Whether she’s in her hospital crib grabbing her toes, or at home sitting on a blanket, it seems that Annabel Mendoza is usually smiling.
She has her moments, as most nearly 1-year-olds do, but that’s usually when she’s tired or sprouting a tooth.
But being fed through a feeding tube every day doesn’t bother her – it’s all she has known since she was born with esophageal atresia, a condition in which her esophagus formed with two distinct ends that did not meet in the middle.
Annabel, who is scooting and standing, is the third child in the country to undergo a novel treatment where magnets are used to lengthen and connect the missing portion of the esophagus.
She was born seven weeks early, on May 18 at Women & Children’s Hospital of Buffalo, and weighed just under 3 pounds.
Her condition had been flagged through an ultrasound before she was born.
“I kind of freaked out for a while,” said her mother, Courtney Depoty.
It was confirmed after she was born, and Dr. Kathryn D. Bass, pediatric surgeon and medical director of trauma at Women & Children’s, performed emergency surgery to place a feeding tube in her stomach. Without that, Annabel would not have been able to get the nutrition she needed.
Annabel had an associated problem: a tiny stomach. Doctors waited three months for the little girl, and her stomach, to grow. When she was 4 months old, the gap between the upper portion of her esophagus and the lower section was 7 centimeters, Bass said.
“That’s nearly the entire thorax of the chest in a baby her size,” Bass said.
Annabel underwent surgery that left an open incision where Bass used a telescope to go in and pull on the esophagus multiple times to lengthen it. The gap closed by a couple of centimeters with the first surgery, and the second operation added another couple of centimeters, Bass said.
At that point, she had two choices: open little Annabel’s chest again, or find another way to close the gap.
“You can imagine,” Bass said, “the chest is one of the most painful areas for surgery.”
Bass researched treatments, and found a novel one: placing small magnets in the two ends of the esophagus. Both ends were closed at that point, and they were about 2.5 centimeters apart.
She collaborated with the surgeon who designed the procedure, the medical device company and the Food and Drug Administration to get the device approved. The procedure also was vetted by several in-house committees at Children’s, and the surgeon who pioneered the procedure was flown in from Chicago.
The magnets were inserted, one going through the mouth, and the other going through the opening in the stomach from the feeding tube.
“After about a week’s time, the two magnets slowly worked their way together,” Bass said.
And over four to five days, the tissue on the end of the segments broke down and eroded, while the side walls of the esophagus healed together.
“This was a major advance,” Bass said.
Annabel spent nine months in the hospital, her mother said, including a month in the Neonatal Intensive Care Unit.
“They’re amazing,” Depoty said of the hospital’s staff. “They treated us like family. I don’t think I’ve ever had a mean nurse up there, ever.”
Annabel’s parents, Depoty and Joel Mendoza, were excited but nervous to take her home last month.
“At first it was kind of scary, because we weren’t used to having her here by ourselves,” Depoty said.
Annabel still goes in for treatments to dilate her esophagus.
Her parents are teaching Annabel how to swallow, and she has swallowed some formula, Depoty said. She has learned how to say “papa,” and sometimes wakes up in the middle of the night talking happily.
“It’s like she never was in the hospital,” Depoty said.