Most mothers whose babies are in need of urgent medical attention will do everything in their power to get them the very best care as quickly as possible. Ingrid Negron of Brentwood is one of those mothers.
After being alerted by her local doctor that one of her twins was experiencing a potentially life threatening condition during the 27th week of pregnancy, Ms. Negron was advised that follow up care at a major Children’s hospital in Pennsylvania would be necessary. In the days to follow, Ms. Negron made several attempts to get care she needed for her child, but to no avail. The clock was ticking and that’s when Ms. Negron turned to NYU Winthrop Hospital – a regional leader in fetal surgery – for help. NYU Winthrop, known for its outstanding maternal fetal outcomes, prides itself on the strong multidisciplinary collaboration that exists between its Maternal Fetal Medicine, Pediatric Surgery and Neonatology teams.
Martin Chavez, MD, Chief of Maternal Fetal Medicine (far left); and Sathyaprasad Burjonrappa, MD, MS, FRCS (ed), FACS, MBA, Director of Pediatric Surgery (far right); led the team at NYU Winthrop in providing lifesaving care to Ingrid Negron (second from left) and twins, Ismael (in his mother's arms) and Noah (in his father's arms).
"Its collaborations such as these that result in lifesaving therapies and successful outcomes for scores of our young patients each year," said Sathyaprasad Burjonrappa, MD, MS, FRCS (Ed), FACS, MBA, Director of Pediatric Surgery at NYU Winthrop, who played an important part in the care of Ms. Negron and her children.
When she arrived at NYU Winthrop on July 1, 2015, Ms. Negron was promptly seen by Martin Chavez, MD, Chief of Maternal Fetal Medicine at NYU Winthrop, who performed an ultrasound and quickly confirmed that one of the twins (“Baby B”) was suffering from a condition known as congenital pulmonary airway malformation (CPAM) – a rare congenital birth defect that includes a cystic mass of abnormal lung tissue. As a result, blood flow from the fetal heart to the placenta was being affected, and fluid was quickly building in the baby's abdomen, and around its heart and lungs.
"The baby was dying and something needed to be done immediately," recalled Dr. Chavez, who is a recognized leader and expert in high risk pregnancies, ultrasound diagnosis, ultrasound guided procedures and fetal surgery procedures. In fact, in 2008 Dr. Chavez started the Fetal Evaluation and Treatment Team at NYU Winthrop to offer fetal surgery options for pregnancies which could benefit from in-utero treatment of the fetus.
"In this particular scenario, we knew it would be best to maximize the fetus' time in the intrauterine environment, which is the safest and best possible place for it to grow," said Dr. Chavez.
Dr. Chavez recommended that Ms. Negron undergo fetal surgery to prevent the condition from getting worse, and adversely affecting the other twin and possibly even her.
"Dr. Chavez was very straightforward and calm, explaining to us the severity of the condition and what it could mean for the health of both the twins, and for me," recalls Ms. Negron. "We agreed that something needed to be done immediately and told him to do whatever he needed to do to save our children."
Ingrid Negron's sonogram indicated that "Baby B" was suffering from a life-threatening condition known as CPAM, which caused fluid to build in the baby's abdomen, and around its heart and lungs.
Later that same afternoon, Ms. Negron was on a NYU Winthrop operating table and Dr. Chavez, surrounded by a team of renowned specialists skilled in the latest fetal surgery techniques, went to work, positioning a plureo-amniotic shunt between "Baby B's" chest and amniotic cavity.
The goal of the shunt is to act as a drain to prevent additional fluid buildup and is usually removed shortly after the baby is born. The pleuro-amniotic shunt is only available at select hospitals nationwide, and is performed under local anesthesia. The procedure is intricate and its complexity can be elevated dependent on the clinical scenario, but nonetheless, the NYU Winthrop team was able to successfully position the shunt.
"The procedure yielded immediate results, and the level of fluid around the fetus's lungs began to decrease over a matter of hours," said Dr. Chavez.
A routine sonogram just over a week later, however, revealed that a willful "Baby B" had pulled the shunt out.
"This is common," noted Dr. Chavez. So he and the team performed yet another shunt procedure on July 9.
The weeks to follow involved intense monitoring and a treatment plan aimed at preventing fluid from accumulating once again in "Baby B's" abdomen and chest cavity. With the goal of getting Ms. Negron as far through her third trimester of pregnancy - a critical time of development for babies in utero - and to a safe stage of delivery, Dr. Chavez and the NYU Winthrop team were successful. On July 30, 2015, the twins were delivered via C-section. They were approximately 34 weeks.
Just a few days later, "Baby B"” weighing just around four lbs., and now named Ismael, meaning "God listens," underwent surgery by Dr. Burjonrappa to remove the large mass on his lung.
"Though he was my smallest and youngest patient, he was one of my fiercest," said Dr. Burjonrappa.
Ismael spent a few weeks recovering in NYU Winthrop’s acclaimed Neonatal Intensive Care Unit (NICU) where a dynamic team of doctors and nurses provided the utmost attention and care. His mother and father were thrilled to bring home a healthy baby boy to be reunited with his twin brother, Noah, on August 27, 2015.
Today, Ismael and Noah are thriving, making all of the developmental strides and milestones of their peers. Ismael's mom knows her children are special and is truly grateful for the lifesaving care that was delivered at NYU Winthrop.
"There are not enough words to thank Dr. Burjonrappa and Dr. Chavez for what they've done," said Ms. Negron. "They are both angels and I know that God put them in my path to save me and my babies."