On March 26th, 2011, Sam Kelly was born at Jordan Hospital in Plymouth, Massachusetts, just minutes after his twin sister. An ultrasound had found that there might be a large weight discrepancy between the twins, so doctors recommended that their mom, Sherry, be induced 2 weeks early.
Soon after Sam was born, the community hospital doctors noticed that he was having a hard time breathing, so they sent him to the Neonatal Intensive Care Unit at Tufts Children's Hospital in Boston, MA. As a Level III NICU, Tufts Children's Hospital is able to provide more complex, advanced care than what can be provided in the community. As a routine treatment for premature lung disease, Sam had a breathing tube placed for a few hours for the delivery of a medication into the lungs called surfactant.
A scary phone call and life-saving surgery
A day or so after this seemingly routine and uneventful treatment, Tufts Children's Hospital neonatal specialists noticed that Sam was having trouble with his breathing, so they called Pediatric Otolaryngologist Andrew Scott, MD who performed a bedside exam of the voicebox and windpipe and then recommended a procedure for the next day to get a better look at Sam’s airways.
After Sam was taken back to the operating room that following day, Rich Kelly, Sam’s dad, headed home to get some sleep and work on the family’s natural skin care and cosmetics line, Soy of Life. On his way, he got a call from Dr. Scott telling him that Sam had developed a blockage of early scar tissue within the airway. This narrowing was so severe that Sam wasn’t breathing adequately and that they needed to do an emergency tracheotomy in order to keep him safe.
“That was the scariest call I’ve ever received,” Rich said. “Some time later, Dr. Scott told me Sam only had about 20 minutes to live if they hadn’t done the emergency procedure.”
A tracheotomy is a surgically created hole through the front of the neck, designed to access the windpipe. It creates an air passage to help patients breathe when the trachea is obstructed, impaired or in Sam’s case, narrowed.
A unique and successful approach to treatment
After the successful procedure, Dr. Scott recommended that the care team monitor Sam for the next 9 months and then perform an airway reconstruction to help Sam breathe normally. At the request of Dr. Scott, the Kelly’s got a second opinion at a large Boston pediatric hospital, which told them that their team could perform the same operation but not before age 2. The Kelly’s worried about any negative effects that waiting this long could have on Sam’s speech and recovery.
“We put our faith in Dr. Scott and went with his plan,” said Rich.
After closely monitoring Sam for 9 months and making sure his airway remained open, Dr. Scott performed the airway reconstruction procedure, called a laryngotracheoplasty. During this surgery, Dr. Scott used cartilage from one of Sam’s rib to enlarge his narrowed airway, allowing for the removal of the tracheotomy. This technique allows the reconstructed voice box and windpipe to grow with the patient and reduces the need for any follow-up surgeries later on in life.
At Tufts Children's Hospital, fellowship-trained pediatric otolaryngologists Andrew Scott and Mark Vecchiotti have taken the unusual step of insisting that they perform all airway reconstruction surgeries together. This allows for their respective patients to receive the expertise of two surgeons at the time of reconstruction. The results have been extraordinary. Their success rates are among the highest that have been published in the medical literature, and their complication rates and length of hospital stay are among the lowest ever reported.
“At most institutions, these surgeries are performed by a fellow in training with the supervision of a single attending,” says Dr. Scott. “Here at the Tufts Children's, with a two surgeon approach, children have the benefit of our combined experience as attending surgeons. Dr. Vecchiotti and I are perfectionists, and we keep each other on our toes. His eyes will pick up on something that I might miss, and vice versa; you don’t get that kind of meticulous assistance from a trainee.”
Sam’s operation went without a hitch. As part of the surgery, the tracheotomy tube was removed and the hole in the windpipe closed, and after spending 9 days in the hospital, Sam was able to go home eating normally and breathing comfortably. “Dr. Scott did such a great job. You can barely see the scars and as Sam grows, they’re even less and less visible,” said Rich.
Today, Sam is a happy and healthy 4-year-old who loves playing with his sister. The Kelly’s had their last follow-up visit with Dr. Scott 2 years ago and Sam no longer needs to see a specialist. “Going from being afraid that your son might die to seeing him play as a completely normal 4-year-old is an amazing thing,” Rich said.
He continued, “We can’t say enough about Dr. Scott and the entire Tufts Children's Hospital team. They took a devastating experience and somehow made it positive and exciting. I would recommend Tufts Children's Hospital to any family without a doubt. The nurses in the NICU were incredible. Dr. Scott and the specialists we worked with were wonderful. Every person we interacted with was not only smart and professional, but also nice and approachable.”