Published September 13, 2022
As an obstetrician, Meredith Carbone-Doyle DO, had been looking at ultrasounds all day before it was finally time to see her own. Dr. Carbone was hopeful to see a healthy 20-week baby boy, but she immediately noticed something was not right.
“When I saw the mass on his lung I was in disbelief,” said Dr. Carbone. “You never expect to find an abnormality.”
Dr. Carbone was looking at a congenital pulmonary airway malformation (CPAM), a mass of nonfunctional fetal lung tissue that forms during pregnancy. These masses vary in size and can change during the pregnancy.
Dr. Carbone requested a referral to the Fetal Care Center at Yale New Haven Children’s Hospital (YNHCH) where Dr. Carbone met with the pediatric surgeons and the Neonatal Intensive Care Unit (NICU) team to create a plan where she would be regularly monitored.
Dr. Carbone cared for her patients and her 3-year-old son while staying closely connected with the management of her second pregnancy.
“I had never seen a mass with this ratio,” said Mert Ozan Bahtiyar, MD, director of the Fetal Care Center, an expert in diagnosing and treating complex abnormalities in babies before they are born. “We tried to shrink the lesion with corticosteroid treatment. The mass did not decrease after multiple rounds of steroid therapy. It became clear that surgery after birth to remove the mass was the strongest option.”
The team decided Dr. Carbone would deliver her baby via cesarean delivery at the end of her 37th week so that the baby could be rushed into surgery while Dr. Carbone was being stitched up.
“There were concerns this baby would not be able to survive outside the womb without immediate intervention,” said Emily Christison-Lagay, MD, the pediatric surgeon who performed the procedure. “Our multidisciplinary team at the Fetal Care Center decided that delivering in the Pediatric Surgery operating room was the best way to move forward.”
This operation marked the first time a mom and baby had a simultaneous operation in adjacent operating rooms in YNHCH. Typically, these operations happen in separate spaces due to the different tools and teams required, but in this case a floor transfer would have added an unnecessary risk and delay.
A week before the planned cesarean Dr. Bahtiyar got the midnight text saying Dr. Carbone was in labor.
“It was almost like this day had been pre-decided. Everyone mobilized as if it were happening on the day we planned it,” said Dr. Bahtiyar.
Logan was born on Dec. 27, 2020, at 4:22 am. The neonatology team established an airway and moved Logan to the OR table to begin the lung resection. At 11 am Dr. Carbone and her husband met baby Logan.
“We were celebrating that he successfully made it through surgery,” said Dr. Carbone. “But it was also heartbreaking that here is the baby you just birthed, and you can’t hold him. We were able to sit with him and hold his hands, but it was tough.”
Dr. Carbone was discharged from the hospital after two nights and visited Logan in the NICU daily.
“The NICU nurses and social workers are some of the smartest, most efficient healthcare professionals I have ever encountered,” said Dr. Carbone. “I learned how to make sure I took care of myself so I could be the best mom for my kids and also how to be a resource for my patients who are facing NICU stays.”
Logan’s lungs were inflating as expected given he had most of his right lung removed. After five weeks in the hospital, it was time to for his big brother and grandparents to welcome him home.
Although he is checked annually and spent his first year out of daycare to try to avoid respiratory viruses, Logan is by all accounts healthy. He spent this summer with his family in idyllic toddler fashion, splashing in the pool, chasing little creatures around his backyard and playing with his Buzz Lightyear toys.
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