New life-changing treatments for babies will soon be introduced at Abu Dhabi’s main maternity hospital.
The new treatments will be offered to babies born with spina bifida and could mean the difference between walking and being a wheelchair user.
They will be available soon at Corniche Hospital, along with other treatments given to babies while in the mother’s womb.
“We're looking at introducing the foetal balloon for the congenital diaphragmatic hernia within the next year. And we're also planning spinal surgery for babies in the womb, who have spina bifida,” said Dr Leanne Bricker, consultant and chair of Corniche Hospital's Foetal Medicine and Imaging Department.
Spina bifida is a birth defect that occurs when the spine and spinal cord do not form properly. The average worldwide incidence of spina bifida is one case per 1,000 births.
Corniche Hospital
Typically, the neural tube forms early in pregnancy and it closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube doesn't close or develop properly, causing problems in the spinal cord and the bones of the spine.
While there is no cure for spina bifida, repairing the spine in the womb can minimise the spinal defect.
Prenatal surgery also lowers the need for a shunt, which is a small hollow tube that helps drain the fluid from the baby's brain and protect it from too much pressure.
For babies that have surgery after birth, 82 per cent will require a shunt to be placed in the brain.
Foetal surgery doubles the chance the child will be able to walk and not require a wheelchair from 21 to 42 per cent and reduces the need for a shunt from 98 to 68 per cent.
A foetal tracheal balloon (FETO) for moderate or severe congenital diaphragmatic hernia (CDH) also increases survival rates.
A fetoscopic endotracheal occlusion (FETO) is a procedure to reversibly block the trachea of the foetus with a latex balloon.
This procedure is used for foetuses diagnosed with a severe congenital diaphragmatic hernia and impaired lung development.
Congenital diaphragmatic hernia (CDH) is a defect in an unborn baby's diaphragm.
In severe left-sided CDH, FETO increases the chance of survival from 15 per cent to 40 per cent and in severe right-sided CDH, FETO increases the survival chance from 20 per cent to 42 per cent. In moderate CDH, FETO increases chances of survival from 50 per cent to 63 per cent.
Complex procedures
Corniche Hospital delivers up to 8,000 babies each year.
It has been offering advanced foetal therapy since 2014 and is one of very few facilities in the region performing complex procedures using advanced imaging techniques and innovative resources.
The unit now receives 3,000 babies per year, including referrals from the UAE and elsewhere, with scores of pregnant women flying in from neighbouring countries in the region for treatment.
Typically pregnant women had to travel abroad for many treatments. However, this will no longer be necessary.
“We need to make the point that all these procedures are extremely difficult, require a very experienced team and so we are very cautious,” Dr Bricker said.
“We want to introduce things in the right way, and we do it the right way to get the best outcome.
“We tend to introduce one procedure at a time, get it going and get the whole system around working safely, like getting the trains running on time, like a well-oiled machine. And then we introduce the next procedure.
“So in the next year, we're looking at introducing the balloon and then the spinal surgery.”
To date, the team has performed more than 300 foetal procedures with one of their most unusual ones being a baby whose blood supply was feeding into a large tumour in the placenta.
“I remember the placental tumour,” said Dr Werner Diehl, division chief of the Foetal Medicine Centre.
“There was a tumour in the placenta and it was supplied by a baby's blood so this forced the baby into heart failure.
“What we did is that we cut the blood flow to the tumour so that it stopped feeding the tumour and the baby could recover from heart failure.
“These interventions are very rare but require large expertise and experience in-utero surgery.”
The centre's most common procedure is separating vessels shared between twins or more.
“A lot of people think foetal medicine is just an ultrasound scan,” Dr Bricker said.
“It's not just an ultrasound scan. We use ultrasound scans as part of our consultation. What we're doing is we're taking the whole history and all the details into account, including the findings on the scan.
“Women come to see us if either they've had a previous baby that was born with a major problem, or if they're currently pregnant and on a routine scan the baby was found or suspected to have an abnormality.
“We see a lot of multiple pregnancies because multiple pregnancies can be very complicated and there are women who are on medication and with medical conditions who are at increased risk of having a baby with problems.”
Multiple pregnancies, older mothers and comorbidities, such as diabetes, blood pressure and obesity, all increase the number of cases the unit handles.
