Pretoria - Discovering that your baby has a severe condition is difficult news for any expecting parent – all the more so when it has the potential to dramatically impact brain development and will require surgical intervention just days after birth.
Dr Darsi Boungou-Poati, a neurosurgeon practising at Netcare Pinehaven Hospital, said this was the case for one of his youngest ever patients, who, at just 11 days old, underwent a complex procedure for hydrocephalus, or blockage of water flow in the brain.
This diagnosis came to light during his mother’s sixth month of pregnancy.
“It was a shock when I was told our baby had hydrocephalus – a condition that might result in severe brain damage. As a mother of three, now expecting my fourth child, I tried to equip myself with as much information as possible,’’ said the mother, who did not want to be named to protect the identity of her son.
The mother obtained a second opinion. With the diagnosis confirmed and after considering her options, the mother chose to plan her baby’s birth with Dr Christa Diedericks, a gynaecologist and obstetrician practising at Netcare Pinehaven Hospital, where a multi-disciplinary team was set up.
At 38 weeks Diedericks advised it would be safest for her to deliver via Caesarean section. However, at 36 weeks, she went into labour and was rushed to hospital.
Dr Zoleka Mbhele, a paediatrician at the hospital, said the baby, only identified as Bokang, was admitted to the neonatal intensive care unit shortly after his birth.
“Bokang’s head was very large due to the fluid build-up, but he could breathe independently and had a good heart rate. But it was very early days.”
Boungou-Poati said hydrocephalus entails a blockage, which prevents the drainage of fluid that naturally occurs in the brain.
“This is highly dangerous. The brain constantly produces cerebrospinal fluid. If it cannot drain, the fluid puts pressure on the brain which can result in permanent damage to this vital organ.”
In babies, the skull is still growing, and has slightly more flexibility than an adult, so a build-up of fluid will contribute to an increase in the size of the baby’s head, but the brain will still very much be impacted.
To address Bokang’s hydrocephalus, Boungou-Poati made a small incision behind his ear to insert a cerebral shunt into one of the brain’s ventricles, or pipes.
It has a valve, allowing the flow of fluid and fine catheter-like tubing to divert this fluid away from Bokang’s brain, down into his abdomen to be processed out of his body.
“Following insertion of the shunt, the fluid immediately began to drain properly from Bokang’s brain. While neuro-developmental outcomes will need to be monitored, we began to see early improvements.”
Mbhele said the brain starts developing at around three weeks old in the womb. Most of its growth occurs in the first two years of life, so the sooner hydrocephalus is addressed, the better.
“While the risk of brain damage can never be excluded, the development in a baby’s brain in the first few years may be able to change the overall outcomes for the child.”
Following the procedure, Bokang appeared to begin responding well, she said.
Looking back on their journey, the mother said that there were moments when, as a mother, she was so consumed with worry that she could not eat or sleep, particularly during those first three weeks of his life that were spent in the hospital.
But, she added, it has unquestionably been worth it.
Bokang is now back with his family and is a healthy three-month-old, who has a second lease of life and is doing well.
Pretoria News