Amazing stories: Nathan
Eight-month-old Nathan was at daycare when he first showed signs that he was sick.
“The daycare workers recommended we take Nathan to the doctor, which we did. The doctor diagnosed bronchiolitis. She told us if he had any signs of breathing problems, go to urgent care,” Nathan’s mother, Joanne, says.
Bronchiolitis, a common lung infection found in infants and young children, occurs most often during the winter, which is when Nathan started to get sick. Two days after seeing the pediatrician, Nathan was having difficulty breathing during bath time. His parents bundled up their son and took him to the local urgent care.
The doctors at the urgent care facility thought Nathan might have pneumonia but the Windsor Terrace family would need to go to the emergency department at NewYork-Presbyterian Brooklyn Methodist Hospital to confirm the diagnosis.
Nathan was seen in NewYork-Presbyterian Brooklyn Methodist Hospital’s pediatric emergency room — a self-contained area staffed by physicians certified in both pediatrics and emergency medicine and registered nurses with specialized training. Doctors performed a chest X-ray on Nathan to determine if he had pneumonia. What they found was potentially much worse.
“The doctor said, ‘Yes, it appears to be pneumonia, but we also see an unusual mass in his lung,’” Joanne, who is also an occupational therapist at a school for special needs children, recalls. Nathan was admitted to the hospital to treat the pneumonia and for additional testing.
Over the next few days, Nathan’s parents met with the team of pediatric specialists working to figure out what could be causing the mass. Because of Nathan’s age and the potential for radiation exposure, it was not recommended he undergo the standard diagnostic test — a computerized tomography (CT) scan. Dr. Pramod Narula, a pediatric pulmonologist, who is also the chair of the hospital’s Department of Pediatrics, told the parents to take Nathan home to recover from the pneumonia.
Once the infection was gone, Dr. Narula and his team jumped into action. Nathan was given an ultrasound and magnetic resonance imaging (MRI) test. Dr. Narula’s team determined Nathan had a diaphragmatic hernia — a congenital condition in which the diaphragm did not completely form, causing a hole. The diaphragm is the muscle between the chest and the abdomen that helps with breathing. With diaphragmatic hernia, some of Nathan’s abdominal organs moved into his chest, occupying the space where the lungs should be. A very rare disorder, diaphragmatic hernia can cause feeding problems, respiratory infections, scoliosis, and a host of other conditions.
Nathan would need surgery to fix it. Dr. Narula brought in Dr. Demetri J. Merianos, a pediatric surgeon, to use a minimally invasive technique for the surgery. Minimally invasive surgery is associated with smaller incisions, less pain, and a shorter recovery time than traditional open surgery. Dr. Merianos performed a laparoscopic hiatal hernia repair, returning Nathan’s stomach and intestines back to their original location in his abdomen, and closing the hole in his diaphragm through four 5-milimeter incisions.
“Nathan recovered so smoothly,” Joanne says. “He was immediately back to being himself. We think his feeding improved after the surgery, and he grew a lot.” Less than a week after the surgery, Nathan was back in daycare.
“We were really lucky. Having worked in medical settings, I’m really picky. I know what I’m looking for,” she says. “To have NewYork-Presbyterian Brooklyn Methodist Hospital be walking distance from our house was great. It was so nice to have a local hospital that can provide such high level care.”
To find a pediatric specialist at NewYork-Presbyterian Brooklyn Methodist Hospital, visit brooklyndoctors.nyp.org or call 718-499-2273.