Hunter Makes Up for Lost Time
Hunter was born on August 18, 2007, with a severe diaphragmatic hernia that left very little of his diaphragm in place. He arrived in the world a blue baby – without a diaphragm he couldn’t breathe. Within four hours of his delivery, he was transported by Memorial Hermann Life Flight® to Children’s Memorial Hermann Hospital’s Level III Neonatal Intensive Care Unit (NICU), where Charles Cox, M.D., professor of pediatric surgery at The University of Texas Medical School at Houston, started him on extracorporeal membrane oxygenation (ECMO). A heart-lung bypass technique that removes blood from the body, oxygenates it and pumps it back in, ECMO gives the lungs a rest so that they can heal – or in Hunter’s case, allows oxygenation of the blood to occur in the absence of normal breathing.
Diaphragmatic hernia is caused by failure of the diaphragm to close or to form, for unknown reasons, at approximately eight weeks’ gestation. Most commonly seen on the left side of the body, the defect may also occur on the right side or in the central portion of the diaphragm. The opening left in the diaphragm allows abdominal organs to herniate into the chest cavity. Complications arise when failure of the lungs to develop restricts the exchange of gases necessary for survival.
“Ninety percent of congenital diaphragmatic hernias are on the left side. Hunter’s was among the 1 in 10 that occur on the right side of the diaphragm,” says KuoJen Tsao, M.D., an assistant professor of pediatric surgery at the UT Medical School and co-director of the Texas Center for Maternal and Fetal Treatment at Children’s Memorial Hermann and UT. “It’s easy to miss a right-side hernia in the soft findings on prenatal ultrasound. Unlike left-side hernias, which tend to push the abdominal organs up into the chest, right-side hernias may leave some of the organs in place.
During the two weeks Hunter spent on ECMO, Dr. Tsao repaired his hernia using a Gortex patch to cover the hole. For six weeks following the procedure, Hunter was intubated and carefully monitored in the hospital’s Level III NICU. After he stabilized, he spent four more weeks in the Level II NICU.
“Because of the long hours and days we spent at the hospital, the ECMO and NICU staff are like our extended family,” says Hunter’s father John. “We stay in contact with a lot of the nurses who cared for him. Hunter’s success was phenomenal. Despite everything he went through, he had no other physical problems and no developmental delays. The experience changed our daily lifestyle, and in the end, it changed our lives.”
John, a former production manager for a local bubble-wrap manufacturer, enrolled in nursing school at Alvin Community College because of the family’s experience at Children’s Memorial Hermann. “I saw how nurses can really affect people’s lives,” he says. He will graduate in May 2011.
“All the doctors and nurses were really great,” Hunter’s mother Rachel adds. “We were regulars in the NICU for a long time. The nurses totally understood what we were going through and were always there for us. We got to know other families with babies in the NICU. You form a close and unusual bond.”
John says Hunter has made up for the time he lost in the NICU. “He’s extremely bright and articulate for a three year old. He was using sign language at nine months and talking in full sentences by 16 months. This was not baby talk. It was full-fledged communication. He came into the world a very demanding little man and that hasn’t changed.”
Hunter may need further surgery over his lifetime. “Kids grow, but Gortex patches stay the same size,” Dr. Tsao says. “There’s a fair amount of recurrence with diaphragmatic hernia that requires a patch repair, but with individual patients the chance of recurrence is hard to predict. We follow Hunter with a chest x-ray annually to keep an eye on how he’s developing.”
“We have nothing but praise for Dr. Tsao, Dr. Cox and the staff at Children’s Memorial Hermann because they did so much for us,” Rachel says. “Without them, we wouldn’t have our little guy with us. Because of our experience, our expectations have been raised. Other hospitals now have a higher standard to live up to.”