Georgia doctors team up to save critically ill toddler

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Amir Fleming has spent most of his life in a hospital bed at Children's Healthcare of Atlanta.

Still, with everything this 8-month old Athens, Georgia, boy has been through, his mom Linda Long says Amir is a joyful, easy child.

"Most babies when the wake up they are sad and crying, but he has a whole different personality," Long says.

Amir breathes with the help of a ventilator, after being diagnosed as a newborn with a life-threatening airway obstruction known as tracheo-bronchomalacia.

"It was a lethal diagnosis," Dr. Kevin Maher, Director of the Children's Healthcare of Atlanta's Cardiac Intensive Care Unit, says. "We did not expect him to survive."

The collapsed airway left Amir choking to breathe.

Even with the ventilator on the highest possible setting, Dr. Maher says, the Children's team had to perform CPR several times to bring him back. 

"It became very clear, very quickly, that something more dramatic was going to be needed," Maher says.

Saving Amir Fleming would take a team effort, bringing together specialists from Children's Healthcare of Atlanta, Emory Pediatrics and the Georgia Institute of Technology for a groundbreaking surgery to place custom-made 3-D tracheal splints around the toddler's breathing tubes.

Dr. Scott Hollister the Director of Georgia Tech's Center for Biomedical Engineering says the experimental treatment could be a lifeline for children whose airways are collapsing.

"Before, particularly with this particular condition, kids would have to be put on a ventilator for a year or year and a half," Dr. Hollister says. "Many kids suffered from pneumonia. Some kids die on ventilators."

With Amir gravely ill, Children's Healthcare of Atlanta sent CT scans of the toddler’s airways to Dr. Hollister's team at Tech.

They used the scans to program a laser centering system, printing about 40 3D tracheal splints, layer by layer, out of a powder that will be absorbed by Amir's body over time.

"So that's the beauty of this particular device," Dr. Hollister says.  "You don't have to do another surgery to take it back out. It will dissolve, and the body will basically excrete it."

Early on the morning of August 17, 2018, after getting emergency approval from the U.S. Food and Drug Administration to go ahead with the procedure, Amir was rolled into the OR at Children's Healthcare of Atlanta.

A team of surgeons selected 3 of the tiny splints, placing them around the outside of Amir's breathing tubes, to hold his airway open.

Once the splints were in place, Amir was placed on a heart-lung bypass machine while another team of surgeons repaired his congenital heart defect. 

"In all my years of medicine, this was one of the more dramatic things I've ever seen," Dr. Maher says.  "There was this child who was desperately ill going into the operating room."

Amir Fleming came of out surgery stable, needing a third of the ventilator pressure he had required before the operation.

"It was really a phenomenal success," Maher says.

Two months later, Amir Fleming is still on a ventilator, but he's smiling and interacting with his mother.

Linda Long has been told she may be able to bring her history-making son home by mid-October.

Amir Fleming is the first child in Georgia and the 15th child  in the U.S. to undergo the 3D tracheal splint placement procedure.

The Children's Healthcare of Atlanta and Georgia Tech teams say they hope this is the beginning of collaboration that will help critically ill children beat the odds.