World First In-Utero Surgery Successfully Treats Newborn Baby

Monday - May 8 2023, 05:57 UTC - 1 year ago

A baby girl living near Boston is one of the first to have undergone an experimental operation while still in the womb for a dangerous condition that puts her at risk for heart problems, brain damage, and respiratory difficulties. The team behind the operation successfully treated her and will be treating more fetuses using the same approach. Other, similar brain conditions may benefit from this type of surgery.

She doesn’t know it yet, but a baby girl living somewhere near Boston has made history. The seven-week-old is one of the first people to have undergone an experimental brain operation while still in the womb. It might have saved her life.

Before she was born, this little girl developed a dangerous condition that led blood to pool in a 14-millimeter-wide pocket in her brain. The condition could have resulted in brain damage, heart problems, and breathing difficulties after birth. It could have been fatal.

Her parents signed up for a clinical trial of an in-utero surgical treatment to see if doctors could intervene before any of these outcomes materialized. It seems to have worked. The team behind the operation now plans to treat more fetuses in the same way. Other, similar brain conditions might benefit from the same approach. For conditions like these, fetal brain surgery could be the future.When the two combine, the high-pressure blood flow from an artery can stretch the thin walls of the vein. "Over time the vein essentially blows up like a balloon," says Darren Orbach, a radiologist at Boston Children’s Hospital in Massachusetts, who treats babies born with the condition.

Fetuses with the condition are thought to be protected by the placenta to some degree. But that changes from the moment the umbilical cord is clamped at birth. "All of a sudden there’s this enormous burden placed right on the newborn heart," says Orbach. "Most babies with this condition will become very sick, very quickly." .

The girl’s mother was referred to Orbach’s clinical trial. On March 15, at 34 weeks, she underwent the experimental operation—a two-hour procedure that involved a range of medical professionals.

First, the mother was given a spinal anesthetic to prevent her from feeling anything in the lower half of her body. She remained awake for the procedure, though, says Orbach. "She was wearing headphones and listening to music," he says.

Doctors then used ultrasound imaging to help them guide a needle through the mother’s abdomen, the uterus wall, and the fetus’s skull and into the malformation in the brain. Members of the team fed a tiny catheter through the needle to deliver a series of tiny platinum coils into the blood-filled pocket. Once each was released, it expanded, helping to block the point where the artery joined the vein.

The baby girl was born healthy a couple of days later, says Orbach, who coauthored a report on the case that was published in the journal Stroke. She didn’t need any treatment for the malformation. "The brain looks great," he says. She was monitored in hospital for a few weeks and is now home and doing well, he tells me.

"This is a really exciting breakthrough," says Greg James, a pediatric neurosurgeon at Great Ormond Street Hospital in London. Timo Krings, a neuroradiologist at the University of Toronto, shares his sentiments. "It’s giving a chance to kids who would otherwise have very little possibility of survival," he says. Both add that it will be important to work out who might be the best candidates for this kind of fetal surgery. The procedure comes with risks and might be worthwhile only for severe cases where there is also a good chance of recovery, for example.

Operations like this one might prove useful in treating other conditions, such .