Eight hours of the most delicate surgery fixed a rare issue in a newborn and changed three lives forever.
Each hurdle baby Luca Polidano faced seemed insurmountable.
Over six weeks – from 31 weeks’ gestation when the first abnormality was detected, through to his second week in the outside world when he underwent lifesaving surgery – Nadia and Joe Polidano rode a rollercoaster of doomsday scenarios for their son.
They were initially told to prepare for losing their baby before birth, after scans suggested he had the rare abdominal birth defect, congenital diaphragmatic hernia.
Despite being hospitalised for a dangerously high build-up of amniotic fluid in her uterus, it was at this time the couple started wishing Nadia could stay pregnant forever. As long as he stayed inside her, they still had their little boy.
Next, when further scans suggested a more complex problem, they braced for taking home a seriously ill child who faced surgery and a devastating syndrome.
But Luca remained a boy who was put together with puzzle pieces collected from different boxes. There was something unusual about his fragility and the position of his major organs that doctors couldn’t quite work out before birth, given the limitations of scans in utero.
And yet even when Luca’s true diagnosis was revealed to Royal Children’s Hospital surgeons when they could first peek into the newborn’s chest, there would be no guarantees for the Oak Park couple that their premature son would make it through the operation needed to save his life.
“Our hearts stopped that day we got that first bad news,” said Nadia.
“Now four months later, with our boy home, we wish we could have known it would all work out.
“Everyone kept telling us if he makes it to The Royal Children’s, he’s probably going to make it.
“We’re so grateful to the hospital for making this wish come true.”
Luca was in a bad way when he was born, with his heart working overtime.
After being transferred to the RCH straight after birth, Luca was wheeled into theatre on day six of life for a two-part investigative surgery with renowned neonatal surgeon Joe Crameri.
His first task was to find out what was happening in Luca’s abdomen to cause the excessive build-up of fluid. Secondly, he planned to repair the hole in the diaphragm, so all the organs could sit back in their proper places and begin developing properly. But as soon as Mr Crameri opened Luca up, it all made sense.
Yes, there was a hole in the diaphragm, but it wasn’t a case of not being formed properly. A big tumour, a teratoma, had burrowed through the back of the diaphragm and was taking up two-thirds of the abdomen and chest cavity.
This mass had disturbed all the developing organs around it – the heart, lungs and major blood vessels in the liver.
Mr Crameri had never seen this type of tumour of this size and in this unusual spot.
Luca was even too unstable for even a biopsy to be taken.
The couple initially felt relieved at the news. This meant there was no scary syndrome to face. There was a surgical fix that could free their son to get on with life.
But further scans revealed that because the tumour rested behind major organs and was attached to important blood vessels, it was going to be very risky to remove.
“Because of his young age and prematurity, again we were faced with this situation where they weren’t very confident he could pull through,” said Nadia.
“The tumour was still growing, and it could still be malignant. This was the lowest it got for us.“
The ideal situation was to wait until Luca was four weeks old for the surgery. But at 2½ weeks, it was getting harder and harder to support his stressed lungs and heart.
“We knew we had to take the risk and get this out now, otherwise we may be in a position where he wasn’t strong enough at all to tolerate the operation,” said Mr Crameri.
Luca was then placed on a special type of ventilation reserved for the most fragile bubs, which bought him an extra 24 hours. Doctors used the day to plan the surgery for the next day, December 20, while the couple did all their special rituals with their boy one last time.
Joe read Luca books. Nadia sang to him. They gave him his Christmas present; a soft toy called Luca the Lion, named after the daily mantra they would whisper to him about his strength and bravery.
They said goodbye to their son.
“It was so scary to hand him over for surgery, but we were so reassured we were in the best hands,” said Joe.
Nadia remembers: “When we were in the lift we said to him, ‘We’ll see you in recovery’.
“But both of us strongly felt we were saying goodbye.”
Over eight hours, Mr Crameri and paediatric surgeon Michael Nightingale moved all the major organs out of the way to meticulously resect the tumour.
The operating theatre erupted into applause when finally the 200g benign mass was removed all in one lump.
“As much as it was the worst day of our life, we say it was one of the best days as well,” said Nadia.
“There were so many obstacles and hurdles that had to be overcome, but he made it through. Our boy was tumour-free.”
After almost 10 weeks at the RCH, the Polidanos are soaking up the simple joys of having their precious boy home.
“We’ve always been aunties and uncles. So to be mum and dad, the ones he wants to see and is so comforted by, it just melts your heart,” she said.
“It may be their job at the hospital, but they change lives and they do that day after day.
“In saving Luca’s life they’ve saved our lives, because we were just going to be broken without him.”
Originally published in the Herald Sun on Friday, 15 April
Words: Brigid O’Connell
Images: Alex Coppel and supplied
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