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Team Performs First-of-its-kind Life-saving Procedure at Fetal Care Center

The Hall family and Dr. Crombleholme, who performed baby Lake's life- saving surgery before birth.
The Hall family and Dr. Crombleholme, who performed baby Lake's life- saving surgery before birth.

A baby who would not have survived a traditional delivery recently received historic, life-saving fetal surgery at the Colorado Fetal CareCenter (CFCC) at Children’s Hospital Colorado. Timothy Crombleholme, MD, an international leader in the field of fetal surgery, led the team that performed the procedure, which involved removing a rare cyst while the baby was still attached to her mother's umbilical cord and then delivering the baby. This was the first documented procedure of its kind ever performed.

Savannah and Erik's baby has a tumor on her lung

Savannah Perry and Erik Hall of Lafayette, Colo., were thrilled when they discovered Perry was pregnant in February 2012. However, during a routine 20-week visit, Perry's maternal fetal medicine (MFM) specialist in Boulder, Colo., discovered an anomaly and referred her to the Colorado Fetal Care Center on the Anschutz Medical Campus in Aurora, Colo. Further testing determined the fetus had a benign tumor, or congenital pulmonary adonamatoid malformation (CPAM) in the upper lobe of her left lung. CPAMs are usually non-cancerous, but they can grow and occupy space, which can prohibit normal lung growth. The diagnostic testing also identified a small bronchogenic cyst, a type of fluid-filled cyst that usually does not cause a problem prenatally.

The experts from CFCC partnered with Perry's MFM specialist,who monitored mother and baby weekly to keep a close eye on the CPAM and cyst. At 30 weeks, a fetal ultrasound revealed that the CPAM was shrinking; however a marked enlargement of the bronchogenic cyst was compressing the fetus' left mainstem bronchus (the windpipe that attaches the left lung to the trachea). Over the next few weeks, the cyst continued to enlarge, completely obstructing the left mainstem bronchus, causing the left lung to over-inflate from retained fluid and shift the baby's heart to the right side of the body, thus compressing the right lung.

Dr. Crombleholme determines surgery is needed before birth

“There was too much pressure on the baby’s distal trachea and left main stem bronchus to establish an airway after a conventional delivery,” said Dr. Crombleholme, Children’s Colorado’s surgeon-in-chief and director of both the CFCC and CIMFH. “The baby needed surgical intervention just prior to birth in order to survive. As a result of tremendous planning and effort by a committed team from the CIMFH, a beautiful baby girl is home who might otherwise never have made it out of the delivery room.”

Perry was slated for an EXIT (ex utero intrapartumtreatment)-to-Resection procedure, followed immediately by delivery, at 36 weeks. The procedure was needed to remove her daughter’s bronchogenic cyst and restore her airway and lung function prior to birth.

On the day of delivery, the baby – whom Perry and Hall named Lake – was partially pulled out of her mother’s uterus. Lake remained connected to her mother via the umbilical cord during the surgical procedure, because the umbilical cord serves as both a passageway for anesthesia and a heart-lung machine.

Drs. Crombleholme and Stig Somme, pediatric general surgeon,removed the cyst and inserted a breathing tube prior to the baby’s delivery.The umbilical cord was cut upon completion of the procedure. At that point, the baby was fully delivered and handed by Dr. Crombleholme to the neonatal team, who were able to assist with the baby’s breathing.

Baby Lake, a "perfectly healthy baby girl," goes home early

On Lake’s fourth day, her chest tube was removed, and she was weaned off the ventilator and advanced to full feedings by mouth. Mom and dad were expecting a 6-8 week stay for their daughter in the neonatal intensive care unit at Children’s Colorado, but Lake exceeded everyone’s expectations and was home within three weeks.

“Lake is doing great. She’s now a perfectly healthy baby girl,” said Dr. Crombleholme during her recent five-month follow-up appointment. “Our work is done.”

“Lake wouldn’t be here if it weren’t for our amazing team of doctors and nurses,” said Perry and Hall. “The coordination and care we received was unparalleled. We can’t thank them enough.”

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