Tiny Technology for Tiny Hearts

by Katie Nussbaum, Wolfson Children's Hospital

The smallest child to date to have a PDA closed at Wolfson Children’s, Jaden was less than five pounds at the time of the procedure.

New heart device helps the smallest patients.

Jaden Stewart was removed from oxygen support and breathing on his own in July.

Born 17 weeks premature on March 29, 2022, Jaden Stewart has spent the first five months of his life in neonatal intensive care. Thanks to a tiny new technology and procedure recently introduced at Wolfson Children’s Hospital, Jaden is home with his family.

Soon after birth, Jaden, who weighed less than two pounds, was diagnosed with patent ductus arteriosus, or PDA, a potentially life-threatening opening between the two major blood vessels leading from the heart.

“The lungs tend to be fairly fragile in premature babies and that extra blood flow that goes into the lungs through that PDA can cause a lot of issues,” said Robert English, MD, a pediatric interventional cardiologist who practices at the C. Herman and Mary Virginia Terry Heart Institute at Wolfson Children’s Hospital. “They require support to be able to ventilate and oxygenate and that extra blood flow may cause prolongation of the need for support. That support can be damaging to the lungs over time.”
While required in fetal life, the vessel opening typically closes on its own within a few days after birth, but that’s not always the case, especially in premature babies.

“The opening was always of moderate size but it never got any smaller,” said Jaden’s mom, Tiffany Stewart.

In mid-June, Jaden was transferred to the Wolfson Children’s Hospital Neonatal Intensive Care Center from another area hospital. Two weeks later, he underwent a non-surgical procedure to close the PDA using the Amplatzer Piccolo™ Occluder, which is so small it fits on the face of a dime. Wolfson Children’s is the only hospital in Northeast Florida to offer this procedure.

Dr. English is specially trained to implant this technology in babies weighing as little as two pounds

​"For a long time, we have been able to close these vessels in older and bigger infants and children because the devices used to close them are of a certain size, but they're too big for the premature babies," said Dr. English, who performed Jaden's procedure. "This tiny device is the first technology that allows us to close a PDA in premature infants."

Dr. English is specially trained to implant this technology in babies weighing as little as two pounds through a cardiac catheterization procedure in which the wire mesh device is guided through the vessels to close the opening.

A non-surgical option for premature infants

Previously, the only other option to close a PDA in infants was surgery.

"Heart surgery is more invasive and involves an incision between the ribs," said Dr. English. "The children usually recover well following the surgical procedure, but there are some risks associated so we prefer a non-surgical procedure to close the PDA when possible."

The smallest child to date to have a PDA closed at Wolfson Children's, Jaden was less than five pounds at the time of the procedure. Stewart said she noticed a positive change in Jaden just hours after the procedure was completed.
"Almost immediately, you could see a difference just with his oxygen support levels," she said.

Within a couple of days, Jaden was taken off the ventilator and put on low-flow oxygen support.

In late August, Jaden was removed from all oxygen support, breathing on his own and ready to join his dad Justin and sisters, Jordan, 12, and Riley, 10, at home.

"He's doing a lot better with his breathing and he's even starting to bottle feed now," Stewart said. "He is definitely pacing himself as far as being able to breathe and swallow at the same time, but the procedure turned things around."

Stewart said Jaden is growing stronger each day and hitting milestones a lot quicker than before.

"He's on his way to being healthy and being able to really function without as much support as he needed before," she said.
 
The pediatric cardiology, imaging, cardiac intensive care, cardiac anesthesiology and heart surgery teams with Wolfson Children's C. Herman and Mary Virginia Terry Heart Institute treat a full range of pediatric cardiac conditions, from defects present at birth to heart rhythm disorders. To learn more, call 904.202.8550 or visit wolfsonchildrens.com/heart