Saving Samirah

Experts from CHKD, EVMS, and Sentara team up to provide lifesaving care before, during, and after birth through CHKD’s new Fetal Diagnostic and Treatment Center

Having a baby and creating a family meant everything to Jodi-Ann and Hassan Spivey. When the Portsmouth couple found out Jodi-Ann was pregnant, they couldn’t have been more thrilled.

Their excitement was soon overshadowed by fear, however. When Jodi-Ann was 22 weeks pregnant, an ultrasound at the Maternal Fetal Medicine (MFM) program at EVMS revealed three tumors in the sac around their baby’s tiny heart. The main tumor was centered on the baby’s aorta. Two more were compressing her lungs. Doctors told the Spiveys that their unborn daughter, already named Samirah, would need open heart surgery as soon as possible after birth.

Jodi-Ann remembers turning to her husband in the elevator as they left. “What if she doesn’t make it?” she asked.

Unbek nownst to the Spiveys, dozens of medical and surgical specialists would soon begin a coordinated collaboration to save their baby. The first member of this team was Dr. Elena Sinkovskaya, who diagnosed the tumors during an ultrasound at MFM. Dr. Sinkovskaya quickly alerted the Fetal Diagnostic and Treatment Center, a new CHKD program that works closely with other regional health systems and specialty practices to coordinate the complex care high-risk babies require before and after they’re born. The program’s clinical director, Dr. Philip Smith, is CHKD’s chief of cardiac surgery. He brought in Drs. Jonathan Fleenor and Robert Escalera from CHKD’s cardiology team; his new partner in cardiac surgery, Dr. Emily Downs; and others, to prepare for Samirah’s birth.

Samirah’s type of tumor – teratoma – is estimated to occur in about 1 in 40,000 births per year. Most of these tumors grow on the end of the tailbone or in a different location of the chest. Teratomas inside the pericardium, the space around the heart, are very rare.

Jodi-Ann and Hassan Spivey admire their beautiful daughter during a follow-up visit to her cardiologist at CHKD’s Heart Center.

The Spiveys searched online to find anything reassuring about their daughter’s condition, but found very little. Fearing the worst, they decided to put off painting the nursery. They also kept the diagnosis mostly to themselves. They knew everyone would have questions they couldn’t answer.

“I didn’t want to add to my stress,” Jodi-Ann said. “The doctors told me the longer my pregnancy lasted, the stronger Samirah would be for surgery, and I didn’t want to push myself into pre-term labor. Every week that went by made me feel better.”

The team from CHKD and EVMS closely monitored mother and baby. At one point, Samirah developed significant fluid around her heart. A collaborative decision was made to remove the fluid, and Dr. Alfred Abuhamad, longtime chair of obstetrics and gynecology at EVMS and now president, provost, and dean of the medical school, and his MFM colleague Dr. Camille Kanaan were able to drain the fluid, giving Samirah more time to grow and develop before her dramatic entry into the world.

The team at CHKD’s Fetal Diagnostic and Treatment Center, determined to be completely prepared for Samirah’s birth, held drills to simulate the process of transporting her safely from Sentara Norfolk General to the CHKD neonatal intensive care unit. They wheeled an empty incubator through a corridor that connects the two hospitals, measured how many people could fit in the elevator with the baby for the trip from the NICU to the operating room, and set up a special team-activation process so everyone involved in her care would know when she was arriving. Her care team included specialists from pediatric and cardiac anesthesia, radiology, neonatology, cardiology, otolaryngology, and cardiac surgery.

When Samirah was born on Dec. 22, 2022, at 35 weeks gestation, more than 25 people were in the delivery room at Sentara Norfolk General. They wore name tags on their surgical caps to identify themselves and their specialty. Each was prepared to step in and provide whatever Jodi-Ann or Samirah might need. “We had a plan for every contingency,” said Dr. Smith.

Samirah weighed 6 pounds, 12 ounces, and elated her parents by letting out a soft cry in the delivery room. “She came out ready for surgery,” Jodi-Ann said.

After safely ferrying their precious cargo to CHKD, Samirah’s team went to work. Their first order of business was to insert a breathing tube. With her heart and lungs compressed by the tumors, each of them now the size of a golf ball, Samirah needed help to breathe. “It was clear she was at risk for low blood pressure and lung problems without alleviating the pressure caused by the tumors,” explained Dr. Downs, who prepared to do the surgery immediately.

To remove the tumors, Dr. Downs made an incision through the breastbone. Once the pericardial space was opened, the tumor in the middle of Samirah’s chest popped up, relieving pressure on her aorta and allowing her blood pressure to rise toward a normal level. Next, Dr. Downs removed the tumors that were in the spaces around the lungs. This enabled the surgery team to see the blood vessels around the heart in case they needed to use the heart-lung bypass machine. Dr. Downs then delicately detached the tumor on the aorta. “Fortunately, we never needed the heart-lung bypass,” said Dr. Downs.

Samirah was in the operating room about four hours. “During surgery, they called every hour to give us an update,” said Jodi-Ann. Later that night, she and Hassan were able to see their newborn, but they couldn’t hold her yet. She was too fragile, surrounded by wires and tubes connected to machines that monitored her vital signs and delivered nutrition and medication. “I should have been scared by all those tubes, but I was just happy to see her and to know she made it through surgery,” said Hassan.

“She was just beautiful to us,” Jodi-Ann added.

Samirah spent four weeks in the NICU recovering from surgery. The Spiveys were able to be with their daughter, watching her daily progress and preparing to take her home. Samirah’s tumor has some risk of coming back, so she will see CHKD cardiologists and hematology/oncology specialists at regular intervals for the first year of her life. “If the tumor hasn’t come back by that point, the risk of it returning is very low,” Dr. Downs explained.

Today, Samirah has completely healed and continues to grow as she should. For now, she sleeps in a bassinet right next to her parents’ bed, but soon she’ll move into her nursery … which her parents recently painted pink and gray for their beautiful, healthy daughter.

Samirah’s arrival was carefully planned and practiced so everyone involved in her care was prepared for immediate action.

The Fetal Diagnostic and Treatment Center at CHKD

The Fetal Diagnostic and Treatment Center at CHKD works with other regional health systems and specialty practices to coordinate the complex medical needs of babies who have serious or life-threatening conditions diagnosed before birth.

Since opening in October, more than 75 patients have been referred to the center. Roughly 40% of them have congenital heart problems. Other CHKD specialties involved in the program include urology, neurosurgery, neurology, orthopedics, craniofacial, and hematology/oncology. The center’s advisory group includes representatives from CHKD, Sentara Norfolk General, and EVMS Maternal Fetal Medicine.

“Our mission is to build trust with our patients and address their fears,” said Dr. Philip Smith, CHKD’s chief of cardiac surgery and the center’s clinical director. “The best way we can do that is to amass an army of experienced medical and surgical specialists who can provide the care they need and make sure their experience – in an extremely challenging time – is as good as it possibly can be.”

Cardiac Collaborative Ranked No. 20 in the Nation

U.S. News & World Report has ranked the Virginia Congenital Cardiac Collaborative, CHKD’s partnership with University of Virginia Children’s Hospital, one of the best cardiology and heart surgery programs in the country. The publication’s 2022-23 “Best Children’s Hospitals” guide ranked the collaborative No. 20 among the top 50 pediatric cardiology and heart surgery programs in the country.