A Miracle Baby
Multidisciplinary Team Joins Forces for Complex Pediatric Surgical Case
Theresa Delgado was 20 weeks pregnant when she found out the news: the baby boy growing within her had a large tumor originating at the base of his tailbone, a condition called sacrococcygeal teratoma that affects approximately 1 in 50,000 births. The news knocked the wind out of the expectant parents, Theresa and her wife of two years, Angela McCray.
“It was pretty overwhelming,” said Angela. “You don’t expect anything negative to happen to a child even before they’re born.”
Angela, as an emergency medical technician with the New York City Fire Department, was well-equipped to become the “question-asker,” and there were none better to ask questions of than Martin Chavez, MD, Chief of Maternal-Fetal Medicine and Fetal Surgery at NYU Winthrop Hospital.
“Dr. Chavez was amazing,” added Angela. “Being in the medical field, I loved the fact that he was straightforward. There was no sugar-coating. He said, ‘Here’s what it is, and here are your options.’”
As the weeks progressed, Dr. Chavez observed the tumor growing, and it began stealing blood from fetal circulation, causing the baby’s heart to work in overdrive and causing the fetus to go into cardiac failure. In a race against time, Dr. Chavez performed surgery in-utero at 30 weeks to close off as many blood vessels to the tumor as possible. This would reverse the cardiac failure and also allow the fetus to become bigger and stronger in the best place possible – the maternal uterine environment. A laser was used to seal off as many vessels in the tumor without harming the fetus inside the mother’s uterus. At that point, he also tapped the expertise of a colleague, Chief of Pediatric Surgery Brian Gilchrist, MD, who also happens to be an expert in the sacrococcygeal teratoma condition.
“This was not a garden variety tumor,” explained Dr. Gilchrist. “The tumor had worked its way up the spinal cord.” This complication called for an addition to the multidisciplinary team in the form of John Grant, MD, Director of Pediatric Neurosurgery at NYU Winthrop.
“The three of us coordinated every aspect of pre-natal care, and we began anticipating the complicated post-natal surgery,” said Dr. Gilchrist. “This was the ultimate team effort, from planning to execution.”
By 35 weeks, the tumor had grown so large – the size of a large grapefruit – that a C-section for Theresa would have been impossible without causing harm to the baby at the time of delivery. Dr. Chavez stepped in again. Employing a special needle, he drained fluid from inside the tumor, thus “deflating” the cystic portion of the tumor to safely make way for a C-section delivery. Caleb Matthew was born shortly thereafter on September 11 to his NYPD police officer mom.
Two days later, after stabilizing Caleb, it was all-hands on deck in the surgery division of NYU Winthrop as Drs. Gilchrist and Grant began an incredibly complex seven-hour surgery, joined by Rachel Ruotolo, MD, an expert in complex reconstructive plastic surgery, and anesthesiologist Clifford Katus, MD. The latter was tasked with the challenge of intubating Caleb in the prone position (belly down), a position in which the lungs can become compressed and pose risks to preterm babies like Caleb with lungs not yet fully developed. Dr. Katus had the well-honed skills that allowed all to proceed smoothly.
Dr. Grant then opened up the spinal area of Caleb, performing incredibly intricate neurosurgery to remove the tumor from its resting position on the spinal nerves alongside the vertebral column. The surgery was then handed off to Dr. Gilchrist, who removed the sacrococcygeal teratoma from the buttocks area. Next, Dr. Rattola stepped in to close the wounds after the tumor was resected and refigure the skin to form a normal-appearing backside.
“The biggest fear to the operation was blood loss because the tumor was so large,” noted Dr. Gilchrist, “But we successfully located and secured the artery and blood vessels that had been feeding the tumor.”
At day’s end, the seven-hour operation “went beautifully,” according to Gilchrist. “Caleb is truly a miracle baby.”
Caleb returned home just over a week later and began regular physical therapy aimed at helping him regain mobility. And, while he is not entirely out of the woods – the swelling of the spinal cord nerves can take six to 12 months to subside – Dr. Grant is very confident that Caleb’s mobility will, soon enough, be like any other healthy, bouncing baby boy.
“We’re still overwhelmed,” said Angela, “but we’re happy.”
But of course the new parents are overwhelmed…because now Angela is pregnant and in her second trimester. Caleb, the miracle baby, has a little sister on the way. The growing family is once again turning to NYU Winthrop, knowing that when it comes to babies, the hospital’s maternal-fetal medicine and pediatric experts make for the consummate multidisciplinary medical team.