Saved from a life-threating condition by an advanced in-utero keyhole blood transfusion procedure at 25 weeks while still in his mother’s womb, baby Mihle Biyela’s parents were overjoyed last week to take their healthy and bouncing son home from Netcare St Augustine’s Hospital in Durban, where he was born on 12 February this year.
Mihle’s parents, Mr Phiwayinkosi Biyela and Mrs Ntombenhle Biyela, say that they regard their little boy as a “miracle baby”, as they had been warned that the foetus suffered from a life-threatening condition known as hydrops fetalis, which was characterised by a fluid build-up around the heart, lungs and other locations, and was unlikely to survive.
Fortunately, Mrs Biyela sought a second opinion from gynaecologist and obstetrician, Dr Bongani Mazibuko who practises at Netcare St Augustine’s Hospital, after it was recommended that her pregnancy be terminated. Dr Mazibuko in turn contacted foetal specialist, Dr Ismael Bhorat, KwaZulu-Natal’s only foetal specialist in private practice, for assistance and they commenced investigations into what was causing the condition. The diagnosis of the foetal anaemia was made using advanced sonographic and Doppler techniques investigating the peak flow velocity in an artery in the brain.
“Hydrops fetalis can be caused by a variety of different underlying conditions, which can result in a myriad of potential complications. The prognosis for the foetus is dependent on establishing the exact cause and then treating it early and appropriately. Without this, the condition is almost invariably fatal for the foetus,” says Dr Bhorat.
Dr Bhorat, who practises at Netcare uMhlanga Hospital, led the team who performed a life-saving in-utero keyhole blood transfusion procedure called an IUT (intrauterine blood transfusion), when the foetus was only 25 weeks.
Grateful for their little survivor, the Biyela family decided to name the baby “Mihle Imisebenzi kaNkulunkulu”, which translates from Zulu as “Beautiful work of God”. “It has been a difficult and painful journey with Mihle, as we were originally warned that he had very little chance of surviving,” said Mrs Biyela. “Through the mercy of God and thanks to the wonderful care of the doctors and nurses, we were overjoyed to be taking Mihle home.
“I can’t wait to spend more time with him, as a mom needs to bond with her son,” added the mother of two, who originally hails from Nkandla in northern KwaZulu-Natal, and now lives in Durban.
Dr Bhorat adds: “What baby Mihle’s case highlights, is that with accurate diagnosis and early and appropriate specialised intervention, there is hope for many hydrops babies and they can often be saved. The proper identification of the cause or causes of the condition is critical, however, as these have to be addressed in order to have a chance of resolving the hydrops fluid build up.
“We are absolutely delighted to have been able to save baby Mihle’s life, who was suffering heart failure due to severe anaemia since the heart had to pump harder to get blood to the cells and the heart eventually failed.
“We established that the hydrops was not as a result of immune system problems, but was likely caused by a viral infection that had attacked the foetus’ red blood cells, resulting in severe foetal anaemia. Under such circumstances the in-utero blood transfusion procedure is indicated. Before performing the procedure 1-2 ml of foetal blood is extracted, in a procedure called a cordocentesis, to determine the haemoglobin level of the foetus.”
“This information is needed to determine the exact volume of blood to be transfused. The foetus immediately started to recover after just a single IUT procedure, and suffered no further complications as a result of the hydrops, and continued to develop strongly. Working closely with Dr Mazibuko, we were then able to get baby Mihle to a healthy 36 weeks when he could be safely delivered.”
Dr Bhorat says that the minimally invasive IUT procedure is well described, but is only indicated in rare cases such as this. Hydrops can so easily result in complications, and has a mortality rate of some 90%, and the procedure itself is intricate, requiring blood to be carefully replaced in the correct volume.
A needle has to be guided through ultrasound control into the umbilical cord so that the blood can be sampled for testing, and the blood transfusion can then be undertaken. Complications that can occur are slowing of the heart rate, leakage of blood from the insertion site or clot (haematoma) formation in the cord.
“We managed to obtain the necessary O-negative irradiated blood within two days. Often a number of blood transfusions are necessary before the hydrops begins to resolve but in this case the foetus responded after a single transfusion.”
Dr Bhorat says that the haemoglobin of the foetus was determined to be 3g/dl which is extremely low and explains the cardiac failure (normal foetal haemoglobin is 15-16g/dl).
“The team is delighted that we got every aspect of the condition and treatment accurate and correct, and that it was such a success. When I saw baby Mihle for the first time after birth, it brought tears to my eyes.”
“We would like to convey our appreciation to our families, colleagues, friends, and brothers and sisters of our church, ‘The House Of The Twelve Apostles, for their support and prayers through our experience with Mihle,“ said Mr Biyela.
“My family and I are also most grateful to Dr Bhorat, Dr Mazibuko and their teams at both Netcare St Augustine’s and Netcare uMhlanga hospitals. They kept us informed and reassured us every step of the way through the treatment and the pregnancy. From thinking that I was sure to lose my baby, to being able to take Mihle home, is the greatest gift I have ever been given,” added Mrs Biyela.
Netcare St Augustine’s general manager, Heinrich Venter, says that the staff and management of the facility were all deeply moved by baby Mihle’s case and celebrated that he could go safely home last Thursday.
“We are delighted at the positive outcome and to have played a role in baby Mihle’s care. We wish him and his family all the very best in the future,” Venter concludes.
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