesthesiologists monitored the baby girl and mother while Cass worked to remove the lesion from the baby’s right lung.
“We’re talking constantly,” pediatric cardiologist Dr. Rukmini Komarlu remembered. “’Do we need to give atropine for a slow heart rate? Epinephrine to enhance contractility? And what fluid should we give? Blood? Saline?’”
Cass praised the team for working together well to save the baby and protect her mother throughout the process. After removing the lesion, they closed the baby’s chest, placed her back inside her mother and then stitched up the mother’s uterus.
The surgery was huge success. The unborn baby girl stayed in her mother’s womb for 12 more weeks before she was born in December at nearly full term.
Cass said the infant’s lungs are functioning normally now, and she is expected to live a normal, healthy life.
