Complex Surgery Gives Baby a Chance at Life

Team Approach Leads to Successful Tumor Removal

Six months pregnant, Shenella Parker went to her local obstetrician for a routine check-up. But when an ultrasound revealed a bulky mass on her unborn child's neck, Parker learned it would take extraordinary skill and effort to give her daughter, Daziyah Clark, a chance at life.

Ultrasound of teratoma Ultrasound image showing large neck mass.

Parker was referred to the Fetal Center at the University of Chicago Medicine, where Director Laura DiGiovanni, MD, assembled a multidisciplinary team of obstetricians, pediatric surgeons and anesthesiologists to plan the complicated delivery of the infant, who had a cervical teratoma, a rare tumor of the neck made up of a variety of tissues.

Although the scans depicted the bulge on Daziyah's neck, none were clear enough to indicate if the infant's body had developed an airway.

"The unknown was what the airway would actually look like," said pediatric ear, nose and throat surgeon Dana Suskind, MD. "The major risk was death to the child if we couldn't secure the airway or if the airway had never developed."

The team, including DiGiovanni, Suskind, pediatric surgeons, and others, came together to develop a partial-birth delivery that would allow Daziyah to receive blood and oxygen through her mother's umbilical cord while the doctors located her airway.

"Our plan going in was like a football playbook where we had our different plays set up," Suskind said.

Daziyah Daziyah

Using special anesthesia to relax Parker's uterus, the team performed the incision for a cesarean section at 38 weeks of gestation and cautiously pulled out Daziyah's head and neck, leaving the rest of her body inside the uterus and still attached to the placenta. The operation lasted for more than an hour, during which time DiGiovanni's team used a special uterine stapling apparatus to prevent Parker from hemorrhaging while her uterus was surgically opened.

They attempted to insert a breathing tube into the baby girl's airway but the neck mass made that impossible. The worst scenario had occurred--the mass completely blocked the airway.

"You couldn't see any part of her upper airway," Suskind said. "We had to shift our goal to placing the tracheostomy," a surgical procedure to create a semi-permanent opening through the neck into the trachea, or windpipe, but this time performed with the half-born child still partly in utero.

Changing plays, the team located Daziyah's trachea low in her neck, near her upper chest, and made an incision in her windpipe, into which they inserted a tube to enable them to pump air into her lungs. After surgeons secured Daziyah's breathing and placed her on a ventilator, they completed the C-section and tackled the 10-centimeter tumor.

"It was solid, like a rubber ball," Suskind said of the mass. They were able to remove it, however, and took the child to the neonatal intensive care unit for recovery.

Today, Daziyah is a "miracle baby," according to Suskind, noting that Daziyah's procedure was one of the most challenging tracheostomies she has performed. Although the infant will need future work to smooth over some scars, she's expected to live a normal, healthy life.

After the successful complicated procedure, Shenella Parker held her daughter for the first time. "I feel grateful," she said, "and blessed."

April 2008