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Dozens Collaborate to Save Baby from CHAOS

The Olivares family thanked dozens of clinicians who assisted in Justin’s lifesaving care. A Long Island boy born with a totally blocked airway — one of only 50 reported cases in the past 20 years — recently went home after four months in the Steven and Alexandra Cohen Children’s Medical Center of New York’s (CCMC) Neonatal Intensive Care Unit.

Justin Olivares recently greeted the world at a news conference accompanied by his parents, Derly and Julian. The family thanked dozens of physicians and nurses who assisted in his dramatic delivery at Long Island Jewish (LIJ) Medical Center.

While he was still in his mother’s womb, clinicians detected Justin’s condition — known as congenital high airway obstruction syndrome (CHAOS) — during a prenatal exam at LIJ. Somewhere between six and eight weeks of gestation, Justin’s airway failed to develop. Without surgical intervention, he wouldn’t be able to breathe once he was born. Besides cutting off oxygen, CHAOS causes fluid produced in the lungs to accumulate, dangerously enlarging the lungs. This leads to abnormal development and function of the lungs and diaphragm.

“The extreme challenge of CHAOS called for the close coordination of teams of physicians and nurses from numerous pediatric subspecialties at CCMC with maternal/fetal medicine specialists from LIJ and North Shore University Hospital,” said Dennis Davidson, MD, chief of neonatology at CCMC. During Justin’s delivery, the clinical team established an airway while he was still supported by the placenta. This ensured that the baby received enough oxygen during the procedure so that he would not suffer severe brain damage — or death.

The procedure was Justin’s only option and was a major risk to his mother. The clinical team decided to deliver the baby at 36 weeks, before Ms. Olivares went into labor, so physicians could control the complicated process of performing a tracheostomy (insertion of a breathing tube) while the baby was still attached to the placenta. In Justin’s case, the obstruction was surgically bypassed while he and his mother were still attached by the placenta. When Justin was delivered, he received oxygen through mechanical ventilation.

In addition to the blocked airway, it was discovered in utero that Justin would be born with ventricular septal defect — a hole in the wall between his heart’s two major pumping chambers. Fortunately, doctors report that the hole is beginning to close on its own, so cardiac surgery may prove unnecessary.

After treatment in the Neonatal Intensive Care Unit, Justin is breathing on his own, has developed normally, and is ready to live at home with his parents and 8-year-old brother, Jason, who is very happy to be a big brother to this miracle baby.

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