Cayden Pillay: the newborn who beat the odds

Posted on 3 February 2020

Foetoscopic surgery for spina bifida is not a cure. But that prenatal repair greatly reduces the need to divert spinal fluid from the brain and can improve mobility and the possibility that a child will be able to walk independently.

Cayden Pillay was born at 9am on 26 June, 2019. A few weeks premature, he was delivered by Caesarean section and discharged from the neonatal intensive care at Mediclinic Morningside, three days later, to his happy, loving and above all relieved parents.

Why the relief? Just 10 weeks prior, Cayden had undergone in utero, foetoscopic surgery to repair the effects of severe spina bifida, while still in his mother’s womb.

At the time, this was the first time the groundbreaking surgery had been performed in Africa. And Cayden’s case is a good example of how successful this surgery can be, says Professor Ermos Nicolaou, a specialist obstetrician and gynaecologist, and specialist in maternal and foetal medicine at the WITS Maternal and Fetal Medicine Centre at Mediclinic Morningside, who led the surgical team.

“Cayden is happy, healthy and at home with his family,” he says. “He has some scarring on his lower back, which, with time, will hopefully fade – but if we have to balance the advantages against the risks of this surgery, we have to say this is a good example of the surgery’s benefits.”

Spina bifida is a birth defect caused by an incomplete closing of the spine and membranes around the spinal cord during a foetus’ early development. There are three main types, and Cayden was diagnosed with the most severe form: myelomeningocele, or open spina bifida.

In a case like Cayden’s, membranes and spinal nerves push through an opening in the spinal canal, which extends along several vertebrae in the lower or middle back. This results in a sac on the baby’s back that contains exposed tissues and nerves.

If a baby is born with condition, he is prone to paralysis and life-threatening infections. In most cases, gynaecologists and other experts will recommend that the parents make the heart-breaking decision to terminate the pregnancy, or go through with the pregnancy and try to manage the after-effects by surgically repairing the spine after birth.

That management process is typically fraught with difficulty, says Professor Nicolaou. “With such an abnormality, you would expect serious handicaps after birth: total paralysis, partial paralysis, issues with continence and impotence. A lot can go wrong – which is exactly what we wanted to avoid.”

Professor Nicolaou and his team from Mediclinic Morningside were joined in theatre by Professor Mike Belfort, the obstetrician/gynecologist-in-chief at Texas Children’s Fetal Center’s department of Maternal Fetal Medicine.

Today, Cayden is taking his first steps into what promises to be a normal life. For the surgeons who were a part of the project to bring this innovative procedure to Africa, this is what success looks like. “We put months of planning into this,” explains Professor Nicolaou, “and we carefully measured and assessed how Cayden was developing in the womb. The real danger was that some of the structures in his brain were being damaged as an effect of the spina bifida.”

Cayden’s doctors set themselves an ambitious primary aim: to use in utero foetoscopic surgery as a means to close the opening in Cayden’s spinal canal and prevent further damage. “By doing so we also hoped to reverse some of the damage that had already occurred in his brain – and as we can now see, some of the structures have started to show an improvement already.”

The surgery – which involved inserting a number of endoscopes into Cayden’s spine, via his mother’s womb – was a delicate one. “We were mindful of risks, of course; preterm labour was a danger, as was postoperative infection. This was a complex case. These can happen. There is no guarantee that every surgery will be a success. But thanks to careful planning, lots of research and slow, meticulous, constant assessment of the situation, we managed to achieve the best possible result.”

 

Published in Innovation