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Medical teamwork and an unusual delivery called EXIT help save a baby

TAMPA — Six-week-old babies slurp from bottles and suck on pacifiers all the time.

But when Anna Robinson did those things at Tampa General Hospital on Thursday, she showed what a medical marvel she is.

Anna was born with a massive, benign tumor wrapped around her neck. It stretched to her back and the right side of her face. It was detected while she was still in her mother's womb.

She entered the world Oct. 1 through an unusual partial delivery, with doctors from TGH and the University of South Florida removing just her head through a Caesarean-like incision. While the umbilical cord supplied oxygen to Anna, surgeons performed a procedure to ensure she had a clear airway. Then the delivery was completed.

Called ex utero intrapartum treatment or EXIT, the delivery procedure was a first for Tampa General Hospital, where a team of physicians practiced intensely to make sure they were ready for all the possible complications.

So many doctors and other medical professionals were present for Anna's birth, the lead obstetrician lost count at 25.

Anna's dramatic delivery was just the start of her long medical journey. She had another major surgery two weeks ago and will need at least one more.

"We were just so blessed that there's something they could do to give her a chance," said her mother, 31-year-old Susan Robinson of Temple Terrace. "We're so amazed at everything they can do. I'd never heard of an EXIT procedure prior to this."

Tumor blocked fluids

Robinson was 19 weeks pregnant and thrilled to see Anna's heartbeat on her first ultrasound when doctors saw a problem.

During the pregnancy, Anna developed a cystic hygroma, which results from blockages in the lymphatic system. Fluid that doesn't drain properly starts to collect in a big mass.

At its largest, Anna's tumor was 15 centimeters in diameter, said Dr. Valerie Whiteman, the lead obstetrician and an assistant professor of obstetrics and gynecology at USF.

The situation called for the EXIT procedure, which Whiteman had performed twice previously before coming to Tampa. While still unusual, the approach is becoming more common in cases where babies are born with a condition that could impede breathing. Doctors at Bayfront Medical Center in St. Petersburg, for example, say they have performed at least three in the past year and a half.

The procedure requires multiple teams to attend to mom and baby, and takes advance planning to make sure the collaboration goes smoothly.

"If you're listening to a symphony and everyone is doing their own thing, it sounds horrible, but if everyone is doing what they're supposed to be doing, that same sound becomes a perfect piece of music," said Whiteman, a Beethoven aficionado. "That's what we had on Oct. 1st."

More surgery to come

After 12 days in neonatal intensive care, Anna went home to join her brother, 4, and sister, 2. But the tumor, which looked like water balloons under her skin, grew rapidly and began to press on her tongue, affecting her ability to nurse.

Two weeks ago, she underwent an extensive surgery with Dr. Charles Paidas, director of pediatric surgery at USF. Her parents waited for eight anxious hours while he removed the tumor from her neck.

"This is really, so far, a happy story," Paidas said Thursday. "All signs right now are we're pretty optimistic."

He hopes to send Anna home in a few weeks, but she will need to have a tumor inside her chest removed in two or three months.

Then only time will tell whether her face grows normally, and whether she is left with scarring or other damage.

For all her struggles, Anna is a sweet-tempered little girl, her mother says.

"She's got a little spunk in her too, which we know is part of the reason she made it this far," Robinson said. "She's a little fighter on the inside."

Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322. For more health news, visit www.tampabay.com/health.

Medical teamwork and an unusual delivery called EXIT help save a baby 11/12/09 [Last modified: Thursday, November 12, 2009 11:25pm]

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