Collaborative Efforts between Holtz Children’s and Bahamian Care Team Save Critically Ill Child

By: Miranda Torres

Bahamas native Robyn Phipps was 38 weeks pregnant when she attended a routine prenatal visit with her OB-GYN. During the visit, her care team was unable to get a read on her baby’s heartbeat, which led to an emergency C-section to save her child’s life. On August 3, 2021, Joshua Phipps entered the world pale, blue, and unable to breathe. It quickly became apparent to everyone in the delivery room that he would be facing a complicated medical journey.

An echocardiogram scan of his heart and brain revealed he had tetralogy of fallot with pulmonary atresia, a birth defect that affects normal blood flow through the heart. The scan also found patent ductus arteriosus and, double aortic arch, a congenital anomaly that compresses his airway and leads to respiratory distress. The condition could be fatal if left untreated. The next day, Joshua was admitted to a neonatal intensive care unit at a different hospital in Nassau.

His medical team decided that Joshua’s best chance at survival would include a transfer to Holtz Children’s Hospital at University of Miami/Jackson Memorial Medical Center. Since Phipps was recovering from her C-section, Joshua was left in the hands of his medical team and grandparents.

“You expect to go home with your baby. Then you don’t, and they tell you he was going to die. I couldn’t do anything at that point but cry. I felt all hope was lost,” Phipps said.

Joshua was admitted to Holtz Children’s cardiac intensive care unit under the care of Leonardo Mulinari, MD, the hospital’s chief of pediatric and congenital heart surgery. He underwent a central shunt procedure and double artic arch repair, as well as a patent ductus arteriosus ligation, a corrective surgical procedure for children whose ductus arteriosus does not close after birth.

Joshua’s team tried multiple interventions to keep his airway open, such as a tracheotomy performed by Leonardo Torres, MD, an ear, nose, and throat specialist at Holtz Children’s. Since Joshua suffered from severe tracheomalaci, he required a tracheostomy tube in his neck to be able to breath on his own. Dr. Mulinari performed an aortopexy, which allowed Joshua to have the tracheostomy tube removed. After three months in the hospital, Joshua was able to return to the Bahamas. He remained at home until May 2022 when he underwent a successful complete repair of the tetralogy of fallot, under the guidance of Dr. Mulinari.

Joshua had extensive follow-up in the Bahamas with a pediatric cardiologist. He remained in good health until May 2023 when he suffered severe respiratory distress, requiring him to be placed back on a ventilator. Desiree Machado, MD, a pediatric cardiac intensivist, and director of Holtz Children’s extracorporeal membrane oxygenation (ECMO) program, immediately accepted the request for Joshua to be transferred, but due to insurance, they had to wait 24 hours before he could be airlifted. During this time, Joshua’s carbon dioxide and oxygen levels were so low the medical team was certain he would not survive long enough to be transferred. In order to give him a fighting chance, Dr. Machado suggested putting him on ECMO in the Bahamas, which had never been done on a pediatric patient in the country.

Joshua’s Bahamian care team had to use adult bypass cannulas, which ultimately saved his life. Sandeep Sainathan, MD, a UHealth Jackson Children’s Care pediatric cardiothoracic and congenital cardiac surgeon at Holtz Children’s, together with Dr. Mulinari, virtually guided Joshua’s Bahamian care team to perform the ECMO cannulation.

Dr. Machado stayed in constant communication with the team in the Bahamas while transportation logistics were arranged from virtual procedure performance, stabilization, complex transportation, navigation through complex health systems, “it shows how a team can effectively work to deliver care without borders, and this case took more than a village, it took two countries”, Dr. Machado said.

The fastest and safest way to transfer Joshua was for his Bahamian care team to travel with him, so they applied for emergency visas. Upon arrival, Dr. Torres discovered and corrected Joshua’s tracheal narrowing, and he returned home without further complications after 22 days.

“I am very humble in saying that if it wasn’t for a multidisciplinary team approach, we would not have been able to save his life,” Dr. Torres said.

Looking ahead, Joshua’s follow-up poses challenges due to his residence outside the U.S., requiring careful monitoring and potential airlifts for emergencies. The multidisciplinary teams involved will closely follow his progress, ensuring his ongoing well-being for the next two years. Joshua’s journey exemplifies the potential for collaborative, cross-border medical care to enhance survival rates for patients facing reversible conditions.

“I can’t thank Jackson Health System and the team of doctors in the Bahamas enough for saving Joshua’s life,” said Phipps. “He is alive thanks to their incredible teamwork.”