Newswise — LOS ANGELES (October 17, 2017) – Twin brothers Logan and Liam Chang were born on Dec. 29, 2016, seven weeks premature, at Providence Saint John’s Health Center in Santa Monica. Their mother had been admitted about a week earlier because of concerns about how the babies were developing, and though the doctor's decision to deliver had come unexpectedly that night, their births overall had gone smoothly.
"It was kind of a whirlwind," says the twins' father David Chang.
It wasn't until nine days later, on Jan. 6, 2017, that Logan started having issues.
When Logan suddenly stopped eating and his belly became bloated, Children's Hospital Los Angeles (CHLA) neonatologist Theodora Stavroudis, M.D., ordered X-rays and found something dire – necrotizing enterocolitis ("NEC"), a disease that kills intestinal tissue and can cause waste to enter the bloodstream, causing infection and sometimes death.
Dr. Stavroudis, who had recently started working at Saint John’s as part of CHLA’s new partnership to operate the hospital's Neonatal Intensive Care Unit, decided Logan needed to be rushed to CHLA's main campus for specialized treatment, and eventually, lifesaving surgery. Like anatomical detectives, doctors searched for a source to the disease, and they found the culprit in Logan’s heart.
The diagnosis – Logan had coarctation of the aorta, a congenital defect that narrows a major blood vessel and prevents the heart from pumping oxygen-rich blood to the child’s vital organs. In Logan’s case, poor blood flow from his heart to his bowels was causing his intestines to die. But this created another problem: In order to fix Logan's aorta, doctors needed to first remove and repair the necrotic portions of Logan's bowel that was making him so critically ill.
"It was kind of a balancing act," says David, "because they had to fix the NEC first before dealing with the heart."
Neonatologists started Logan on medication to help with blood flow, and then the CHLA Pediatric Surgery team went to work. Initially, pediatric surgeon Eugene S. Kim, M.D., and his surgery fellow, Shannon Castle, M.D., had hoped to manage the infant’s condition with antibiotics because the child’s life might be at risk in surgery due to his serious heart condition. But Logan’s condition continued to deteriorate and surgery became necessary to give him a chance at survival. Kim and Castle then went in and removed a large amount of the small intestine, which was necrotic and dead, but had to delay the ostomy procedure until Logan got stronger. A few days later, pediatric surgeon Cathy Shin, M.D., performed the ostomy, a surgical opening in the child’s abdomen so waste products could leave the body, enabling the child to eventually eat.
Once he was strong enough, Logan was ready for the critical repair of his coarctation, which was forcing his heart to pump twice as hard so oxygenized blood could reach distant organs. On Feb. 14, CHLA's Cardiothoracic Surgery team performed a life-saving two-hour procedure to reconstruct and widen the blood vessel.
“He was so sick, but now he is recovering and growing while he awaits being able to go home to his brother,” says CHLA Cardiothoracic Surgeon Cynthia Herrington, M.D.
Logan's brother Liam Chang weighed 4 lbs., 3 oz. at birth, and didn’t have the chronic health issues his twin brother faces, says his father. He was released from Providence Saint John's three weeks after birth, on Jan. 16, after he started eating orally. "Now he eats a lot," says dad. "He's a big boy now."
Logan, on the other hand, was born 2 lbs., 14 oz., about 30 percent smaller than Liam, one reason why doctors decided to deliver early. As of mid-March, doctors were still monitoring his post-surgery recovery. Logan was able to feed through the tube, his medication had been reduced and his father says Logan was "definitely more alert" than before.
David says it's tough seeing one son in the hospital while his other son is already home, and they are glad for help from family, including David's mother who flew in from Taiwan to help care for Liam. And they continue to stay positive.
"We’re doing OK with it, because we’re always seeing progress," says David. "We can be the type of people who just dwell on our mishaps and not move forward, but in all the different issues that Logan’s been dealing with, he’s able to tackle them and get better and move forward. So that’s really what we are focusing on."
"This case exemplifies our partnership in the community to better neonatal healthcare," says Philippe Friedlich, M.D., chief of the Division of Neonatology and director of the Fetal and Neonatal Institute at Children’s Hospital Los Angeles.
"Now that CHLA has Neonatologists on site at the Saint John’s NICU, we can offer the full spectrum of services and identify difficult cases on site and then utilize resources at CHLA if necessary. Saint John’s now can handle riskier pregnancies, and local obstetricians now have the confidence to refer riskier cases to the Saint John’s NICU. For example, if a mother has diabetes or another complicating condition that could affect the newborn, we can identify any medical issues on site," says Friedlich. "With Logan, after the neonatologists diagnosed the intestinal disease, we had Logan undergo surgery at CHLA to remove the intestine and to repair his heart."
As Logan recovered, the Changs split their time between their new home in the San Gabriel Valley and CHLA, looking forward to the day when the family could be together.
"Even if you are going through the hardest thing in life, there is hope," says David. "At a certain point in the beginning, it was very hard to deal with the info that we got, it was hard to see a future, but we just relied on the support and didn’t try to tackle everything ourselves. And day by day, things got better, became a new normal, and we saw a light at the end of the tunnel, and the chance to raise Logan back home side by side with his brother."
That special day came last May, when Logan was discharged and able to return home, reunited with his twin brother Liam.
About Children's Hospital Los Angeles
Children's Hospital Los Angeles has been ranked the top children’s hospital in California and sixth in the nation for clinical excellence with its selection to the prestigious U.S. News & World Report Honor Roll. CHLA is home to The Saban Research Institute, one of the largest and most productive pediatric research facilities in the United States. Children’s Hospital is also one of America's premier teaching hospitals through its affiliation with the Keck School of Medicine of the University of Southern California since 1932. For more information, visit CHLA.org. Follow us on Twitter, Facebook, YouTube, LinkedIn and Instagram, and visit our child health blog (CHLA.org/blog) and our research blog (ResearCHLABlog.org).
About Providence Health & Services
Providence Health & Services, Southern California, is a Catholic not-for-profit, mission-driven healthcare system. Providence Southern California operates six award-winning hospitals and a comprehensive, fully-integrated network of primary care clinics, urgent care centers, home care, TrinityCare and TrinityKids Care hospice as well as Providence High School. Providence is anchored locally by Providence Holy Cross Medical Center in Mission Hills, Providence Saint Joseph Medical Center in Burbank, Providence Saint John’s Health Center in Santa Monica, Providence Tarzana Medical Center and Providence Little Company of Mary Medical Centers in Torrance and San Pedro. With more than 3,400 physicians, Providence provides coordinated primary and specialty care through an array of physician groups and individual providers including Providence Medical Institute and physician groups in the South Bay, the West Valley, Santa Clarita and the Westside. Providence affiliate, Facey Medical Group, provides primary and specialized care in the San Fernando and Santa Clarita valleys and in Simi Valley. For more information, visit California.providence.org.