In a medical first, doctors used plastic particles and a 3-D laser printer to create an airway splint to save the life of a baby who used to stop breathing nearly every day.
It’s the latest advance from the booming field of regenerative medicine, making body parts in the lab.
In the case of Kaiba Gionfriddo, doctors didn’t have a moment to spare. Because of a birth defect, the Ohio boy’s airway kept collapsing, causing his breathing to stop and often his heart. Doctors in Michigan had been researching artificial-airway splints but had not implanted one in a patient yet.
In one day, they “printed out” 100 tiny tubes, using computer-guided lasers to stack and fuse thin layers of plastic, instead of paper and ink, to form various shapes and sizes. The next day, with special permission from the Food and Drug Administration (FDA), the doctors implanted one of the tubes in Kaiba, the first time it has been done.
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Suddenly, a baby who doctors had said would probably not leave the hospital alive could breathe normally for the first time. He was 3 months old when the operation was done last year and is nearly 19 months old now. He is about to have his tracheotomy tube removed; it was placed when he was a couple months old and needed a breathing machine. He has not had a breathing crisis since coming home with the airway splint a year ago.
“He’s a pretty healthy kid right now,” said Dr. Glenn Green, a pediatric ear, nose and throat specialist at C.S. Mott Children’s Hospital of the University of Michigan in Ann Arbor, where the operation was done. It’s described in Thursday’s New England Journal of Medicine.
Independent experts praised the work and the potential for 3-D printing to create more body parts to solve unmet medical needs. “It’s the wave of the future,” said Dr. Robert Weatherly, a pediatric specialist at the University of Missouri in Kansas City. “I’m impressed by what they were able to accomplish.”
Kaiba had an incompletely formed bronchus, one of the two airways that branch off the windpipe like pant legs to the lungs. About 2,000 babies are born with such defects each year in the United States and most outgrow them by age 2 or 3.
In severe cases, parents learn of the defect when the child suddenly stops breathing and dies. When Kaiba was 6 weeks old and at a restaurant with his parents, April and Bryan Gionfriddo, he stopped breathing. “He turned blue,” and his father did CPR to revive him, April Gionfriddo said.
More episodes followed, and Kaiba went on a breathing machine when he was 2 months old. Doctors told the couple, of Youngstown, in northeast Ohio, his condition was grave. “Quite a few of them said he had a good chance of not leaving the hospital alive. It was pretty scary,” his mother said.
A doctor at Akron Children’s Hospital, Marc Nelson, suggested the experimental work in Michigan. Researchers there were testing airway splints made from biodegradable polyester.
Kaiba had the operation on Feb. 9, 2012. The splint was placed around his defective bronchus, which was stitched to the splint to keep it from collapsing. The splint has a slit along its length so it can expand and grow as the child does, something a permanent, artificial implant could not do.
The plastic is designed to degrade and gradually be absorbed by the body over three years, as healthy tissue forms to replace it, said the biomedical engineer who led the work, Scott Hollister.
Green and Scott Hollister have a patent pending on the device and Hollister has a financial interest in a company that makes scaffolds for implants.
Dr. John Bent, a pediatric specialist at New York’s Albert Einstein College of Medicine, praised the researchers. “I can think of a handful of children I have seen in the last two decades who suffered greatly … that likely would have benefited from this technology,” Bent said.