André Casado, Hospital da Luz Intensivist, Explains “Miracle Babies” at SIC Channel

Andre Casado e Cristina Ferreira

The case of the young woman in brain death who gave birth at Centro Hospitalar Universitário São João, at Oporto, in the last week of March, was the pretext to a discussion in TV show “Programa da Cristina”, at SIC channel, where André Casado, internist and specialist in Intensive Medicine from Hospital da Luz Lisboa, was a guest.

The physician explained to the public in the TV show “Programa da Cristina Ferreira” that “the scientific and technical evolution of the last 60 years allowed doctors to recognize brain death as such, as the death of the brain, the complete loss of the brain function, simultaneously giving us the conditions to sustain the remaining organs in order to maintain body stability”. The TV host had questioned André Casado how is it possible to “sustain a baby inside a dead mother”. The specialist explained that these cases are rare and there is still little knowledge and experience at world level, but the intention is to create the technical conditions that allow the body to stabilize and continue to fulfil its basis functions, “without that great maestro of the body which is the brain”.

Cristina Ferreira also asked whose decision was it “to maintain pregnancy, when such situations occur”. “First of all, there is a clinical component of the decision: when we consider the foetus to be viable in the circumstances the mother is in, even in brain death, we always propose to the family to proceed with the pregnancy. It is logic and desirable that we do so”, the physician answered, adding that: “There are not properly rules or specific ethical guidelines for these cases, as it happens with the removal of organs in people in brain death”. Anyway, further declared André Casado, once the decision to proceed with pregnancy is taken, “in these situations, anything that could be beneficial from the intrauterine point of view of the foetus is valid”, concerning the relationship of proximity established with the team that followed-up the young woman, while she was interned in the hospital. On the other hand, “in a team involving multiple health professionals and the family itself, there is a very complex emotional dynamic. There are days of great sadness, because we are dealing with a corpse. The very day of the childbirth is also a mixture of sadness and joy. And the challenge remains, although differently”. The baby was born premature and will have to be followed-up with the same level of demand that was necessary during the gestation period.

Salvador was the name chosen by the family of the 26-year-old young woman, that three months before was admitted to Centro Hospitalar Universitário São João, in Oporto, with a fatal asthma attack. The young woman, that was only 12 weeks pregnant, entered in brain death, the development of the foetus being followed-up in the intensive care unit of that hospital, by a multidisciplinary team. The young woman was only declared dead, after Salvador was born. With only 24 weeks, the baby will remain in the Neonatology Service of Centro Hospitalar Universitário São João.