16 months after the day he was born, Garrett Peterson had still not left the hospital in Salt Lake City, Utah. Every day of his short life, his infant body was fighting a constant battle against itself to stay alive.
Even the slightest change in his condition, something as small as having his nappy changed, could cause Garrett to stop breathing, his face turning from healthy pink to deep blue in a matter of seconds.
These episodes would happen as often as five times a day, meaning a team of doctors had to be available, around the clock, to resuscitate young Garrett with strong medicines and high pressure ventilators.
Garrett was born with Tetralogy of Fallot with an absent Pulmonary Valve, a congenital heart defect that, in extreme cases, can lead to severe tracheobronchomalacia. His was such a case. This rare though deadly condition softens the trachea and bronchi, reducing the airways to small slits and not allowing the child’s windpipe to strengthen and develop as a normal body would.
For parents Jake and Natalie, 2013 was a whirlwind of pain and trepidation, as they watched their son pushed to the edge of death on a daily basis. Doctor’s kept him on a ventilator at the maximum levels of pressure almost around the clock. They even put Garrett into a medically induced coma to prevent his body working against the equipment that was keeping him alive.
“It’s really hard to watch your child basically suffocate and pass out before you could revive him and bring him back, over and over”, says Jake. “He could go from being totally fine to turning blue sometimes – not even kidding – in 30 seconds,” added Natalie.
With doctors seeing no improvement in their son’s condition, a glimmer of hope arrived in May of last year when the Petersons read about Dr. Glenn Green and Professor Scott Hollister of the University of Michigan.
The team had just used a 3D printed airway splint to save the life of three month old Kaiba Gionfriddo, an Ohio baby with the same condition as Garrett’s.
Though the method had proven successful for Kaiba, Natalie and Jake were still not sure if it was the best course of action for Garrett, as his condition was even more severe and there was no guarantee it would work again.
In December, however, the choice was taken out of their hands. Garrett’s stomach had begun to shut down as the pressure levels of the ventilator became too high for his body to handle. He was moved to intensive care, with doctors delivering a grim forecast. The Petersons contacted Green and Hollister, who moved Garrett to Ann Arbor and got to work on creating a device that would give him a shot at survival.
The team began by taking a CT scan of his windpipe. Using this information, they designed a tube that would specifically fit the shape of Garrett’s right and left bronchi. The hope was that this could act as a protective shell, allowing air to pass through the windpipe without it collapsing. They then printed it using a biopolymer called polycarbonate that would biodegrade in Garrett’s body over the next three years. That period should give the windpipe the time it needs to toughen and develop to the point it can work on its own.
Though Green and Hollister had been here before, even they were not sure the splint would be successful. The splint is not approved by the Food and Drug Administration and, legally, surgery could not commence without the governing body’s approval. With Garrett’s chances becoming slimmer by the hour, the team desperately petitioned the FDA to sign off an emergency waiver that would allow them to begin the radical procedure.
As Hollister put it:
In some senses we were thrown directly into the fire. We characterised it as a sort of Hail Mary pass.
The FDA’s waiver came through and on the 31st January, surgery commenced at the C.S. Mott Children’s Hospital, under Richard G. Ohye, M.D, Head of Paediatric Cardiovascular Surgery. As soon as Ohye looked inside Garrett’s chest, he could see the extent of the damage. Not only had the windpipe collapsed completely, one of the lungs had turned white – a condition usually only found in someone who has already died. He got to work across the next 8 hours, sewing the two splints in place.
Then came the real test. Ohye allowed air to pass back through Garrett’s windpipe, to see if it could deal with the intake of oxygen. For the first time since he was born, Garrett began to breathe in a regular, healthy manner. The pipe stayed open and his lungs filled, turning from white to pink in response.
One and a half months later, and Garrett is getting stronger and stronger each day. He now only requires a quarter of the pressure in his ventilator and, more and more, he can breathe without any assistance at all. Doctors are now predicting that Garrett could be well enough to be taken home in a matter of months. His overjoyed mother explains:
He has been doing so good. He’s been smiling, and it’s crazy to be able to see him get really upset and not change colours. He’s being more interactive and more alert and reaching more for his toys. He’s just starting to be more like a normal child.
For Dr. Green, however, the battle has only just begun. He now feels that the evidence proves his method is the clear solution for conditions like Garrett’s, yet there are obstacles in his way. Transporting babies to a facility where the process can take place is expensive and insurance companies are reluctant to pay for the journey.
It is one of the most frustrating things that I’ve been through, knowing that there’s something that we have that can help and looking at all the roadblocks that are in place in trying to make it happen.
The next step for he and Hollister is to launch a formal study that will prove the efficacy of the method and, hopefully, give more children born with breathing problems a chance.