Heart-lung machine keeps baby alive at Valley Children’s Hospital

The louder Xavier Angel Briones Rodriguez cried in his crib at Valley Children’s Hospital, the bigger his mother’s smile grew.

Every cry or coo made by the 3-month-old gave Janet Rodriguez of Corcoran reason to celebrate: Her son’s lungs are healthy.

She had spent 11 days by her son’s bedside after his birth, watching a heart-lung machine support his breathing and draw blood from his veins and push oxygen-rich blood back into his arteries.

On Monday, Rodriguez held her her fussy 14-pound son – no breathing machine or even an oxygen tube attached. Nestled in her arms, she touched noses with Xavier and said: “Seeing him like this is just incredible.”

Valley Children’s doctors shared Rodriguez’s happiness. Xavier’s recovery had been made possible by an expansion of the hospital’s ECMO (Extracorporeal Membrane Oxygenation) program that is allowing more newborns and children to be put on the heart-lung machine.

Xavier, whose lungs were underdeveloped, was Valley Children’s first newborn ECMO patient put on the heart-lung machine for a respiratory condition.

Valley Children’s has provided heart-lung support for years to children who need it for a few days after heart surgery, but the hospital didn’t have the ability to offer the heart-lung machine for other conditions. Children in need of the life-sustaining support for a longer period had been transferred to children’s hospitals in Northern and Southern California.

A hospital has to have enough heart-lung machines to safely operate a program. Any time a patient is on a machine, back-up machines must be available. Each costs about $250,000. Valley Children’s now has three and is looking to buy more, said Dr. Carl Owada, a pediatric cardiologist.

Putting a baby on a heart-lung machine is not without risk. Blood clots, brain bleeding and stroke are potential complications. It’s taken a team of people to build the ECMO program at Valley Children’s, said Dr. Harry Kallas, medical director of the ECMO program. The hospital has contracted with an outside company, ECMO Advantage, for consultation to help build the program and train staff, he said.

“It requires a lot of expertise to do this right,” Kallas said.

Kallas said Xavier’s 11 days on the heart-lung machine required constant monitoring. “But he did not have any major complications at all. For him, it all went very well.”

On May 9, when Xavier was born by cesarean section at Kaweah Delta Medical Center in Visalia, Rodriguez and husband Javier Briones knew something was wrong. The operating room was too quiet. “A baby is supposed to cry when he’s born and he didn’t even cry,” Rodriguez said.

Briones watched as his newborn son started to turn purple. “That’s when they put the oxygen on him,” he told his wife.

Doctors rushed Xavier to the Valley Children’s neonatal intensive care unit, where X-rays and other tests revealed the problem: a congenital diaphragmatic hernia.

Xavier had a hole in the left side of the diaphragm, the muscle separating the chest from the abdomen. Loops of small intestine had penetrated into the lung cavity and were filling half of it. The intestines had pushed his lungs and heart to the right side, and with little room to expand and grow, his heart and lungs were stunted.

No one knows why the birth defect occurs. The condition happens in about 1 in 5,000 newborns.

Xavier needed to go on the heart-lung machine. Rodriguez said doctors explained the risks involved in putting her son on the machine, but she and Briones knew it was necessary. “I had a lot of faith,” she said.

A day after his birth, doctors hooked Xavier to the heart-lung machine.

It was a long 11 days, Rodriguez said. “He was just laying there and blood was going through, and blood was pumping out of his body.”

But the days Xavier spent on ECMO gave his heart and lungs a rest, Owada said, describing the machine’s action to a motorized bicycle. “You can pedal, but going up a hill, the motor kicks in.”

When Xavier’s condition improved, he was weaned off the heart-lung machine, and doctors operated to repair the hole on the left side of his diaphragm.

His lungs now have room to grow.

On Monday, Rodriguez and Briones prepared to take their son home. The only reminder of the hospital: a feeding tube that Xavier needs for nourishment. But he’s learning to take a bottle.

Xavier, hearing his mother say his name, locked eyes with her. “Look at him,” Rodriguez said. “He’s really smart.”

Then Xavier yawned in his father’s arms. Rodriguez grinned: “He’s our miracle.”

This story was originally published August 9, 2016 at 3:48 PM with the headline "Heart-lung machine keeps baby alive at Valley Children’s Hospital."