2005 News Releases
July 21, 2005 - Local Family Coming Home with Newborn after Novel In-Utero Treatment for Diaphragmatic Hernia
Fund Set Up to Assist Family with Healthcare Costs
CINCINNATI – At 11:30 am on Thursday, July 20, 2005, Jessica, Don and DJ Burgett and Kaitlyn White, of South Bend, Indiana, are coming home with their new brother and son, Riley Burgett, one month old. Riley survived a severe form of congenital hernia which was detected and treated while in the womb.
Riley was born on June 14 with high-risk congenital diaphragmatic hernia / CDH. He was born at Cincinnati Children's Hospital Medical Center and was treated at the Fetal Care Center of Cincinnati.
Congenital Diaphragmatic Hernia is a defect in the diaphragm of the fetus. The diaphragm is the muscle and tissue that separates the chest and abdominal cavities. The abdominal organs push into the chest cavity (or herniate), compressing the developing lungs. This results in severe pulmonary hypoplasia (arrested development of the lungs), causing the lungs to remain below normal in size and underdeveloped. While there is a spectrum of severity of pulmonary hypoplasia in CDH, Riley's case was at the most severe end of the spectrum.
"Congenital diaphragmatic hernia occurs in approximately 1 in 2,500 to 5,000 live births and as frequently as 1 in 2,200 prenatal ultrasound studies," said Timothy M. Crombleholme, MD, FACS, FAAP, fetal surgeon and director of the Fetal Care Center of Cincinnati.
The cause of CDH is thought to be due to failure of the diaphragm to develop at nine to 10 weeks of gestation. What causes the failure of the diaphragm to close is unknown.
Suman Hari-Haran, MD, maternal fetal medicine physician at St. Joseph Regional Medical Center, detected Riley's high-risk CDH while in the womb and suggested Jessica Burgett see specialists at the Fetal Care Center of Cincinnati.
The Fetal Care Center of Cincinnati is a comprehensive fetal care program offering maternal-fetal care, fetal and pediatric surgery and pediatric subspecialty care for women with high-risk pregnancies. The center is a collaboration among Cincinnati Children's Hospital Medical Center, Good Samaritan Hospital and The University Hospital.
"The majority of babies with Congenital Diaphragmatic Hernia will do very well with postnatal treatment in tertiary centers skilled in the management of Congenital Diaphragmatic Hernia," said Dr. Crombleholme. "As in Riley's case, fetal intervention is only needed for the most severely affected fetuses with very large CDH that have a poor prognosis."
Upon further testing, specialists at the Fetal Care Center of Cincinnati suggested a novel EXIT-to-ECMO (ex utero intrapartum treatment to extracorporeal membrane oxygenation) strategy be performed on Riley.
EXIT–to-ECMO required Jessica to undergo fetal surgery. While Jessica was under anesthesia, surgeons from the center made an incision in her lower abdomen and opened her uterus. Riley was partially delivered through an incision in the womb and placed on ECMO, a heart and lung bypass system that circulates oxygenated blood throughout the body.
Once ECMO was functioning, the umbilical cord was cut, Jessica's delivery was completed and she moved into recovery. While being supported by ECMO, Dr Crombleholme was able to repair Riley's CDH and give his lungs time to develop.
"Because of the EXIT-to-ECMO strategy, Riley was never unstable, had normal oxygenation and ventilation and demonstrated a rapid fall in his pulmonary artery pressures after birth, all of which are unusual in this severe form of CDH," said Dr. Crombleholme.
Riley later suffered an unrelated stroke which required a additional care and a longer stay in Cincinnati. "There are no signs of damage yet, but that's a milestone thing. We just have to wait and see," said Jessica.
A "Benefit for Riley Burgett" fund has been set up at all Key Bank locations to help the family offset any costs accrued during Riley and Jessica's care.
Contact Information
Amy Caruso (amy.caruso@cchmc.org), 513-636-5637
