Magnets save a premature triplet
NASHVILLE, Tenn. – Ilyanna, Gideon and sleepy little Willow are the Lamb triplets.
"There is never a dull moment, for sure," said their mother, Trelane Lamb.
The trio has overcome many obstacles together. At 24-weeks pregnant, Trelane was given the news.
"There's a 30 percent chance that Gideon would make it and only I think a 70 percent chance that the girls would make it," Trelane explained.
The preemies came into the world at 27-weeks. Gideon came first, then Ilyanna, both weighing just over two pounds. Willow weighed only 1 pound 13 ounces. Her fight for survival was about to begin.
"They don't know why it happened," Trelane said. "Because the two girls are identical and nothing is wrong with Ilyanna, but Willow had all these issues."
It began with a rectovaginal fistula.
"They came in and said, 'Well she doesn't have an anus,' and I said, 'What does that mean?' They said, 'We are going to have check but she does not have a hole,'" Trelane explained.
At 3-days old, a colostomy was created for her anorectal malformation and a G-tube was placed after further testing revealed her esophagus was not connected to her airway.
"She had a tube down her throat that would suck out basically all of her secretions so that she could breathe because she could drown," Trelane said.
Eight months later, Dr. Harold Lovvorn first performed surgery on her esophagus to bring together the upper and lower ends.
"If your esophagus or food tube in interrupted, obviously you can't eat," said Harold N. Lovvorn, III, MD, Pediatric Surgeon, Vanderbilt University Medical Center, Nashville, Tennessee.
What he'd do next was a first in the U.S. Instead of another major surgery to connect them, he used specially designed medical magnets.
"It saves the baby a lot of additional pain, big scars, and big operations," Lovvorn explained.
The non-invasive procedure takes 20 minutes.
"We can place them through her mouth and then through her gastrostomy tube up the lower esophagus, so that they would have their physical attraction for one another," Lovvorn said.
The magnets wear away at the tissue between them until they connect, creating a perfectly aligned opening between the two ends of the esophagus. This allows food, saliva, and liquid to flow into Willow's body.
"We think her prognosis is excellent," Lovvorn added.
Esophageal atresia is a congenital defect in which the child's esophagus does not develop in the right way. For most babies, it means they can't eat. In most cases of esophageal atresia, the upper esophagus, instead of connecting to the lower esophagus which goes on to the windpipe and stomach, just ends. Other cases can involve simply the narrowing of the esophagus. It's estimated the defect occurs in about one out of every 4,000 births. It's also generally associated with other conditions as well, including tracheoesophageal fistula, heart problems, and other digestive tract complications. (Source: www.nlm.nih.gov)
SIGNS: The defect is considered a surgical emergency, and as such any of the signs need to be seen and reported as soon as possible. Some of the signs include:
- Frothy bubbles in mouth
- Blue color to the skin, especially when feeding
- Difficulty breathing
- Coughing or chocking during feeding
- A round, full abdomen (Source: www.childrenshospital.org)
DR. LOVVORN: "The magnets are interesting because we could place them through her mouth and then threw her gastrostomy tube up the lower esophagus so that they would have their physical attraction for one another. They have to be within 4 centimeters in order to have that attraction. Fortunately her two pouches were still together so they didn't have that much distance to overcome. They had about 7 millimeters, which is what we determined that they needed to overcome the wall of each respective esophageal pouch and scar tissue that had formed. And so really the way it works is it applies about 4 pounds of pressure between the magnets and that pressure over time gradually compresses the intervening tissue causes ischemia and within about 48 or 72 hours that ischemic tissue stuffs. Then a channel is created between the upper and the lower esophagus. So, really it's quite straightforward, we don't have to go back reopen her chest, we don't have to dissect the esophagus. Probably most importantly is we don't have to remove any esophagus that had been induced to grow from her initial operations. So, basically it's a purely intraluminal way to canalize the esophagus without having to mobilize, reset, or jeopardize the integrity of the remaining esophagus."
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