Emma’s Story: Spina Bifida Surgery With Cord Blood

Little Emma was born in 2015. During the pregnancy, her parents learned that their baby had malformations of the spine. The diagnosis was spina bifida, which was determined at the 35th week of gestation.

“It was the first anniversary of our wedding,” said Emma’s mother Daria, “my husband and I went to an ultrasound scan to see our daughter, and we learned this terrible news. I had never heard of such a disease before. I didn’t even look for any information, as till the birth of my baby, I hoped that the doctors had been mistaken, and my daughter was healthy.

” Subsequently, it turned out that preparing for the birth of a baby with such a diagnosis was rather complicated. “Maternity hospitals refused me one by one,” recalls Daria.

“Only doctors of Maternity Hospital No. 5 in Kiev agreed to perform a caesarean section if we found a neurosurgeon who would immediately operate on my daughter. Pavel Plavskiy was such a neurosurgeon. It was he who said that it was necessary to collect cord blood, because it would help our daughter during the operation.

” There is nothing in the world more important to an expecting mother than the anticipation of holding her new baby. But sometimes, when it becomes known that the baby will be born with congenital malformations, parents have to postpone the time for dreams and focus on the problem.

Daria says that she became obsessed with making sure they did everything possible to help save the life of her new daughter. One task she took very seriously was the responsibility to keep the cord blood collection kit with her in the hospital.

“When I was in the intensive care unit before caesarean section, HEMAFUND cord blood bank couriers brought a container to collect umbilical cord blood. I constantly kept this red handbag in sight, and I was very scared when I had forgotten to take it with me to the caesarean section procedure.” Despite her advanced pregnancy and having an intravenous drip in her arm, she did not even allow the nurse to go and bring the container. She went for the red bag herself. “Then I constantly tried to keep my eyes on this bag during the operation. Even when I saw my daughter, I only thought that the doctors would not forget to collect the umbilical cord blood. I only calmed down when the container with cord blood of my daughter was handed over to the specialists of HEMAFUND.”

A few hours after birth, Emma was transferred to the neurosurgical department of Okhmatdet specialized hospital. The cord blood was delivered there in a timely manner by HEMAFUND.

“The operation was very complicated. There was a hernia on Emma’s spine, into which the roots of the spinal cord sprouted” is how Daria describes it. The surgeon had to place the spinal cord in the correct position and remove the hernia. Recovery after the surgical operation was quick and encouraging enough. In a month, Emma was discharged from the hospital, and the worst was over. Daria feels “sure that everything went so well thanks to the use of cord blood”.

The neurosurgeon Dr. Plavskiy conducted a study in which 39 children with spina bifida received intravenous infusions of their autologous cord blood. This type of surgery is performed almost immediately after birth, and the cord blood was administered in fresh condition. The motivation for giving the cord blood during surgery was to replenish blood loss and stimulate stem cell mediated repair. The children were followed for 16 months after surgery and demonstrated improvement in both range of motion and functions of the pelvic organs.

Today, the only reminders of Emma’s condition are regular medical examinations and some weakness in her legs. Her parents admit that the challenges they face now are mainly because spina bifida is not well known in their community.

Source:
HEMAFUND
https://parentsguidecordblood.org/en/news/emmas-story-spina-bifida-surgery-cord-blood

Spina bifida is a birth defect in which there is incomplete closing of the vertebrae in the spine and the membranes around the spinal cord during early development of pregnancy. Among the reasons for spina bifida, doctors name folic acid deficiency, a genetic predisposition, the use of certain drugs by the mother, and poorly managed diabetes. Spina bifida is one of the most common congenital defects that lead to disabilities. Serious cases of spina bifida can usually be detected during pregnancy by fetal ultrasound. There is no known cure for the nerve damage caused by spina bifida, but when surgery is performed shortly after birth it can prevent further neurologic damage by closing the opening in the spine and draining any accumulated cerebral spinal fluid.

HEMAFUND Tweet

Birth Tissues for Surgical Repair of Congenital Hernias

Sometimes babies are born with a hernia, which includes any situation where organs protrude through a weak spot in the surrounding muscle or connective tissue. Mild hernias are fairly common but more serious hernias require surgical intervention. The most common hernia in babies is an Umbilical Hernia, which is a bulge under the belly button that occurs in 10-15% of babies and usually closes on its own by the time the child is a few years old.

A Congenital Diaphragmatic Hernia (CDH) only occurs once in 2500 births but is a serious condition. In CDH, a hole in the diaphragm allows some of the baby’s intestines, and maybe the liver too, to move into the chest cavity. If this is not diagnosed during a prenatal ultrasound, it leads to a crisis at birth, when the baby needs to start breathing through its lungs, but the lungs are compressed by the intestines in the chest cavity. Early intervention is critical. Babies born with CDH need surgery to move their intestines back down to the abdominal cavity and close the hole in the diaphragm so that they can breathe properly. These babies can be at risk for brain injury due to a lack of oxygen in the blood. One clinical trial NCT03526588 launched in 2018 at the University of Texas is attempting to ameliorate neurologic injury in these infants by giving them a few small infusions of their own umbilical cord blood stem cells.

Another serious hernia is Gastroschisis, where a hole in the abdominal wall allows some of the baby’s intestines to escape outside its body. This only occurs once in about 5,000 births but requires surgical intervention. In utero, the portion of the intestine that is outside the body, floating in the amniotic fluid, becomes swollen and may become twisted. At birth, surgeons usually cannot just push this swollen intestine back into the abdominal cavity. The repair may have to be performed in stages, and the baby may require a patch to close the gap in the abdominal wall.

A team in Quito, Ecuador, has developed and published a surgical technique where the baby’s own umbilical cord is used to form a patch during surgery to correct Gastroschisis. Surgeon Edwin Ocaña manually introduces the exposed abdominal contents into the abdominal cavity. He then takes a section of umbilical cord, ligates the blood vessels, and filets the cord lengthwise to expose the interior Wharton’s Jelly without disrupting the blood vessels. This filet of cord becomes a patch which is placed with the Wharton’s Jelly against the defect, and is further protected with a hydrocolloid patch on top. The tissue patch is not fixed in place, but is adjusted every few days while the defect is healing. At the Hospital Carlos Andrade Marin in Quito, the neonatal team sees 4 to 6 patients per year with Gastroschisis. The use of an umbilical cord patch enables them to close a large Gastroschisis defect in one step, instead of a series of stages. They find that surgery with an umbilical cord patch results in reduced healing time, decreased reliance on intravenous nutrition, faster discharge from the hospital, and better cosmetic outcomes.

Spina Bifida is a birth defect where the spinal column does not close completely, leaving the spinal cord and nerves exposed or protruding. This occurs once in about 2,000 births but requires surgical correction immediately after birth. We have previously published the story of Emma, a girl in Ukraine who was infused with her own cord blood as a compliment to her spina bifida surgery. Despite surgery, children with spina bifida often have paralysis or limited use of their lower limbs. Research has shown that exposure of the spinal cord leads to progressive neurologic damage over the course of pregnancy. In order to intervene sooner and preserve mobility, the multi-center Management of Myelomeningocele Study (MOMS) NCT00060606 showed that in utero surgery to close the spinal cord leads to better outcomes. Recently, a team at UC Davis in California registered a pioneering 2020 clinical trial NCT04652908 which combines in utero surgery for spina bifida with a patch consisting of a commercially available matrix that has been seeded with placental mesenchymal stromal cells (MSC).

Research is ongoing to expand the use of birth tissues as a surgical patch. The team in Ecuador is studying the properties of the umbilical cord patch in order to make it more readily available and standardized for use in pediatric surgery. Their current procedure is dependent on access to a fresh umbilical cord, and storage of this living tissue would be costly. They are studying the use of a decellularized umbilical cord that is seeded with a secretome containing growth factors. If this yields satisfactory surgical outcomes, it would make the use of umbilical cord surgical patches more widely accessible as an off-the-shelf surgical tool.

Source:
https://parentsguidecordblood.org/en/news/birth-tissues-surgical-repair-congenital-hernias