x Abu Dhabi, UAESaturday 20 January 2018

Saving babes is now private affair

A Chinese baby underwent surgery a day after birth at Al Noor Hospital. Such an operation is unusual in private hospitals in the UAE.

The baby, of Chinese nationality, was born with a diaphragmatic hernia, a birth defect in which there is an abnormal opening in the muscle that assists with breathing.
The baby, of Chinese nationality, was born with a diaphragmatic hernia, a birth defect in which there is an abnormal opening in the muscle that assists with breathing.

ABU DHABI // A lifesaving operation for newborn babies, routinely performed in government and teaching hospitals, has been carried out at a private hospital in Abu Dhabi for what is believed to be the first time.

The baby, of Chinese nationality, was born with a diaphragmatic hernia, a birth defect in which there is an abnormal opening in the muscle that assists with breathing.

The hole causes the stomach, spleen, liver and intestines to move into the chest cavity and place pressure on the lungs and heart.

"This is a major surgery to be performed at a private hospital and really signifies a new era for private healthcare facilities in the country," said Dr Mohammed Amin al Jawhari, the surgeon who led the operation last month at Al Noor Hospital.

Dr al Jawhari, the head of the paediatric surgery department at the hospital, said it was not rare for babies to be born with this condition.

"This type of hernia occurs at least once in every 5,000 births, so in a year there may be six or seven in hospitals around the emirate," he said.

Dr al Jawhari has performed more than 60 such operations, but said it was unlikely it had been done at a private hospital in Abu Dhabi before.

"Putting critical and difficult cases, especially of a baby that was just born with a life-threatening condition, in the care of a private hospital is unprecedented because we just didn't have that level of expertise before," he said.

"This may be part and parcel of paediatric surgery but it is still something for us to be proud of."

The procedure requires a medical management team that can sustain the child before the operation and provide post-operative care.

Dr al Jawhari said the skill and resources required usually meant the operation would be done at a large teaching hospital.

"The surgery is just a small part," he said. "We had to put the baby on an artificial respiratory system to stabilise him as soon as he was born, and then rely on different skills during the surgery, from the neonatologist to the anaesthesiologist to the surgeon to the nurses.

"This was an excellent test of our resources."

Dr Qasim al Awm, the general manager of Al Noor Hospital Group, said the hospital's recruitment of highly skilled and experienced doctors was "in line with the strategy of the Health Authority - Abu Dhabi [Haad]".

Haad "is keen to support the private medical sector to boost performance in this vital sector so it can effectively participate in developing health services", Dr al Awm said.

Haad last week released its Health Statistics 2010 report, which highlighted the importance of developing the private healthcare industry to meet the projected needs of the next 10 years.

Paul Hetherington, the head of planning at Haad, said meeting those needs - by hiring more doctors and nurses, building more hospitals or ensuring there were more critical care and emergency beds available - meant "encouraging the private sector to invest in health care is key".

But gaps remain, said Dr al Jawhari. The baby's birth defect should have been diagnosed during pregnancy through ultrasound images.

The baby's mother, who did not wish to be identified, said she was not told anything was amiss during her pregnancy.

"When he was born, it was a surprise to us something was wrong," she said. "They took him away immediately to treat his condition."

The baby, now nearly a month old, is doing well. And after the gruelling 90-minute surgery and spending the first 10 days of his life in hospital, he is now thriving at home.

"Everything is fine now and his recovery has been very good," his mother said.

"Thank God that the hospital was able to deal with the situation as soon as they saw that he would need surgery."



Lot of weight for such a little chest to bear

ABU DHABI // The baby saved in Al Noor Hospital was born with most of his intestines in his chest, said Dr Mohammed Amin al Jawhari.

“The weight of the intestines compress the lungs and heart and makes them work overtime, which is dangerous in a newborn and can lead to collapse quite quickly,” Dr al Jawhari said.

As soon as the baby was born, he was attached to a ventilator while doctors worked on stabilising him and preparing him for surgery.

Twenty-four hours later, the medical team at Al Noor began patching the hole in the baby’s diaphragm. The procedure uses artificial tissue or tissue taken from the patient.

“We first adjust the location of the organs,” Dr al Jawhari said. “Then we use the muscle tissues from the abdominal wall to form a flap that can bridge the edges of the hole.”

The outcome usually depends on closing the hole but other factors, such as the effect on the lungs after surgery and the amount of tissue the baby is left with, are also key indicators, he said.

“In this case, the baby did not need to be on a ventilation machine for long – just a few days. In other situations, a baby’s lungs might not sustain him and blood would have to be oxygenated artificially.”

* Hala Khalaf