There were wide smiles on the faces of Sanel and Mathew Winder of Cape Town when they recently left Netcare Blaauwberg Hospital, cradling their precious one-month-old baby son, Evan, who they described as a “little miracle”.
The couple’s joy as they prepared to leave the hospital with Evan was all too evident. This is not surprising when one considers that Evan had to be delivered eight weeks prematurely on 28 January 2015 by emergency caesarean section at the hospital after he had developed life-threatening complications as a result of a massive tumour. When Evan was delivered, the multi-cystic solid tumour, which weighed 1.2 kilograms, was a third of his body weight of 3.6 kilograms.
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Neonatologist, Dr Ricky Dippenaar, who is world-renowned for his expertise with very premature neonates and practises at Netcare Blaauwberg Hospital, says that the foetus had developed a rare form of tumour known as a sacrococcygeal teratoma.
“There are different types but this particular one consisted of multiple large cysts and solid areas. These kinds of tumours can grow very aggressively, and this one had rapidly developed to such a size that it threatened to compromise normal blood flow to the foetus. If left untreated, it would have resulted in heart failure and intrauterine death,” he explains.
“In general, the larger a sacrococcygeal teratoma becomes, the more dangerous it is to the foetus. Such large foetal tumours can also pose a very real risk to the mother resulting in Mirror syndrome. Although it was still two months to Evan’s due date, his condition had started to become critical and the antenatal foetal assessment team consisting of obstetricians Dr Sarel Brand, who practises at the Netcare Blaauwberg Hospital, and Dr Lou Pistorius, concluded that Evan had to be delivered immediately by C-section,” notes Dr Dippenaar.
After the successful delivery, the team of neonatal medical specialists stabilised Evan for 24 hours before the neonatal surgical team led by paediatric anaesthetist, Dr Lance Thompson, and paediatric surgeon, Professor Daniel Sidler, performed a highly intricate four-hour operation to remove the tumour. Dr Dippenaar says that the teratoma was one of the largest that any of the members of the highly experienced medical team had ever seen, and little Evan required multiple blood transfusions during the lengthy procedure.
“The tumour had developed from the baby’s coccyx, resulting in a maternal response of excessive amniotic fluid accumulation, further compromising the pregnancy. As it turned out, we could see that one of the larger cysts had already ruptured, most likely resulting in the dramatic increase in the amount of amniotic fluid and discomfort Mrs Winder was experiencing. Had the cyst not ruptured prior to birth, the tumour would have been even larger than it was,” points out Dr Dippenaar.
Sanel, whose first son was delivered at the hospital two years ago, admits that she was terrified when she was told early in her pregnancy about Evan’s tumour, which was quite visible in utero with the aid of a sonar and other medical imaging technology.
“Fortunately the medical team at Netcare Blaauwberg Hospital, led by my gynaecologist Dr Sarel Brand, was extremely supportive and left nothing to chance. They were absolutely remarkable and kept my husband and I fully informed about the process that was to be followed and the risks involved. They were also highly professional, reassuring us every step of the way,” says Sanel.
“Within just a few days of the operation, Evan was feeding and passing stools normally. By last weekend, his respiratory support had been removed and it was clear he was making a strong recovery. I am so grateful to the entire medical team whose expertise made it possible for our son to lead a normal life, and to the nursing staff in the neonatal ICU at Netcare Blaauwberg Hospital who took special care of him during his month-long stay in hospital,” adds Sanel.
Here is an image of baby Evan at Netcare Blaauberg Hospital, this image was supplied:
Dr Dippenaar says that the procedure to remove the large sacrococcygeal teratoma is a highly specialised one, and should only be performed by a multi-disciplinary team of neonatal experts. The team who operated on Evan was brought together by Dr Brand and included Dr Dippenaar, Dr Thompson and Prof Sidler. Prof Abdool Samad Shaik, a highly experienced foetal surgeon who has performed a number of groundbreaking, minimally invasive in-utero operations on foetuses in recent years at the Netcare Parklands Hospital in Durban, was also consulted.
“Evan’s operation involved excising a large highly vascular multi-cystic and solid tumour that was deeply enmeshed in the surrounding muscles. It was a highly complex procedure and no easy task. As it turned out, thanks to the expertise of the multi-disciplinary medical team, Prof Sidler was able to completely remove Evan’s coccyx together with the tumour. Evan required highly specialised nursing care in the hospital’s neonatal ICU, but we were delighted with the rapid progress he made,” notes Dr Dippenaar.
“We expect Evan to be able to live a completely normal life, although we suspect he may have some residual functional disability and will require close monitoring to ensure that he does not develop any further tumours in future,” adds Dr Dippenaar.
Dr Dippenaar says that sacrococcygeal teratomas occur in a few different sub-types and are more common in girls than boys. It has been suggested that this condition is prevalent in some 1 per 27 000 live births. As in Evan’s case, the tumours are usually benign or non-cancerous, although larger, immature tumours seem to have a much higher risk of being malignant.
Netcare Blaauwberg hospital manager, Dirk Truter, says that it is comforting to know that the facility, and indeed the country, can call upon such an outstanding team of neonatal experts to treat complex and unusual cases. “The success of this procedure demonstrates that South African medicine has world-class expertise in this field,” adds Truter.
“Baby Evan crept deep into the hearts of the staff at the hospital during his stay. We are grateful to have been able to make a meaningful difference in Evan and his parents’ lives and wish them everything of the best for the future,” concludes Truter.
This is the video of Baby Evan's story:
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