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Shortly before Christmas Tamara preformed an US on herself to confirm the baby's gender. Baby Adducci was indeed a Boy, but Tam also discovered something else. The baby had a quite significant abdominal wall defect. She is very fortunate to work with amazing colleagues and my perinatologist ( a Dr specializing in fetal ultrasounds and high risk pregnancies) performed a confirmatory ultrasound that next morning. He then recommended Mike and Tamara both return later that evening for a more extensive ultrasound and discussion.
We returned later that evening for a very intense ultrasound where we studied our little one in every possible way looking for any other anatomic defects. We couldn't find any. The baby does however have a giant omphalocele.
An omphalocele is an anterior abdominal wall defect were the abdominal wall does not fully close early on in utero. This can leave bowel and other stomach contents herniated outside of the stomach cavity. Our baby's omphalocle involves the bowel and liver. This classifies it as a giant omphalocele.
More information about omphalocele's here:
http://www.chop.edu/conditions-diseases/omphalocele (
http://www.chop.edu/conditions-diseases/omphalocele)
That evening we also had some genetic testing preformed. This blood work unfortunately was misplaced by FedEx over the holidays and there was an agonizing week delay in results. This fortunately returned completely normal. This was baby's boy first hurdle.
We later met with a pediatric surgeon, Dr. Aiken. He reviewed my ultrasound and was extremely reassuring. He expects that as long as no other anatomic defects are discovered prenatally or at birth this baby has an excellent prognosis. He expects no long term developmental problems.
He reassured us that in the case of a giant omphalocle bigger is actually better as this provides for better blood flow to the abdominal organs.
Our expected treatment plan was as follows:
I transferred my care to Froedtert Hospital
-This is the large medical center connected with Children's Hospital and where I based most of my training.
-A repeat cesarean section was planned for 39 wks (Oliver had other plans)
The baby will be admitted to NICU at children's hospital most likely for an 11-12 wk stay.
They perform a "paint and wait" technique. Every day the omphalocele will be painted and dressed. This causes the sac to scar.
The baby can then come home at approximately 3 mo of age. There is a chance this could be much earlier given our "high functioning status"as parents if we desire to perform some of this medical care ourselves.
We also discussed potential complications:
-Lung development: There is a chance baby could be born with smaller than normal lungs. Dr. Aiken however reassured me that this rare in children with no other anatomic findings.
-Feeding: Most babies start oral feedings early. The baby may require full or partial tube feeds during the initial NICU stay.
Skin will then grow over the scar and the omphalocele will be completely enclosed by skin at 3-4 mo of age. The baby will then essentially have a large hernia.
Starting at 8-9 mo of age the bay will undergo 4-5 operations to remove the scar and slowly tighten the abdominal wall muscles. These operations are pretty minimal and involve only an overnight stay in the hospital. Minimal complications are encountered.
AT 18 mo our little boy will hopefully be completely anatomically normal :)
Later on at age 3-4,if we desire plastic surgery,can create a belly button for our little one.
