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Monday, August 2, 2021

Sidra Medicine saves life of a baby with ‘rare’ Omphalocele condition

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The little boy has successfully recovered thanks to the medical team at Sidra Medicine and still visits regularly for check-ups.

A multi-disciplinary team of physicians at Sidra Medicine has performed life-saving surgery on a 1-year-old boy with Omphalocele— a rare condition that sees some of the infant’s organs stick outside of the belly through the belly button.

Baby Mikhail’s condition was discovered through an ultrasound at a clinic in Doha when his mother was pregnant with him at 12 weeks. The news came as a shock to the parents, given that they were unfamiliar with Omphalocele and the clinic did not have the right facilities to treat such cases.

“It was an uncertain time for us as this was our first pregnancy and at my 12 week scan at another clinic, it was identified that my baby had a major abdominal wall defect known as Omphalocele. This meant that his bowels, liver and other organs were sticking outside the abdomen in a sac,” his mother Branca said.

“The clinic also didn’t have the expertise in being able to advise next steps regarding babies born with the condition.”

Branca said that her excitement soon turned into fear and anxiety the moment her baby was diagnosed, especially because of her inability to understand the future prospects of her pregnancy.

After extensive research, Branca and her husband decided to go to Sidra Medicine after hearing about the hospital’s top fetal medicine and pediatric services. “We felt hopeful that they would be able to provide answers to our questions,”  Branca said.

During the consultations, a professional team of physicians from maternal-fetal medicine, neonatology, and pediatric surgery met with the parents to discuss the options available and what the doctors could do to help the baby.

“I vividly remember the warmth, support, and positivity the entire team of specialists provided us during our first meeting. They gave us hope that the pregnancy could continue and that they would be able to give the most appropriate care after I gave birth,” said Branca.

Omphalocele, also known as exomphalos, is a rare birth defect of the abdominal wall in which the infant’s intestines, liver, or other organs stick outside of the belly through the belly button.

The organs are covered in a thin, nearly transparent sac and the condition affects 1 in 5,000 births.

Prof. Karim Kalache, Division Chief of Maternal Fetal-Medicine at Sidra Medicine, said that the hospital has dealt with several cases in Qatar before and is well-equipped to guide the parents through the treatment and care process.

“It was critical to determine the size of the defect on the baby, which organs were affected, and to exclude associated anomalies. It was also important that the parents were aware of the risks and the opportunities of personalised care and treatment available,” said the doctor.

“We discussed the wide spectrum of outcomes to ensure that Branca and her husband were able to make an informed decision regarding the birth and care programme.”

Read also: Groundbreaking surgery helps child suffering from Apert Syndrome.

After intensive and regular monitoring of both mother and baby, Branca safely gave birth to Mikhail via a planned caesarian at the hospital on the 5th of March 2019. The hospital assigned a team of specialists on hand during the surgery to ensure the baby would receive immediate medical attention as soon as he was born.

“The minute he was born my heart leapt for joy on hearing the tiniest cry. He made it out alive and breathing by himself without any respiratory support. This was his first big accomplishment,” Branca explained.

“The transition from breathing in-utero to normal air without any respiratory support is a big miracle as most babies born with Omphalocele, require breathing support due to the pressure on their lungs. We named him Mikhail, and he has been a fighter and trooper since then. We knew that we would be in safe hands at Sidra Medicine and felt supported every step of the way.”

Dr. Guy Brisseau, Senior Attending Physician in General and Thoracic Surgery at Sidra Medicine, explained that babies born with this condition can sometimes have heart, spine, lungs, and digestive problems. After Mikhail was born, he underwent a thorough check-up to ensure that he wasn’t at risk with other conditions, apart from the large Omphalocele.

“We elected to allow the skin on his abdomen to grow over. And that he would undergo the next procedure until he turned two or three years old. This method called the “Paint and Wait” technique that would assist in skin formation over the thin sac.  It would allow his belly to grow and be stretched enough before surgery. The repair to his abdomen required that the process of care and treatment, be carried out in stages,” the doctor explained.

The health professional further explained that there are many different dressings are available to “paint” the thin sac to protect it from damage and bacteria. To help speed up the baby’s recovery and guarantee his safety, the team used a new but ancient technique of honey dressings.

This technique uses the natural ingredients of honey to physically protect the thin sac while we waiting for the skin to grow over and protect the sac. It is a safer option because medicinal honey does not have the side effects of previous dressings, continued Dr. Brisseau.

After his birth, Mikhail was admitted to Sidra’s Neonatal ICU in order to keep him under constant supervision, especially during feeding times given that his intestines were partially outside his body. He stayed there for around two months, the hospital said.

“Feeding babies with Omphalocele is a challenge and requires specialist expertise. In order to support his growth, nutrition was given through a central venous line into the blood (parenteral nutrition). Mikhail was fully fed with milk at only one month of age. The milk was started slowly and was gradually increased,” said Dr. Charlotte Tscherning, Div. Chief of NICU at Sidra Medicine.

The management of such a condition, especially after birth, is extremely precise and difficult, the doctor added, as many complications can occur. Luckily, the team managed to support the growth of Mikhail and to discharge him safely.

Branca said that she received mental health support throughout her son’s entire stay at NICU to help her cope with the process, as the images of what your child goes through can have a lasting impact on the mother’s well-being.

“Mikhail’s stay at NICU was fantastic and he received the best care from the NICU trained nurses, doctors, speech specialists, occupational specialists who provided Mikhail and us with holistic treatment and support. As parents, we learned a lot and grew so much during our stay”.

Mikhail was successfully discharged after over a two-month stay in the neonatal ICU, thanks to the hospital’s great efforts in ensuring his nutrition and health.

Read also: Sidra Medicine saves young boy’s life with complex epilepsy surgery

However, in July 2020, Mikhail started vomiting black-greenish fluids and was quickly rushed to the children’s emergency department at Sidra Medicine for an urgent gastrointestinal scan.

The results confirmed that Mikhail had developed an obstruction to his bowel, known as a paraduodenal hernia, a rare congenital anomaly in which his small intestine became trapped.

Given his condition, such disease could have been potentially life-threatening if not treated immediately. The baby was rushed into emergency surgery to fix the bowel obstruction.

A team of two surgeons, three nurses, and three anesthetics performed the surgery for over three hours, during which they decided they could also close his belly muscle and fix the omphalocele.

After relentless and precise efforts from the medical team, the surgery was a major success. The surgeons rectified the hernia as well as closing the abdominal defect without the use of any mesh, the hospital said.

Mickail was then sent home after spending eight days in the paediatric intensive care unit and floor and recovered in two months. He still regularly comes to Sidra Medicine for check-ups.

“Today if you see Mikhail, he is a chatty, bubbly and positive little boy. No one can ever believe that our little champ has been through so much. We are proud parents of a very strong little boy! He has taught us many life lessons which we will forever cherish. We are immensely grateful to the wonderful team at Sidra Medicine. Thank you,” said Mikhail’s parents.


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