How Cape Town doctors used an amniotic sac to save a baby’s life

A Cape Town doctor’s decision to save a mother’s amniotic sac during a complex C-section birth has saved the life of baby Ephraim Maleho, who was born with vital organs outside his abdomen.

Ephraim’s intestines and half his liver were protruding from his body in a translucent bubble due to a condition called exomphalos when he was born at 38 weeks.

After 100 days of neonatal intensive care at Netcare Blaauwberg Hospital in Cape Town, including the use of amniotic tissue to protect the organs from potential infection, the three-month-old has gone home to Vredenburg.

“We wondered, how can our child live?” his mother Beneline Maleho said this week.

“Ephraim’s father and I knew there is something special about this child, and even though there were major risks, we would stop at nothing to give him the chance to live.

“I thanked God every day when I opened my eyes and felt the baby kicking. It was like he was saying, ‘don’t worry, mommy, I’m fine’.”

After his birth in March, Ephraim was kept in a carefully controlled environment to protect the thin membrane forming the bubble around his organs.

“Our biggest challenge was that as a result of all of those contents being outside his body, his abdominal cavity had not developed,” said Dr Ricky Dippenaar, a senior neonatologist.

“His intestines and organs could not simply be moved into the position they would usually be in. We needed time for the skin to grow to make enough space in his tummy.”

Dippenaar preserved the amniotic sac, a clear, tough membrane formed inside the mother’s uterus to encapsulate the unborn baby and amniotic fluid.

This tissue not only cushions and provides nutrients to the growing baby but contains stem cells which saved Ephraim’s life.

Dippenaar said he used this amniotic sheet twice when any other treatment would have been insufficient to prevent infection, and to buy time to let the abdominal cavity grow and the skin to creep over the ventral abdominal defect.

“It seemed logical to use the very membrane that protected baby Ephraim inside the womb as a natural barrier,” he said.

“This membrane is known to contain a number of healing cytokines and essential growth factors and help reduce pain. It also has anti-bacterial properties, and reduces inflammation and scar tissue.”

The amniotic membrane became crucial after the sac that contained some of the organs started to break down in two areas, putting Ephraim at risk for life-threatening septic complications. 

“The amniotic tissue incorporated well, reinforcing the bubble of tissue around Ephraim’s organs, which then underwent a transformation and started contracting,” said Dippenaar.

“Together with the constricting dressing, the bubble reduced dramatically, gently squeezing the organs into his abdomen and allowing Ephraim’s abdominal cavity to expand.”

After two months, the cavity was large enough to fit all Ephraim’s organs safely inside and the external sac had shrunk to resemble “a tiny rhino horn, tough, firm and providing total protection”.

At last the baby was ready for surgery. Paediatric surgeon Dr Beelke D’hondt and his plastic and reconstructive surgeon colleague Dr Alexander Zühlke performed the intricate procedure to close the abdominal wall with all organs in their correct place.

“The surgery was interesting and multifaceted but proved to be very feasible and successful. Ephraim showed us what it is to be a little hero,” D’hondt said.

Ephraim’s father, Melvory van Wyk, said the family was relieved.

“We were very worried, and we knew it was the start of a long journey. We thank God for sending these angels to look after our son.

“They were open about the risks and supported us to make the necessary decisions for our son informed by the facts.

“We want other families to know there are people who understand what it is like to go through a difficult journey like we had with Ephraim, and there is hope. He is our little miracle warrior.”

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