Correcting birth defects

Jul 18 2007

Traditionally when a baby was born with a malformation of the lung or esophagus, they had to undergo open surgery involving a large chest incision with risk for serious complications.

Now, pediatric surgeons at Morgan Stanley Children's Hospital of NewYork-Presbyterian are one of only a few in the United States to offer the corrective surgery using innovative minimally invasive techniques -- with benefits including reduced pain, risk for complications and visible scarring.

Esophageal atresia is a dangerous condition in which the lower part of the baby's esophagus is connected to its windpipe instead of its upper esophagus, thereby preventing proper eating, drinking and breathing. Congenital lung conditions involve a benign lung mass that has grown either inside or outside the lung, putting the baby at risk for infection, compromised lung development, and, in rare cases, cancer. The minimally invasive surgery to correct these conditions -- thoracoscopic lobectomy and thoracoscopic repair of esophageal atresia and tracheoesophageal fistula -- involve three small incisions the diameter of a pencil through which the endoscopic instruments are inserted.

Traditional "open surgery" requires a large chest incision beginning under the shoulder blade and continuing to where the nipple is. Recovery can be particularly painful, according to surgeons, hurting with every breath. In addition, traditional surgery increases risk for long-term complications, including scoliosis, chest development and muscle weakness.

"Due to advances in ultrasound technology, these thoracic malformations are increasingly diagnosed before birth at our Center for Prenatal Pediatrics. We offer medical consultations to mothers even prior to birth through the Center. Parents and pediatricians should be aware of these advanced techniques designed to improve quality of life for children," says Dr. Keith Kuenzler, pediatric surgeon at Morgan Stanley Children's Hospital of NewYork-Presbyterian, assistant professor of surgery at Columbia University College of Physicians and Surgeons -- and one of only a very few in the country to perform such advanced innovative surgery in newborns and children.

The uniqueness of this resource is to be emphasized. "It's only in children's hospitals and institutions such as this that we can bring medical faculty together to offer truly state-of-the art care for children -- our most vulnerable patients," says Dr. Charles Stolar, director of pediatric surgery at Morgan Stanley Children's Hospital of NewYork-Presbyterian and the Rudolph N. Schullinger Professor and Chief of Pediatric Surgery at Columbia University College of Physicians and Surgeons.

Congenital malformations, or birth defects, occur in one out every 100 births in the United States. They are the leading cause of infant mortality in the United States, present in one third of all infant deaths. Caused by genetic factors or prenatal events, malformations may involve many different organs, including the brain, heart, lungs, liver, bones and intestinal tract. Common malformations include heart defects, cleft lip or palate, Down syndrome, spina bifida and limb defects.