3:18am

Mon March 17, 2014
Shots - Health News

Doctors Use 3-D Printing To Help A Baby Breathe

Originally published on Mon March 17, 2014 10:59 am

Ever since the day Garrett Peterson was born, his parents have had to watch him suddenly just stop breathing.

"He could go from being totally fine to turning blue sometimes — not even kidding — in 30 seconds," says Garrett's mother, Natalie Peterson, 25, of Layton, Utah. "It was so fast. It was really scary."

Garrett was born with a defective windpipe. His condition, known as tracheomalacia, left his trachea so weak the littlest thing makes it collapse, cutting off his ability to breathe.

"When he got upset, or even sometimes just with a diaper change, he would turn completely blue," his mother says, "and that was terrifying."

So the Petersons contacted Dr. Glenn Green at the University of Michigan, who specializes in conditions like Garrett's. He teamed up with Scott Hollister, a biomedical engineer who runs the university's 3-D Printing Lab, to create a remarkable solution to Garrett's problem — a device that will hold open Garrett's windpipe until it's strong enough to work on its own.

Instead of shooting ink onto a flat page to print words or pictures, 3-D printers use other material, such as plastic or metal, to create three-dimensional objects.

"You build up layers until you have the complete 3-D structure," Hollister says.

3-D printers have been used to build jewelry, art and even guns. But Hollister is using the technology to create medical devices. He uses a 3-D printer that melts particles of plastic dust with a laser. He has already built a jawbone for a patient in Italy and has helped another baby with a condition similar to Garrett's. But Garrett is a lot of sicker and his condition is a lot more complicated.

"It's just been issue after issue with breathing, and just trying to keep him breathing at all," Jake Peterson, Garrett's dad, says.

At 16 months old, Garrett had never been able to leave the hospital. Every time he stopped breathing, it was a mad rush to save him. And the doctors weren't sure how much longer they could keep him alive.

"In some sense we were thrown directly into the fire," Hollister says. "We characterized it as sort of a Hail Mary pass."

So they rushed Garrett from Salt Lake City to Ann Arbor on Jan. 18 and got to work.

First they took a CT scan of Garrett's windpipe so they could make a 3-D replica of it. Next they used the 3-D printer to design and build a "splint." It's a small, white flexible tube tailored to fit around the weakest parts of Garrett's windpipe.

"It's like a protective shell that goes on the outside of the windpipe and it allows the windpipe to be tacked to the inside of that shell to open it up directly," Green says.

But the device has not been approved by the Food and Drug Administration. So Green and Hollister had to convince the agency to give them an emergency waiver to try it. And they were running out of time.

"His condition was critical. It was urgent and things needed to be done quickly. It was highly questionable whether he would survive and how long he would survive," Green says.

Garrett's parents knew they were taking a leap of faith. But they felt like they had to try.

"We were just so excited for that glimmer of hope that this could be what would help Garrett get home," Jake Peterson says.

Hollister and Green got the FDA's approval and scheduled the surgery for Jan. 31.

As soon as the surgeon, Dr. Richard Ohye, opened up Garrett's chest, he and Green could see that Garrett's windpipe had collapsed. One of his lungs was completely white.

"The only time I'd seen a white lung was in somebody that had died," Green says.

They quickly got to work, gingerly placing the first of two splints on one side of Garrett's windpipe. It fit perfectly. So they got started on a second splint, which fit perfectly, too.

After more than eight hours, both splints were securely in place. Then came the most important moment: What would happen when they let air flow through Garrett's windpipe into his lungs?

This time, Garrett's windpipe stayed open, and his white lung turned pink.

"That was just amazing to me," Green says. "Here something that we'd worked on, that had been constructed just a week ago to match this defect. It had worked just the way we had hoped. I said, 'This is going to change this boy's life and his family's life forever.' "

Garrett is 18 months old now and is still in the hospital, but in the weeks since the surgery, he has gotten stronger and stronger and needs less help breathing. His parents are ecstatic.

"He has been doing so good. He's been smiling, and it's crazy to be able to see him get really upset and not change colors," Natalie Peterson says.

"He's being more interactive and more alert and reaching more for his toys. He's just starting to be more like a normal child," Jake Peterson adds.

Garrett's splint is designed to expand as he grows and eventually dissolve in his body as his own windpipe gets strong enough to work normally.

Green wants to save more babies this way, but it's expensive to transport these extremely sick children across country. It has also been hard to convince insurance companies to pay for the trip.

"It is one of the most frustrating things that I've been through, knowing that there's something that we have that can help and looking at all the roadblocks that are in place," Green says.

So he's hoping to launch a formal study, which may enable him to try more splints to save more babies.

Green says this is the most exciting thing he has seen since medical school. "We're talking about taking something like dust and converting it into body parts," he says. "And we're able to do things that were never possible before."

They've already started using 3-D printing to build more body parts, including ears and noses, by combining the plastic structure with human cells. Other scientists have gone even further, using 3-D printing to make blood vessels, skin and even primitive organs out of cells.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

DAVID GREENE, HOST:

This is MORNING EDITION from NPR News. Good morning, I'm David Greene.

RENEE MONTAGNE, HOST:

And I'm Renee Montagne.

Today in Your Health, a remarkable story about a 3D printer and a very sick baby. We've been hearing a lot lately about how people are using 3D printers to make all sorts of things: jewelry, clothing, even guns. Now doctors are starting to use this technology.

NPR's Rob Stein reports on doctors in Michigan who used 3D printing to save a boy who couldn't breath and this the first time they've talked about the case.

ROB STEIN, BYLINE: Ever since the day Garrett Peterson was born, his mom, Natalie, has had to watch him suddenly just stop breathing.

NATALIE PETERSON: He could go from being totally fine to turning blue sometimes, not even kidding, in like 30 seconds. It was so fast. It was really scary.

STEIN: It happened every day, over and over again. Jake Peterson is Garret's dad.

JAKE PETERSON: It's just really hard to watch your child suffocate basically multiple times a day.

STEIN: Garrett was born with a defective windpipe. The tiniest little thing makes it collapse.

PETERSON: When he got upset or even sometimes just with a diaper change, he would turn completely blue. And that was terrifying.

STEIN: It's so bad that after 16 months, Garrett's never been able to leave the hospital. Every time he stopped breathing, it's been a mad rush to save him. And the doctors weren't sure how much longer they could keep him alive.

PETERSON: It's just been issue after issue with breathing and just trying to keep him breathing at all.

STEIN: So the Petersons contacted a doctor in Michigan, an expert in problems like Garrett's. Dr. Glenn Green, at the University of Michigan, has watched babies like Garrett die year after year.

DR. GLENN GREEN: It's a horrible suffocation. And there would be nothing that we had that seemed to work for those children. It's frustrating to see something that had such an impact and not be able to do anything about it.

STEIN: One day Green was talking about his frustration with a colleague.

GREEN: And that person said: Hey, I know the perfect person for you to talk to.

SCOTT HOLLISTER: My name is Scott Hollister. I'm a professor of biomedical engineering at the University of Michigan.

STEIN: Hollister runs a lab down the road from Dr. Green's office, where scientists are experimenting with something new in medicine.

Hollister is standing in front of a huge white machine.

HOLLISTER: This is the machine we use. It's about twice the size of a typical refrigerator.

STEIN: It's a 3D printer. And it's printing something designed to save Garrett Peterson's life.

HOLLISTER: If you watch really closely, you might see these dark patches sort of appearing.

STEIN: Instead of shooting out ink onto a flat page to print words or pictures, 3D printers use other stuff - in this case tiny particles of plastic dust that are melted into place layer by layer by a laser.

HOLLISTER: They build what are often complicated three-dimensional structures on a layer-by-layer basis. You build up layers until you have the complete 3D structure.

STEIN: Hollister and Green thought they could use 3D printing to build something to help Garrett breathe. Hollister had already built part of a jawbone for a patient in Italy and it even helped another baby like Garrett. But Garrett was a lot of sicker and his condition a lot more complicated.

HOLLISTER: In some sense we were thrown directly into the fire. We characterized it as sort of Hail Mary pass.

STEIN: They rushed Garrett from Salt Lake City to Ann Arbor and got to work. First they took a CT scan of Garrett's windpipe so they could make a perfect 3D replica of it. Next they used the 3D printer to design and build something they thought would work. Back in Dr. Green's office, he shows us what they came up with.

GREEN: This was the backup one for Garrett in case the other one fell on the floor. So I'm opening it from the sterile pouch right now.

STEIN: Green and Hollister say it's like a splint. It's a small flexible tube tailored to fit perfectly around Garrett's windpipe.

GREEN: It's like a protective shell that goes on the outside of the windpipe.

STEIN: A shell designed to be sewn onto Garrett's windpipe to hold it open.

HOLLISTER: Like putting up a tent - if you think about a collapsed tent as the trachea, the polls as the splint - so essentially you are running the suture through the outer wall of the collapsed airway and pulling it through the holes in the splint and pulling the trachea open

STEIN: But the device hadn't been approved by the Food and Drug Administration. So they had to convince the FDA to let them try it. And they were running out of time.

GREEN: It was urgent and things needed to be done quickly. It was highly questionable, whether or not he would survive and how long he would survive.

STEIN: Garrett's parents knew they were taking a leap of faith. But they felt like they had to try.

PETERSON: Scared us half to death.

PETERSON: Oh yes, scared us half to death.

PETERSON: But we were just so excited for, you know, that glimmer of hope that this could be what would help Garrett get home.

DR. RICHARD OHYE: Alright, here we go - forceps, please.

STEIN: The hospital recorded the day-long procedure.

OHYE: Alright, I'll take towel clip, please.

STEIN: As soon as the surgeon, Dr. Richard Ohye, opened up Garrett's chest...

OHYE: OK...

STEIN: ...he and Dr. Green could see how bad-off the little boy really was.

OHYE: Oh yeah, I can see where it's really soft right here on the left. I don't know if you can see that, Glenn, it's really collapsed right here.

GREEN: Yeah.

OHYE: It's totally pancaked.

ROBERT STEIN, BYLINE: And one of his lungs was completely white.

GREEN: The only time I've seen a white lung has been in somebody that had died.

Nurse.

STEIN: They quickly got to work...

GREEN: Forceps.

STEIN: ...gingerly placing the first of two splints onto Garrett's windpipe.

GREEN: So this is that right side of the splint.

STEIN: It fit perfectly.

GREEN: Good.

STEIN: So they got started on the second splint.

GREEN: So that will fit like that. That's perfect too - perfect length.

OHYE: That's exactly how that goes on. That is awesome.

STEIN: After more than eight hours, they were done.

GREEN: There's the distal trachea there. There's the left splint in place and the right splint in place.

STEIN: Then came the most important moment. What would happen when they let air flow through Garrett's windpipe into his lungs?

GREEN: Yeah, that's nice. Look at that. That's beautiful. There he goes. Life just got a lot better for Garrett.

OHYE: Nice. There it goes.

GREEN: There we go. There we go. Up and down. Both sides moving nicely.

OHYE: OK. Great. That's it.

STEIN: The surgeons closed Garrett up and brought him back to his room to recover.

GREEN: That was, that was just amazing to me. Here's something that we'd worked on, that had been constructed just a week ago to match this defect. It had, it had worked just the way we had hoped. I said, this was going to just change this boy's life and his family's life forever.

PETERSON: Do you want your toy?

(SOUNDBITE OF RATTLE)

PETERSON: Good job.

STEIN: In the weeks since the surgery, Garrett's gotten stronger and stronger and needed less and less help breathing.

PETERSON: Where's your smile? Where are they hiding? Where - are you talking?

STEIN: His parents are ecstatic.

PETERSON: He has been doing so good. He's been smiling, and it's crazy to be able to see him get really upset and not change colors.

PETERSON: You know, he's is being more interactive and more alert and reaching more for his toys. And so he's just, you know, starting to be more like a normal child. He just wants to be held for a few minutes or do normal baby things.

PETERSON: Yeah. Yeah. Exactly.

STEIN: The splints are designed to expand as Garrett grows, and eventually dissolve in his body as hopefully, his own windpipe gets strong enough to work normally.

GREEN: His changes are excellent. Right now, I expect him to have a normal life from a windpipe standpoint and hopefully, he can get off the ventilator and be breathing on his own in the near future.

STEIN: Green wants to save more babies this way. But it's expensive to transport these extremely sick children across country. And it's been hard to convince their insurance companies to pay for the trip.

GREEN: It is one of the most frustrating things that, that I've been through is - knowing that there's something that, that we have that can help and, and looking at all the roadblocks that are in place to trying to make it happen.

STEIN: So he's hoping to launch a formal study, which would let him to try more splints to save more babies. And Green sees this as just the beginning.

GREEN: This is the most exciting thing since - that I've seen since medical school. We're talking about taking something like dust and converting it into body parts. And we're able to do things that were never possible before.

STEIN: Hollister and Green have already started using 3-D printing to build more body parts, combining plastic with human cells to make ears and noses. Other scientists have gone even further, using 3-D printing to make blood vessels, skin and even primitive organs out of human cells.

Rob Stein, NPR News.

MONTAGNE: You can see photos of Garrett Peterson and his parents, and a video of his surgery, at npr.org. Transcript provided by NPR, Copyright NPR.