In the Loop

News and views from across Mayo Clinic

November 9, 2017

Mayo Surgeon Performs Unique Procedure to Save Baby — Before She’s Even Born

By In the Loop

When Haley and Tyler Nolen’s young daughter, Faith, was diagnosed with congenital diaphragmatic hernia during a 20-week ultrasound, a family member urged them to come to Mayo Clinic where fetal surgeon Rodrigo Ruano would go on to correct the condition in utero.

Haley Nolen knew something was wrong as she stared at the image of the baby growing inside of her. Call it an ultrasound technician's instinct.

Haley Nolen instantly knew something was wrong. As she stared at the ultrasound image of the baby girl, 20 weeks along, growing inside of her, her own training as an ultrasound technician quickly came into play. "I can see on the screen her stomach's up in her chest next to her heart — that's a sign that something is not right," Haley tells the Sioux City Journal.

It was a sign of congenital diaphragmatic hernia (CDH), a rare condition that the paper reports "occurs when the diaphragm fails to close correctly during gestation, allowing abdominal contents to spill into the baby's chest cavity and compromise lung development." It was a shocking development in a pregnancy that up until that point, Haley says, had been "normal and exciting."

After the ultrasound, Haley and her husband, Tyler, were referred to a specialist in Nebraska who wanted to wait until Faith was born before surgically correcting her condition. Haley's sister-in-law, "a pediatrics resident who was set to begin a neonatology fellowship at Mayo Clinic in Rochester," the paper reports, contacted "her fellowship director to see what additional treatment options might be available for Faith" at Mayo Clinic.

At Mayo's Rochester campus, the Journal reports that Haley and Tyler learned from staff at Mayo Clinic's Fetal Care Center that Faith's condition "was more severe than initially thought." They recommended Faith have a unique procedure — a fetal endoscopic tracheal occlusion (FETO) — that would involve "placing a balloon into Faith's airway in utero" to help her lungs develop. "They may die before they get the surgery postnatally, so that's why we offer FETO to those babies who have a more severe form of CDH," Rodrigo Ruano, M.D., Ph.D., chair of Mayo Clinic's Division of Maternal and Fetal Medicine, tells the paper. Mayo Clinic, the paper reports, "is one of just eight centers in the United States, and the only one in the Midwest, with FDA approval for the procedure."

And so on April 13, "using ultrasound guidance," Dr. Ruano performed the procedure, inserting "a tiny scope" into Haley's uterus and then advancing it "into Faith's mouth to her trachea, where he deployed and inflated a latex balloon." That would give her little lungs the additional support they needed to continue growing. "We want to increase the lung size," Dr. Ruano tells the paper. "We believe that if we close the trachea, we are going to promote the lung growth. That's why we consider this treatment part of regenerative medicine, because we are trying to regenerate the lungs or the lung tissue."

All of that care and treatment paid off when, early one morning in late June, the Journal reports, Faith came into the world "weighing a healthy 8 pounds, 6 ounces." And after undergoing a second procedure to repair her hernia, the now "talkative, happy" Faith received another glowing report from her care team at Mayo Clinic during a recent three-month checkup. "They were so impressed with her," Haley says. "They were so glad that she was doing so well." (As are we.)

You can read the rest of Faith's story here. Then, impress us by leaving us a comment below before using the social media tools atop this page to share this story with others.



Tags: congenital diaphragmatic hernia, Dr. Rodrigo Ruano, Mayo Clinic Children's Center, Mayo Clinic's Fetal Care Center, Patient Stories

Truly a wonderous effort and outcome.

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