A brave Plymouth toddler has defied all odds after being born weighing the equivalent to 144 tea bags and her parents being told she was unlikely to survive.
Little Effie-Jean Anne Duke made a surprise appearance on Boxing Day 2018, three months earlier than her due date.
Her mum, Chloe-Jean Duke, was just 25 weeks into her first pregnancy when she was covered in blood and rushed to hospital.
She was told to prepare herself for the worst, but after just one day on a ventilator, she was breathing on her own alongside an oxygen tube.
Warning: This article contains an account that some may find upsetting
“Through all this I wasn’t scared I had 100 per cent complete faith that my baby was going to be okay,” Chloe-Jean said.
“I could see she was so strong and already had a little personality of being feisty. I never had any doubts.”
On January 11, 2019, Chloe-Jean and her husband, George, were given the news that their daughter had a rare condition called Phenkylketonuria.
Whilst in Derriford Hospital, the pair were devastatingly told that unless Effie-Jean was “transferred to another hospital” she was “probably going to pass away”.
Chloe-Jean, who is also mum to six-month-old Poppie Christine Zoe Duke said: “They didn’t know what was wrong with her, resulting in her having to travel to Bristols St Michael’s Hospital for two surgeries.
“If Effie-Jean did not have the surgery when she did, we were told by doctors that she would have passed away.
“She had her first surgery when she was just 28 days old. Surgeons did warn us that there was a possibility they may not be able to do anything and we may lose her.”
Chloe-Jean said that she “always had faith” and didn’t believe the doctors.
“I always always had faith in her,” she said.
“Her surgery consisted of having part of her bowel removed which was perforated by the clogged milk that was given to her and so she had a temporary colostomy bag.”
In March last year, the operation was reversed and her stoma was put back into her body.
Effie-Jean can now go to the toilet normally, but has to take regular medication.
The little one also formed a blood clot in her right thigh and Chloe-Jean had to administer blood thinning injections.
“It eventually reduced the clot however this has resulted in damaging some of Effie-Jean’s veins around her thigh and may have difficulty with her mobility in the future.
“Effie-Jean at almost two and still cannot walk unaided but is able to stand on her own and take steps holding my hand.”
She then underwent a third surgery in April last year and was told that if she did not undergo the treatment, she could go blind.
“We were told by Derriford that if she didn’t have this then she would go blind, Effie-Jean had the surgery and so far her eyes have been perfect.
“This surgery was particularly hard for me as she had already been through a lot but again always had faith and she was absolutely fine just like I always knew.”
Chloe-Jean said her daughter is now “doing amazingly” with her diet and has a “very strong and hilarious personality”.
Effie-Jean still has follow up appointments with the Bristol Metabolic Team and regular blood spots taken each week and follow up appointments with her optitions.
“Effie-Jean is expected to start nursery next Easter,” Chloe-Jean said.
“She has been fighting her whole little life and does it brilliantly and is a very happy little girl.
“The Plymouth and Bristol NICU were brilliant but most importantly the St Michael’s Hospital doctors and the surgeons saved my daughters life.
“I could never ever find the words to say how grateful I am to them.”
What is PKU?
Phenylketonuria (PKU) is a rare but potentially serious inherited disorder.
Our bodies break down the protein in foods, such as meat and fish, into amino acids, which are the “building blocks” of protein.
These amino acids are then used to make our own proteins. Any amino acids that are not needed are broken down further and removed from the body.
People with PKU cannot break down the amino acid phenylalanine, which then builds up in their blood and brain. This can lead to brain damage.
At around 5 days old, babies are offered newborn blood spot screening to test for PKU and many other conditions. This involves pricking your baby’s heel to collect drops of blood to test.
If PKU is confirmed, treatment will be given straight away to reduce the risk of serious complications. Treatment includes a special diet and regular blood tests.
With early diagnosis and the correct treatment, most children with PKU are able to live healthy lives.
About 1 in 10,000 babies born in the UK has PKU.
Symptoms of PKU
PKU does not usually cause any symptoms if treatment is started early.
Without treatment, PKU can damage the brain and nervous system, which can lead to learning disabilities.
Other symptoms of untreated PKU include:
- behavioural difficulties such as frequent temper tantrums and episodes of self-harm
- fairer skin, hair and eyes than siblings who do not have the condition (phenylalanine is involved in the body’s production of melanin, the pigment responsible for skin and hair colour)
- repeatably being sick
- jerking movements in arms and legs
- musty smell to the breath, skin and urine
The main treatment for PKU is a low-protein diet that completely avoids high-protein foods (such as meat, eggs and dairy products) and controls the intake of many other foods, such as potatoes and cereals.
In addition, people with PKU must take an amino acid supplement to ensure they’re getting all the nutrients required for normal growth and good health.
There are also several low-protein versions of common foods (such as flour, rice and pasta) specifically designed for people with PKU and related conditions to incorporate into their diets. Many of these are available on prescription.
If a high phenylalanine level is confirmed, a baby will immediately be started on a low-protein diet and amino acid supplements.
Phenylalanine levels are regularly monitored by collecting blood from a finger prick on to a special card and sending it to a laboratory.
A dietitian will create a detailed dietary plan for your child that can be revised as your child grows and their needs change.
As long as a person with PKU sticks to a low-protein diet throughout childhood, and their phenylalanine levels stay within certain limits, they’ll remain well and their natural intelligence will be unaffected.
People with PKU must also avoid food products that contain aspartame, as it’s converted into phenylalanine in the body.
Aspartame is a sweetener found in:
- sugar substitutes such as the artificial sweeteners often used in tea and coffee
- diet versions of fizzy drinks
- chewing gum
- squash and cordial
- some alcopops
All food products that contain aspartame or a related product should be clearly labelled.
There are also medicines that contain aspartame, such as some children’s cold and flu remedies.
It’s a legal requirement for any medicine that contains aspartame to state it on the patient information leaflet that comes with the medicine.
Regular blood tests
A child with phenylketonuria will need regular blood tests to measure levels of phenylalanine in their blood and assess how well they’re responding to treatment.
Only a drop of blood is needed, and it can be collected at home and sent to the hospital by post.
You may be able to have training so you can do your child’s blood tests, or be able to test yourself if you have PKU. This will make testing more convenient.
It’s recommended that children who are:
- 6 months of age or younger should have their blood tested once a week
- between 6 months and 4 years of age should have their blood tested once every 2 weeks
- over 4 years of age should have their blood tested once a month
Someone with PKU will usually need to have regular blood tests throughout their life.
How PKU is inherited
The genetic cause (mutation) responsible for PKU is passed on by the parents, who are usually carriers and do not have any symptoms of the condition themselves.
The way this mutation is passed on is known as autosomal recessive inheritance. This means a baby needs to receive 2 copies of the mutated gene to develop the condition – 1 from their mother and 1 from their father.
If the baby only receives 1 affected gene, they’ll just be a carrier of PKU.
If you’re a carrier of the altered gene and you have a baby with a partner who’s also a carrier, your baby has:
- a 1 in 4 chance of inheriting the condition
- a 1 in 2 chance of being a carrier of PKU
a 1 in 4 chance of receiving a pair of normal genes
Adults with PKU
Many adults with PKU find they function best while on a low-protein diet. The current advice is for people with PKU to remain on a low-protein diet for life.
Unlike in young children, there is not yet any evidence that high phenylalanine levels cause any permanent brain damage in adults with PKU.
Some adults with PKU may have higher phenylalanine levels because they find it difficult to follow the low-protein diet or have returned to a normal diet.
As a result, they may find they do not function as well. For example, they may lose concentration or have a slower reaction time.
These adverse effects can usually be reversed by going back on to a strict diet to bring the phenylalanine levels down again.
Anyone who returned to a normal diet should still be supported by their clinicians and have a regular follow-up to monitor their condition for any complications that might arise.
For women with PKU, it’s essential that they return to a strict diet if they’re considering becoming pregnant, as high phenylalanine levels can harm an unborn child.
PKU and pregnancy
Women with PKU must take particular care during pregnancy, as high levels of phenylalanine can damage their unborn baby.
Provided that phenylalanine levels are strictly controlled during pregnancy, problems can be avoided and there’s no reason why a woman with PKU should not be able to have a normal, healthy baby.
It’s recommended that all women with PKU plan their pregnancies carefully. You should aim to follow a strict low-protein diet and monitor your blood twice a week before becoming pregnant.
It’s best to try to conceive once phenylalanine levels are within the target range for pregnancy.
During pregnancy, you’ll be asked to provide blood samples 3 times a week and will be in frequent contact with a dietitian.
As soon as your baby is born, phenylalanine control can be relaxed and there’s no reason why you cannot breastfeed your baby.
Contact your PKU doctor and dietitian as soon as possible if you become pregnant when your phenylalanine levels are not adequately controlled.
If your phenylalanine levels can be brought under control within the first few weeks of your pregnancy, the risk of damage to your baby should be small. But your pregnancy will need to be monitored very carefully.
More information can be found on the NHS website, here.