Published On:Friday, January 27, 2012

By DANA SMITH

dsmith@tribunemedia.net

A PARASITIC twin was successfully removed from the back of a three-week-old baby girl on Wednesday evening, marking an "historic milestone" in Bahamian medicine.

Doctors and nurses from the obstetrical, neonatal, and neurological units at Princess Margaret Hospital (PMH) were joined by the baby's parents to announce the success, noting it was the first time in the country that such a surgery had been performed.

Baby Shakera was born at PMH to Chantal and Osee Joseph on January 3, with a parasitic twin attached to her back.

The partially-formed mass had a "small leg with some toes" and was "completely binded" with Shakera's spine.

Neurosurgeon Dr Magnus Ekedede, who led the operation to separate Shakera from the underdeveloped twin, said he "had tremendous stress" at first because he "didn't believe we could do it in the Bahamas".

But, he felt more "at ease" following prayer, careful surgery planning, and "excellent support" from his team.

"Everybody did everything right," Dr Ekedede said, thanking the doctors and nurses who assisted in the surgery. "It's not about me ... I thank everybody that has to do with this."

He continued: "The Bahamas should be happy that we could accomplish this here. Every Bahamian should be happy because if you read through texts book and google this -- it's not easy. From my records, nothing like that has been done in the Caribbean."

Ms Joseph called her child a "miracle baby" and thanked PMH's doctors and nurses profusely.

"Thank you to all the doctors, thank you so much - especially to the nurses," she said. "From when my baby was born, they help my baby, so I say thank you so much."

Mr Joseph said waiting to hear news about his daughter during the surgery was "very difficult."

"I was nervous and shocked because I didn't know that it was going to be the way it is today," Mr Joseph said. "When they told me that they already took off the other part and they only closing, I start to get happy - excited. But at first it was very hard for me and I was really nervous."

According to Dr Geoffrey Pennerman, medical chief of staff at PMH, the surgery was performed in "record time" and without complications. The surgery only took eight hours rather than the planned 15.

"Our patient is comfortable and recovering in our neonatal intensive care unit," Dr Pennerman said. "At this very early stage in her recovery there are no indications of complications as a result of the surgery."

Baby Shakera is presently on a ventilator at PMH and doctors are confident she "will continue to do well."

Dr Gwen McDeigan, director of PMH's neonatal intensive care unit, echoed Dr Pennerman's comments and also spoke on what's to be expected in the "immediate post operative period."

"The surgery was a very prolonged surgery, very arduous... but an uncomplicated surgery so the baby came back without any post-operative complications and I'm happy to report that the baby had, remarkably, a very stable course of a night," she said. "But we're still early yet, it's always the first 96 hours after surgery that can be a very complicated time, but I'm really pleased to see that so far this baby has done very well."

According to Dr McDeigan, what remains to be seen is "the function of some of the organs" following the surgery and baby Shakera being "weaned" off the ventilator.

"We anticipate that once we get her out of the immediate post operative period, remember she's being sedated and getting pain medication, she may not make the best respiratory effort on her own," Dr McDeigan said.

"So we're not trying to be aggressive in getting her off the ventilator - not right yet. We're trying to get her past this post operative period."

Once she is past this period, doctors will be able to start withdrawing her pain medications so she can wake up and begin further tests.

"There's still much of the story to be told," Dr McDeigan said. "We are encouraged and very positive in our outlook that when we get to each of those bridges to cross, that we will cross that bridge, even with difficulty, we will get to the other side."

Dr Ekedede said he doesn't anticipate baby Shakera will have any "major deficits" following the surgery.

"I do anticipate this baby to do well," he said. "There are things that would of told me, or told us, that there would be a problem. Now there are things we may not know - time will say... The first important thing is to make sure she comes out of the ventilator which I think will be very soon."

It was during a routine ultrasound that baby Shakera was diagnosed by doctors with an "abnormality." She was 30 weeks in utero.

According to chief obstetrician, Dr Mildred Hall-Watson, the ultrasound had to be repeated so that she, along with her team, could "confirm what we were dealing with."

It was after repeated ultrasounds and "several" consultations with the parents, that they realized they needed assistance from other PMH departments.

"We looked at what our possibilities were," Dr Hall-Watson said. "One of the important things that we try to pay attention to when we manage patients is inter-department consultation and so we immediately went to the neo-natologist (and) as a result of that we realized that we were going to have to have consultation with the neurosurgical team."

Together, this team of doctors from the various PMH departments carefully planned the delivery of the baby and "the appropriate time" for a surgery to remove the abnormality that was attached to Shakera's back.

"The delivery itself, needless to say, was challenging," Dr Hall-Watson said. "Imagine trying to get out say a baby who weighs maybe 11 or 12 pounds - not easy... but a baby who also has another extensive attached parasitic twin on its back, that was even more challenging."

Shakera was born by cesarean section surrounded by obstetricians, paediatricians, and neurosurgeons, before being immediately placed in PMH's neonatal intensive care unit.

Dr McDeigan said Shakera was "very stable" following her birth, but paediatricians still classified it as a "very challenging case" as they had to "maintain the integrity" of the parasitic twin.

"Any loss of integrity - any infection in the parasitic twin could have led to the demise of this baby," she said. "It is really with due credit to our nurses who are at the bedside of the baby, 24 hours a day, and our doctors who are on call monitoring the baby, that this baby was able to survive and make it to surgery."

Now that the surgery has been successfully completed, Dr Ekedede believes baby Shakera could make it home in as little as two to three weeks.