Healthy Kids - Spring 2021

“Airway problems are very common in children with major diseases,” explains Dr. Brigger. “We often see them in babies who are born premature and have to be intubated early on. Breathing tubes save lives, but they also generate problems.” Children with congenital heart defects, like Jacob, also frequently experience airway issues due to breathing tubes or congenital airway problems. The multidisciplinary Aerodigestive Program at Rady Children’s is perfectly poised to treat these problems. Bringing together specialists from otolaryngology; pulmonary/respiratory medicine; gastroenterology, hepatology and nutrition; and speech-language pathology and occupational therapy, the team provides diagnosis and management of complex disorders involving the respiratory and digestive systems. “This multidisciplinary team is essential,” Dr. Brigger says. “It ’s not just the airway that ’s affected. We’re looking at how they ’re expecting to grow over time. It ’s a culmination of all these things—breathing, swallowing and feeding—coming together.” It ’s complex cases like Jacob’s that drive Dr. Brigger to continue his work in innovating advancements for airway issues. “I ’ve known I was going to be an airway surgeon for years,” he says. “As part of my practice, we take the most complex kids, synthesize their problems and, in many cases, make advances that weren’t possible before. We can restore voice and swallowing in a variety of ways. We are lucky to have the resources of the Rady Children’s institution, the expertise of a very tight team and the ability to make a huge difference in these kids’ lives.” A LOOK AT PEDIATRIC AIRWAY ISSUES OPEN AIR

tired a lot, so we made the appointment for his surgery. We were so excited to finally get a second opinion that we trusted, we didn’t mind at all having to travel to San Diego for it.” In November 2019, the Griffiths went to Rady Children’s for yet another heart surgery. “It was the shortest hospital stay we ever had,” Katie says. “It was amazing to see Jacob have normal vital signs after that.” That’s when the next step in Jacob’s journey could begin—the journey to help him breathe easily again. OPENING THE AI RWAY With no plans to return to their home hospital, the Griffiths put their faith in the Rady Children’s team to restore their son’s health. Dr. Nigro introduced them to Matthew Brigger, MD, MPH, chief of the Division of Otolaryngology at Rady Children’s and a professor of surgery at UC San Diego School of Medicine. It was February 2020, around Jacob’s first birthday. Dr. Brigger was confident he could perform surgery and improve Jacob’s condition. “The thing that makes Jacob’s situation unique is that he came to us from a different institution, having gone through a variety of surgeries with a combination of airway scarring and vocal cord paralysis in the setting of compromised cardiac function,” Dr. Brigger explains, adding that Katie thought her son would have a tracheostomy and a feeding tube his whole life. “The family came in without a lot of hope, and we basically started from scratch.” Using a multidisciplinary approach, Dr. Brigger and the specialists in the Aerodigestive Program at Rady Children’s—which is designed for children with complex breathing, swallowing and feeding issues— worked in tandem with Jacob’s other physicians on his case. “Together, our team devised a plan. We would address his heart first— since that was his limiting function— and then work on his airway,” Dr. Brigger says. “Once we had his heart in shape, we were able to work in an aggressive fashion to get him off a ventilator.” Dr. Brigger presented Jacob’s parents with two options: a wait-and-see approach or an aggressive surgery. The Griffiths opted for immediate action. “We went for the biggest bang we could get in the fastest time,” Dr. Brigger says. He removed a piece of Jacob’s rib through a small incision in his chest. He then placed the rib in

After a week, Jacob’s surgeon closed his chest, but revealed to his parents that, unfortunately, the baby’s laryngeal nerve, which wraps around the aorta and connects to the vocal cord muscles, was injured during the surgery. “The doctor said he wasn’t concerned—that Jacob would just have a raspy voice,” Katie says. Sadly, the news just went from bad to worse. During the first fewmonths of his life, Jacob was intubated and extubated several times. His vocal cords were paralyzed shut, and he had to undergo another procedure to split them in the hopes of making themwork again. His surgeon placed a tracheostomy tube to open his airway and allow him to breathe. His parents were told they’d knowwithin three or four months if his vocal cords were going to regain function. And then Jacob took a turn for the worse: He suffered a stroke due to a dislodged tracheostomy. Caregivers swiftly performed CPR and revived him. “Thankfully, his little brain reworked itself and he’s had no problems as a result of the stroke,” Katie says. Still, the family knew it was time to get a second opinion and transfer their son to another facility where he’d receive optimal care for his worsening condition. Jacob’s cardiologist referred them to John Nigro, MD, cardiothoracic and heart transplant surgeon, chief of cardiac surgery, director of cardiac



transplantation and the Mechanical Assist Program, and director of the Rady Children’s Heart Institute. The Griffith family was excited to meet him. “I hadn’t heard of Dr. Nigro before, but I was part of a moms group on Facebook and everyone had so many good things to say about him,” Katie says. “We met with him and he was confident he could repair Jacob’s AV canal defect. We knew Jacob was getting


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