Baby beats odds thanks to two innovative treatments
HOUSTON, Feb. 6, 2006 – Marissa Cooper loves the color red. Her eyes latch onto any red object and follow it around the room. She laughs and grabs when a red book or toy moves near her.
 Her joy at such simple pleasures hints that Marissa is developmentally several months behind most babies her age. But she can be excused for lagging behind her identical twin sister, Morgan.
Marissa spent much of her first year unconscious and battling for life against a severe respiratory infection. If not for the doctors and nurses at Memorial Hermann Children’s Hospital, she wouldn’t have been there with Morgan to celebrate their first birthday in early December.
The girls were born several weeks prematurely and experienced twin-to-twin transfusion syndrome, explained their mother, Jaymie Cooper. They shared a placenta and a split umbilical cord, through which Marissa received less nutrition than Morgan. Still, thanks to good prenatal care, the girls weighed about 4 ½ pounds each when they were born, so they stayed in the hospital less than a month.
Marissa, however, went home with an oxygen tube and a sleep apnea monitor.
Jaymie and her husband, Jeremy, an electrician, live in a Vidor, Texas, home bustling with five children. The twins were less than two months old when one of their older brothers came down with what seemed like a bad cold.
“One night, the apnea monitor went off and Marissa started turning blue,” Mrs. Cooper recalls.
 The Coopers rushed the infant to an emergency room in Beaumont, but she was quickly transferred to Memorial Hermann Children’s Hospital and diagnosed with respiratory syncytial virus, or RSV (see sidebar). Morgan was briefly hospitalized as well, but while she quickly bounced back, Marissa’s condition deteriorated. “It developed into pneumonia and went down and down and down from there,” Mrs. Cooper lamented.
“Somebody up there really likes this girl,” said Giuseppe Colasurdo, M.D., physician-in-chief for Memorial Hermann Children’s Hospital and chairman of pediatrics at The University of Texas Medical School at Houston.
A team of doctors and neonatal intensive care nurses at Memorial Hermann Children’s Hospital used two innovative treatments to save Marissa’s life.
The first was extracorporeal membrane oxygenation, or ECMO. This heart-lung bypass technique removes blood from the body, oxygenates it, and pumps it back in, giving the lungs a rest so they can heal.
ECMO is used for newborns, especially premature babies whose lungs aren’t completely developed. It may also be used for older children who become gravely ill because of lung injuries or infections, but ECMO appears to be less effective as the child ages.
“It’s a last, desperate effort to keep a kid alive,” said Dr. Colasurdo. While nationally, the survival rate for pediatric ECMO patients with viral pneumonia is approximately 60 percent, the success rate of the ECMO team at Memorial Hermann Children’s Hospital approaches a remarkable 90 percent.
“2005 has been our busiest year to date because of the increase in pediatric patients,” said Kevin Lally, M.D., director of the ECMO program at Memorial Hermann Children’s Hospital and chief of the pediatric surgery division at the University of Texas at Houston. “Our volumes are high, our outcomes are among the best in the country, and our data indicate a growing benefit from pediatric ECMO support in critically ill children.”
Memorial Hermann Children’s Hospital broke its own records by treating 28 patients with ECMO in 2005. Of those, 18 were newborns and four were respiratory patients like Marissa. The rest were cardiac patients.
ECMO is usually a short-term bridge that buys a child time for the lungs to heal. Most children stay on ECMO for less than two weeks. At 2 ½ weeks, however, Marissa’s lungs were still collapsed.
The doctors had three choices with Marissa. They could stop life support and “let her go play,” as Dr. Colasurdo gently puts it. They could continue ECMO and hope for the best. Or they could try a new approach of their own.
Marissa’s parents and the doctors chose the third option.
“This is a typical example of the family-centered care environment in our institution” Dr. Colasurdo said. “Marissa’s parents were shoulder-to-shoulder with the doctors during this challenging journey and were closely involved with the care delivered to their child.”
Cells in the lungs manufacture surfactant proteins which, among other things, keep our lungs from collapsing. RSV attacks these cells and turns off the genes that tell them to produce these proteins, Dr. Colasurdo explains. He and his team had been researching surfactant proteins and felt they might help Marissa’s lungs repair themselves.
“It’s an expanding area of investigation but an unexplored territory in clinical practice,” Dr. Colasurdo admitted.
The doctors mixed up a cocktail containing surfactant proteins in an attempt to reopen the lungs and boost the immune system against the virus. Using a flexible bronchoscope and syringe, they injected the proteins into the child’s lungs while she was on ECMO.
Marissa improved after the first two injections, but the effect faded. In a last-ditch attempt to save her, Dr. Colasurdo and the ECMO team tried one more pair of treatments. This time, the team saw lasting results.
Gradually, and with many stops, starts and setbacks, Marissa got better. All told, she spent 34 days on ECMO and about five months in the hospital. She has made several visits to the clinic since. Babies who get as sick as Marissa when they are so young develop problems with swallowing. As a result, a feeding tube was placed and a surgery to prevent reflux of milk into her lungs was performed as she relearns how to suck and swallow. These procedures are done to prevent further injury to her lungs and to promote Marissa’s development.
“We have our good days, and we have our bad days,” said Mrs. Cooper, who hasn’t been able to return to her job at a staffing agency since the twins were born.
On top of everything else, the Cooper’s new home in Vidor sustained heavy damage from Hurricane Rita. Their truck was destroyed, and Mrs. Cooper says they weren’t able to find the children’s bicycles. Without electricity, she spent weeks in Houston with the children before they could move back home.
“If someone sat back and looked at my life over the past year, they wouldn’t believe it,” she said.
Nurses help the Coopers care for Marissa at home. She will continue to need extra oxygen for a few months, until she grows and gains more healthy lung capacity. Dr. Colasurdo says she may not play competitive soccer, but she should be able to participate in physical education classes at school and play softball some day.
For now, Marissa can laugh, smile and interact with her older siblings. During a recent visit to Dr. Colasurdo’s office, she played with the plastic plunger from a large syringe.
“After everything she’s been through, she’s the happiest baby,” Mrs. Cooper said. “Dr. Colasurdo calls her our miracle baby, and we do too.”
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RSV
Respiratory syncytial virus (RSV) is by far the most prevalent respiratory pathogen affecting infants and young children. Each year about 125,000 children are hospitalized in the United States with RSV infections.
Practically all children contract RSV by age 3, but symptoms vary widely. Most experience the disease as a bad cold, but RSV can be deadly for premature babies or those with low birth weight, heart disease, lung disease or immunodeficiencies. Exposure to tobacco smoke or air pollutants and a family history of asthma also can raise risk.
Until ten years ago, an estimated 5,000 American children died annually from RSV, but thanks to improved intensive care practices, that number has dropped to 500, said Dr. Giuseppe Colasurdo, physician-in-chief at Memorial Hermann Children’s Hospital and chairman of the pediatrics department at The University of Texas Medical School at Houston.
Awareness of RSV as a risk to the elderly is growing as well.
Like the common cold, RSV is most prevalent from fall through spring. It is also spread like a cold – through sneezes, coughs and runny noses. The germs can live for hours on shared toys or other surfaces. The home of Jaymie Cooper, mother of RSV patient Marissa Cooper (see main story), has hard-surface floors that can be easily disinfected. Cooper also limits Marissa’s exposure to her four siblings, especially if any of them are sniffling.
Hand washing remains the best way to prevent the spread of RSV, Dr. Colasurdo says.
Some high-risk children, especially premature infants, receive monthly injections of a synthetic antibody that can help reduce the severity of RSV infection. Dr. Colasurdo says it’s not a miracle drug because it does not prevent the infection, but it can be a useful tool when treating those susceptible to severe symptoms.
For more information, contact Media Relations.
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