Andrei Fagurel - English

Andrei is dressed up in baby clothes for the first time. They stopped the crib heater and they covered him with the baby blanket. He is very scared of this fluffy and heavy animal lying on him.

Andrei is released today from all the devices and tubes. Instead of the tube going through his trachea, he has one little one around his little nose now, which supplies him with oxygen in variable amount. The goal is to decrease slowly the oxygen concentration.

ittle Andrei was checked again. Luckily they have not found another fistula in the trachea. He has no problems with the heart and the infection from his lungs is gone. The right vague and frenicus nerves are affected and also the diaphragm on the right side is not functioning and elevated which makes the lungs not able to function at 100%. The German medical staff decided to let him go with it for the moment and to interfere only in case he could not cope with it. We are proposed an intervention consisting in an elongation of the esophagus in order to repair it. The specialist in this procedure and also the inventor of it, is professor Dr. Foker from the University of Minnesota. In USA the operation costs 200.000 EURO( approx $255.000). Dr Gitter invites Dr. Foker in Germany to operate Andrei in a videoconference set up to lower the costs of the procedure.

Andrei, together with his mother, Doina left Bucharest by a plane operated by DRF - German Air Rescue to Bremen, since Klinikum Bremen Mitte agreed to bring Andrei in. The trip has been good with no major events. In Bremen all the medical staff were waiting for them (surgeon, pediatrician, specialist in ventilation). Andrei was set up in a little crib with toys around and a little colorful pillow that keeps his legs and arms, and Doina got a room inside the hospital.

Andrei was born on March 2^nd 2006 in Bucharest, Romania with a congenital malformation: esophageal atresia with tracheo esophageal fistula (lack of approx. 3 cm of the esophagus and a little hole by which the trachea is linked to the esophagus). He could not eat and gastric secretions were flooding his lungs.

He was immediately admitted into the Pediatric NICU of the Grigore Alexandrescu hospital for children in Bucharest, Romania, where they tried to operate and treat him. He was operated on 4 times, 3 times to perform an anastomosis(i.e. put together the esophagus pouches)- unfortunately all 3 surgeries were failures. The 4^th time, doctors tried to perform an esophagogastrostomy (the upper pouch of the esophagus was taken out to the skin at the neck and so he has a little hole which helps him eliminate secretions; a small feeding tube was inserted in his stomach). After each anastomosis, Andrei had complications pneumothorax (collections of liquid acummulated in his chest and compressed his lungs, followed by mediastinitis (an infection of the mediastinum, the membrane that separates the lungs from the other organs in the thoracic cavity: the heart, the trachea, the esophagus etc). He also developed severe bronchopneumonia. Despite the whole support of the medical staff at the Grigore Alexandrescu Hospital, the baby?s health could not be restored If everything had gone fine, the baby should have started to recover after the last operation that was performed on March 11^th 2006. Yet, he was still mechanically ventilated and didn?t react to the treatment for pneumonia. As a consequence the baby had episodes of desaturation (lack of oxygen) and of brachycardia (the pulse was going low). During the last month spent in this hospital, he suffered at least 5 cardiac arrests because of these reasons. It was very likely that the baby had also developed a heart condition, but this could not be clearly diagnosed in this hospital (even though this might sound like a bad joke, it?s not the NICU unit lacked the necessary equipment and the doctors would not risk transporting the baby to the adjoining building where the equipment was).

There was also a risk that the baby had sustained brain damage, but that could not be diagnosed either under the circumstances, because of the lack of technical equipment. So far we had been waiting for him to recover in that hospital. Unfortunately, it seemed like this wouldn?t happen or at least not there. His overall condition got worse and worse.Because we were afraid the baby would not resist much longer, we contacted the Klinikum Bremen Mitte hospital from Germany, which has more experience in treating this type of cases. The doctors we had been in contact with told us there was a great chance that the baby had not been diagnosed correctly (the baby could have had a little fistula in his trachea that had not been identified or an infection of the mediastinum and, because the cause of the pneumonia might not be properly addressed, they can?t take him off ventilation and we risk losing him. At the time this story was written, we were expecting the official acceptance from the Klinikum Institute from Bremen, Germany. They had suggested some investigations that should have been performed in the hospital here in Romania, but the investigations could not be carried out, either due to the lack of medical equipment or because there was no experienced medical personnel to deal with these types of problems in neonates. Besides that, the Romanian doctors excluded any other cause for the pneumonia except the hardships the baby had been already through. So it was clear no further investigations would be performed.

Therefore, despite all the big risks involved for a baby in such a severe condition, we decided to move him to Germany. There, at least he had the chance to undergo all the necessary investigations and we would have the certainty that he would be correctly diagnosed. Maybe they could do more over there either, but at least we wanted to try to help him, give him a chance and not let him fight in vain by himself. After all, how long can a baby with no immunity, weighing a little over 5 lbs (2kg 500 gr) hang on by himself…