GIFT OF LIFE
Taj Bogatek and Shaun O’neill are among countless babies who are alive thanks to incredible, life saving in-womb surgery at the Mater Hospital’s Centre for Maternal Fetal Medicine
Kim Bogatek is halfway through her first pregnancy when she’s given the devastating news – her baby is dying. Baby Bogatek has an extremely rare malformation of the right lung. A blockage is causing a build-up of fluid and putting pressure on a heart so tiny it’s no bigger than the size of an olive. The doctor is blunt – this baby is in heart failure. “It’s terminal,” Kim and husband Damien are told during an ultrasound appointment in Brisbane.
Another scan the next day at the Royal Brisbane and Women’s Hospital confirms the dire diagnosis. The same doctor, a radiologist, talks about termination, as if there are no other options, no hope. Kim, who has spent years trying to conceive through in vitro fertilisation, is too upset to reply. “I’m not doing that,” she tells herself. “I’ll just keep this baby until he passes away.”
Right at the end of the consultation, the Bogateks are thrown a medical lifeline. In what seems like an afterthought, the name of maternal fetal medicine specialist, Dr Glenn Gardener, based at the Mater Mothers’ Hospital in South Brisbane, is brought into the conversation. “He won’t be able to help you but he likes cases like this. Are you sure you want to go?” the radiologist asks. Kim cries in the car all the way home to Warana, on the Sunshine Coast, a 100km trip.
Baby Bogatek has what’s known medically as main-stem bronchial atresia. In simple terms, the main airway to his right lung is blocked, causing an overwhelming accumulation of fluid. His lung has swelled so much, it’s compressing his heart.
Two days later, the Bogateks are sitting in Gardener’s office as he formulates a plan for delicate in-utero surgery. “He started drawing up all sorts of things they could do,” Kim says. “I had to stop him and I said: ‘Oh, I’m sorry, but we were actually told you wouldn’t be able to help us’.
“He said: ‘I can’t guarantee a good outcome, but if you’re willing to try, I think we can try something’.”
Finally, some hope. Still, they were acutely aware the odds were bleak. In-utero surgery had been attempted previously on babies with similar issues in the US, but only one had survived.
At 23 weeks’ gestation, baby Bogatek was operated on while still in the womb. Gardener admits the situation was so unusual he had to try something unconventional. He used a scalpel to make a cut in Kim’s abdomen and inserted a long, thick needle into her uterus. Guided by ultrasound, after the baby was injected with painkillers and anaesthetic to ensure he stopped moving during the procedure, Gardener manoeuvred the needle through the baby’s chest to place a tiny coiled tube, known as a pigtail shunt – or Harrison shunt – into the narrow airway below the blockage in his lung. The tube worked like a tap, draining the excess fluid from the baby’s
lung into his abdomen. It was effectively a plumbing solution to a medical problem.
The Harrison shunt was designed to treat bladder blockages, but in the surgical equivalent of winging it, Gardener repurposed the device to take the pressure off the baby’s heart.
“It was a bit of a punt,” Gardener admits, almost six years later. “But the baby was going to die. We had to do something. And it worked. It was amazing.”
Kim, an occupational therapist, was awake during the 20-minute procedure. Gardener showed her the needle before operating but despite her health background, she says: “I wish he hadn’t.” For most of the surgery, Kim says: “I didn’t look.”
The expectant mum spent the rest of her pregnancy on tenterhooks. She was warned she was at increased risk of a premature delivery and the Bogateks were told the baby would probably need to have his right lung removed soon after birth. They were booked into Reg Leonard House – accommodation near the Mater Mothers’ Hospital – for three months after the baby’s planned delivery in preparation for significant health challenges.
“That whole period of time, I was pretty shell-shocked,” Kim says. “I didn’t have a baby shower or anything like that. And we didn’t buy anything. We didn’t know whether we would have a baby to take home. We have a few friends that didn’t get to take their baby home and they had a house full of baby stuff. I didn’t want to do that. We had nothing.”
Taj Harrison Bogatek was born by caesarean section at 10.55am on December 30, 2015 – two weeks before his due date. He weighed a healthy 3010g and bore no scars from the surgery that saved his life.
The much-wanted little boy was placed on a ventilator after the delivery to assist his breathing and was admitted to the Mater’s neonatal intensive care unit. But a fortnight later on January 13, the day he was originally scheduled to enter the world, he’d improved so much he was out of hospital having his picture taken with his parents on a beach near their Sunshine Coast house. Taj was discharged from hospital so much quicker than expected that his dad had to rush around buying baby essentials, including a bassinet and car seat, so they could safely take him home.
Taj’s surgery is one of about 750 procedures the Mater Centre for Maternal Fetal Medicine has completed since it began in 1996. The centre was started by respected Hong Kong specialist Professor Fung Yee Chan, backed by a sonographer and a midwife. In 25 years, it has grown to a team of about 40. Gardener took over the leadership in 2007 after Chan, Queensland’s first maternal fetal medicine specialist, died suddenly. “Fung Yee was a
It was a bit of a punt. But the baby was going to die. We had to do something. And it worked. It was amazing