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INFUSIONS HELP FETAL LUNGS WHEN VITAL FLUID’S LACKING

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Breeanna Marie Bailey was a little longer than a ruler and weighed less than a giant bag of peanut m&ms when she was born 12 weeks early.

But thanks to a new procedure at LDS Hospital, the tiny infant had already overcome a big-time problem: under-developed lungs caused by insufficient amniotic fluid or "water" that surrounded the fetus in her mother's uterus.The problem occurs spontaneously, or as frequently as in 1 of 100 pregnant women whose membranes burst after amniocentesis, a common procedure used by doctors to detect fetal abnormalities, such as Down's syndrome.

As a result of the rupture, one of three scenarios occurs - the most desirable being that the hole in the membrane seals over, allowing the fluid to reaccumulate and the pregnancy to proceed normally.

Frequently, however, the mother loses the pregnancy because of infection. Or the baby is born, usually premature, with pulmonary hypoplasia. This abnormal development of lung tissue - a lethal condition - differs from respiratory distress syndrome, a treatable condition observed with prematurity.

Today, however, innovative treatment available at LDS Hospital offers new hope for fetuses with under-developed lungs.

Using an ultrasound and well-positioned needle, Dr. Greggory R. DeVore, a perinatologist, injects a saline solution into the uterus - replacing the life-saving amniotic fluid that is produced by fetal urination.

DeVore's experimental procedure is done several times during the second trimester to replace the fluid that leaks out vaginally when the mother's membrane bursts. At LDS Hospital he has performed it on two women.

Both procedures were done as emergencies, at no cost to either patient.

The first woman had a history of spontaneous ruptured membranes.

DeVore, director of LDS Hospital's Fetal Diagnostic and Treatment Center, began monitoring her fetus during the 15th week of pregnancy.

"As we studied the fetus at 15 to 16 weeks, I had a hard time seeing the kidneys. I could see the bladder but could never see the kidneys."

He began instilling the saline solution at 18 weeks.

During the 17th procedure in the 30th week, the fetus, freed up in the fluid, kicked the umbilical cord into the needle, causing immediate hemorrhage.

The baby died the following morning.

"The good and the bad of it was that an autopsy showed that because of the procedure, the baby's lungs were normally developed," DeVore said. It also showed there were no kidneys.

"The blessing in disguise was that we learned that if fetuses don't have kidneys, 100 percent of the time they develop pulmonary hypoplasia. Yet even in the worst-case scenario - no kidneys and no fluid - the lungs still develop by instilling the fluid."

DeVore discovered that if the solution is injected weekly, even though it leaks out over a two-day period, "that seemed to be enough time for the lungs to do what they needed to do to develop properly."

No one was more interested in the outcome of the procedure than Kaylene Bailey, hospitalized across the hall from DeVore's first patient.

She too had been admitted with a spontaneous ruptured membrane. Yet fear of the unknown kept her indecisive about the experimental injections.

"It was a hard decision because we didn't know if it was going to be successful," she said. "I didn't know what to do because I was half way through the pregnancy, so I teetered on this (decision) for a month."

Kaylene was well aware of the dangers associated with prematurity. Her daughter, Brittnee, 4, arrived two months early, spending the first six weeks in the hospital.

Yet, Kaylene and her husband, Steve, also knew they had few options, if any. Though the new procedure carries a risk, the alternative for their child was death.

Kaylene Bailey became DeVore's second patient after being hospitalized for four weeks with no fluid accumulation. Following five injections, she gave birth to Breeanna.

Despite her well-developed lungs, Breeanna, who weighed 1 pound 15 ounces, has called LDS Hospital's newborn intensive-care unit "home" for nine weeks.

There she has been treated for a host of complications, including respiratory distress and cardiac arrest - keeping her parents on a roller coaster they believed would never stop.

Until now.

Breeanna, at a healthier 3 pounds 7 1/2 ounces, is expected to be released in two weeks.

"I know if it weren't for Dr. DeVore our baby wouldn't be alive," said Kaylene Bailey, who once believed she'd only hold her dark-haired, blue-eyed child on Breeanna's way to the morgue.

Now the 24-year-old mother is a walking testimonial for the procedure developed at LDS Hospital and also being used by high-risk obstetricians on an experimental basis in California and in West Germany.

LDS Hospital's Institutional Review Board will soon be presented a protocol doctors will follow in future local cases.

"The benefit of this concept is in the past a woman with a ruptured membrane had no alternative," said DeVore. "This adds a new dimension to fetal treatment."