Episode 3 Children's Emergency Rescue

From headquarters just outside Barnsley in South Yorkshire,

a dedicated team of doctors and nurses

fights to keep some of Britain's sickest children alive

long enough to reach the specialist care they desperately need.

If a child needs a life-saving operation...

Down to ten, please.

..or a premature baby has to be moved to a neonatal unit,

it's the Embrace team's job to provide intensive care

in the back of a moving ambulance, plane or helicopter.

I was shaken, thinking, I don't really want to let him go.

His heart's so small, how is he going to survive?

It just felt like the whole world

had come down. We didn't know what to do.

As the NHS concentrates specialist care for babies and children

-in fewer and bigger hospitals...

-Mick, will you pull over, mate?

..some of the UK's most vulnerable patients

will need to undertake longer journeys to get expert care.

-All right? Tired?

-He's so cute, isn't he? Look at him.

They know what the problem is, it needs correcting

as soon as possible. So let's get him over there as quickly as we can.

I love you...

24 hours a day, every day, Embrace is on standby,

tiny lives in its hands.

'Hello, Embrace, how can I help?'

'Hello, Embrace, Rebecca speaking. How can I help?'

The Infant and Paediatric Transport Service, known as Embrace,

co-ordinates the transfer of sick babies

and children to specialist centres from its base near Barnsley.

Good afternoon. How can I help you?

Thank you very much indeed. Are you a consultant or a registrar?

Every year, it receives 3,500 requests for help

from hospitals across Yorkshire.

Embrace Transport Service. Stacey speaking, how can I help?

Baby Zakaria was born three days ago at Bradford Royal Infirmary.

Doctors suspect he may have a rare heart condition

which is fatal if not treated early.

-'I've got a baby who needs an echo in Leeds.'

-Right, OK.

'I think he has unobstructive TAPVD...'

I didn't expect anything like that. Nothing to do with his heart.

I just thought he'd just be

a normal baby, like my other two children.

An Embrace team has been dispatched to transfer Zakaria

from Bradford to the Children's Heart Unit in Leeds.

You knew there was something definitely wrong.

You just pray for the best, really.

Although Zakaria looks healthy,

the oxygen levels in his blood are very low, and when doctors

scan his heart, the veins connecting his heart and lungs look abnormal.

Zakaria may well have a congenital heart condition called TAPVD,

but this needs to be confirmed by specialists in Leeds.

Shh, shh, shh...

He's all right at the moment.

He's looking quite well. He's breathing by himself.

He's needing a little bit of oxygen, so he's got some oxygen going up

some nasal cannula, as you can see,

and that's working well for him.

He's actually quite a big baby and if we just put him

into our incubator fully dressed, we'll cook him.

He will get really hot on the way. So we're just taking a layer off.

Him in the incubator, and your own child in there,

and a lot of things go through your head,

but you just compose yourself and think,

it's going to be all right, it's going to be all right.

We were more than shocked. We didn't know what to think.

We just thought to ourselves,

just take him.

It's only 12 miles from Bradford Royal Infirmary to Leeds,

but for an anxious parent, the distance seems vast.

We will get him fed straightaway.

He might wriggle around a bit while they're trying to scan.

So while they're getting all their stuff together,

we can feed him and settle him down.

Baby Zakaria is being transported to Yorkshire's only children's heart centre.

This specialist unit has been under threat

because of NHS plans to reduce the number of centres around England

which carry out heart surgery on children.

And then operations were halted overnight

after questions were asked about its mortality rates.

It re-opened just two weeks before Zakaria was born.

'Heart surgery on children

'will resume at Leeds General Infirmary tomorrow,

'after it was suspended over concerns about higher-than-usual death rates.'

-One of the nurses explained the situation to us.

-Yes.

About the death rates, what's happening.

She explained everything before we even asked,

which put your mind to ease, knowing...

-They're not hiding anything.

-Exactly.

So it's opened again for a reason. If it was that bad,

it would still be closed. So it's open again for a reason.

There is no history of congenital heart conditions in Zakaria's family.

His two older brothers have no health problems.

I'm looking, essentially,

for the cause of why his oxygen saturations haven't been normal.

We need to have a really detailed look and see if

we can determine the cause.

Just daft questions! Why? What's wrong? Can you please tell us?

And you had to be quiet all the way through,

-and it just felt like forever.

-Mmm.

-Yes.

The news from the scan isn't good.

Zakaria's mum and dad are told their tiny son will have to have

open heart surgery before he is a year old, otherwise he will die.

She just told us what's happened, and it was just a shock.

Their baby's got a condition called

Total anomalous pulmonary venous drainage, which means that

the veins from the lungs don't drain back to the left side

of the heart as they should do, which means that the pink blood

coming from the lungs is going to the wrong side of the heart.

He will need an operation to put that right.

He's only quite little, he only weighs 2.5, 2.6 kilos,

so it may be that we want to wait a little bit before we do the operation,

to allow him to get to maybe three kilos. And he's very well, there's no sign of any compromise at all.

It just felt like the whole world had come down.

-We didn't know what to do.

-You don't expect it at all.

I mean, not my baby, that's my baby, he looks perfectly all right.

No matter how much they told me,

he'll be all right, he'll be OK, it's been done before,

but you just don't know, do you?

Hello, Embrace, can I start with your name, please?

What makes Embrace different from the other

patient transport services in England

is that it moves any critically ill child aged 16 or under, including newborns.

What I'm going to do now is pass you on to our consultant,

who will take further medical details.

When a call comes in from a hospital,

a senior consultant decides if the patient needs to be moved to a specialist centre.

He has presented today about 15:30 to A&E

with acute, severe, life-threatening asthma, and seemed to respond.

Usually, a trainee specialist doctor and a nurse will do the transfer.

Hello, Embrace, how can I help?

Today, a call is coming in from Grimsby Hospital about a baby

born ten weeks early who has a suspected blockage in her bowel.

Yes, and it's a boy or a girl?

-'It's a girl.'

-And have you got a weight for her?

Baby Amelia is four days old and she still hasn't had a bowel movement.

They're supposed to poo within the first 24 hours, and she never did.

Her stomach just kept getting bigger and bigger.

If her intestine is blocked, she needs urgent treatment.

Her tummy was swollen and she wasn't tolerating her feeds.

Her X-ray showed that some of her bowel loops

were dilated and swollen, and there was a concern that

there was a blockage at some point along the bowel.

Grimsby Hospital doesn't have the facilities necessary to carry out

detailed investigations of Amelia's bowel,

so the team has been called in

to transfer her the 70 miles to a neonatal unit in Sheffield.

Well, she looks quite well. She's lovely and pink.

Not very impressed with me, are you, Miss?

The concern from the team here is that

the two larger areas of bowel look quite dilated,

and the rest of the bowel loops look quite big as well.

So whether there's something blocking the passage of the stool

through the bowel is causing an obstruction at some point.

Amelia is a twin and the transfer will mean

she'll have to be separated from her newborn sister Arrianna,

who'll stay in Grimsby.

'That was the worst thing, cos obviously,'

I wanted to go with Amelia because of her being poorly,

but that left Arrianna, and Mark had to go back to work as well.

She does seem a bit like she's going to be cheeky.

She doesn't like all the things. But she seems really chilled out.

I don't know whether that's because she's not very well,

but, no, she looks like she'll be trouble.

Come on, then, sweetheart. Are you ready?

'I was frightened of them.

'They were so tiny and so fragile, it worried me, picking them up.'

And when the nurses said, "Would you like a hold?", I thought, I'll break her bones, or something!

The twins' mum will travel the 70 miles to the Jessop Wing Hospital

with Amelia, leaving her twin sister in Grimsby.

Dad is a long-distance lorry driver and has to go to work.

When we pulled off, Arrianna was obviously left there

and Mark said, I'll just pop back and say bye-bye to Arrianna.

And me and Amelia just left. I think it was more the unknown for me,

because I didn't know where I was staying, what I was going to do,

I'd had nothing to eat, and it was awful.

Baby Amelia is breathing for herself,

but she is very tiny and very sick,

and like all babies, she has the potential to deteriorate rapidly.

There was a problem with her bowel that, at some point,

the bowel could perforate, so develop a hole in it somewhere.

And that sometimes can make babies and children quite poorly.

We have to be prepared for any eventuality, really.

Thankfully, the journey goes smoothly.

It's always nice to get to the receiving hospital

and know you've completed a nice, smooth, uneventful transfer. Yes.

The Jessop Wing hospital has a level-three neonatal unit,

which means the most critically ill babies can be cared for here.

Specialists will decide if Amelia needs surgery to unblock her bowel.

If she does, it may be many weeks before she is reunited with

her twin sister back in Grimsby.

Hello, Embrace, Audrey speaking. How may I help?

OK. Are you the main consultant for this patient?

Every year, teams from Embrace

transfer over 2,000 sick babies and children.

900 of them are critically ill

and are taken to specialist centres to get expert treatment.

Steve, it's Anne, back at base.

When you get in the ambulance, can you just ring me with

an estimated time of your arrival at Grimsby?

The majority of journeys they make are within Yorkshire,

but occasionally, the team is drafted in

to fly a critically ill child home from abroad.

A thousand miles away from her home in Leeds,

a baby girl has been born in the Spanish holiday resort of Alicante,

13 weeks prematurely.

Baby Ellizeah's parents were visiting family

when she made her early arrival

and she's been in intensive care ever since.

They said that the intestines perforated. They need to do surgery.

And then they said, if we don't do this surgery, she's going to die.

And that's when your whole world just comes crashing down.

You just want to die yourself.

As well as her perforated bowel, Ellizeah has a heart defect

and bleeding on her brain.

She will need specialist care in hospital for many months.

Ellizeah's mum and dad have spent the last seven weeks at the bedside

of their tiny, desperately ill daughter.

Now all they want to do is get her home to a hospital in Yorkshire.

We need to get her back to her hometown,

to where she should have been born, in Leeds.

And I feel like I owe it to her as a parent to do that,

just because of what she's been through now.

I feel like it's the only thing that will make it

a little bit better for her. The hospital here is absolutely brilliant

and we owe her life to them, but as a family, we need to be home.

Back in Barnsley, at Embrace Headquarters,

a community midwife who knows the family has alerted

Lead Consultant Steve Hancock to Ellizeah's plight.

The team would be able to fly her back to the UK.

However, the NHS can't cover the £12,000 cost

of chartering a specially equipped private plane

and Ellizeah's mum and dad don't have travel insurance.

Small babies need looking after in a special environment. They need

full intensive care monitoring,

they may need to be on ventilatory support,

so all of that requires specialist equipment,

and you can't put that specialist equipment on a commercial airliner.

Thank you. Good evening, on the first day of spring!

A Yorkshire couple stuck abroad

after their baby was born prematurely...

Ellizeah's family is determined to raise the money necessary.

Zowie's mum is spreading the word on the local BBC news programme.

We're currently near £12,000.

So, we can have Zowie's baby brought home from a

Spanish hospital to an

English hospital.

I'm very nervous but she's my daughter, that's my granddaughter

and if anything helps them to come home to an English hospital, I'm willing to do that.

Well, joining us now is Carol Lyons, Zowie's mum

and Grandma to baby Ellizeah.

Erm, Carol it's your...

My mum was on the ball.

I don't even know how she did it or what went on,

I just got phone calls saying, "Right we're going to a family meeting.

"This is going on, we're doing this, we're doing fundraisers."

It was just amazing how much effort they actually put in

just to get us home.

But even if they do manage to get the money together for the specialist flight

back to the UK, Ellizeah will be heading straight for intensive care

where she could face weeks or even months of treatment.

Every year 3,500 calls come

into Embrace headquarters with requests to transfer some of

Yorkshire's sickest children.

One of those patients is seven-week-old Eddie.

Hello, Embrace, Becky speaking, how can I help?

Oh, hello, my name's Amy Rushbrook, I'm one of the paediatric registrars

at Bradford Royal Infirmary.

Eddie stopped breathing at home but his parents managed to resuscitate him.

His condition has deteriorated

rapidly since being brought to A&E in Bradford.

He went blue straight away. As soon as I saw that

I just rang the ambulance

and then he stopped breathing

and literally, to be honest the ambulance team were there in minutes.

And then we had to resuscitate him ourselves through the advice

over the phone

and the ambulance team took him to BRI

and then throughout the day it's got worse.

'He started grunting, erm,

'he has these periods of just intermittently

'looking like he's desperately going to expire

'and then picking up and fooling us all and then

'doing it again within the hour.'

Let's erm...take that call.

Eddie is especially vulnerable because he recently had heart surgery,

so Lead Embrace Consultant Steve Hancock

decides he should be moved to the paediatric intensive care unit

at Leeds General Infirmary.

This one has had heart surgery in Leicester, something called a TGA

which is quite a major heart operation

and, I think, recovered, fairly well from that,

but has been represented unwell, but

we are thinking it's more perhaps an infection rather than the heart problem itself.

The trouble is with these little ones when they've had heart surgery they are quite fragile,

and you don't want to sit on them too long before you intervene.

I have my emergency sandwiches.

Doctors suspect that

Eddie may have a severe case of bronchiolitis, a viral infection of

the lower respiratory tract which affects children under a year old.

He's sort of classified as paediatric because he's been

home following his surgery

and Bradford haven't got a paediatric intensive care unit, Leeds have.

It's Ann Jackson from Embrace Transport. Hello there, how are you?

Ann Jackson is one of the most experienced critical care nurses at Embrace,

but because Eddie is so sick, lead consultant Steve is also

travelling to Bradford.

With Eddie it was pretty clear he was very sick

and I think it was an unpredictable situation so I decided

quite quickly that I was going to travel to Bradford.

He's a good size, but he's risky, he's fragile, and,

you know, Bradford to Leeds is not a huge journey but it's long enough

and you really don't want to take any risks.

These children go off remarkably quickly.

Dr Steve hits the road in the rapid response vehicle

so he can react if another more urgent call comes in.

Steve, who is following in our rapid response car rang for an update.

SIREN WAILS

Hopefully, the tube's down, the X-ray will have been done, it's just a case of making sure he's

adequately sedated and we'll have a good look at him and make

sure he's fit for transfer and then it will be a case of loading him

and taking him to Leeds.

Because Eddie is recovering from major heart surgery,

any infection could prove fatal.

We'll get handover and have a look at him

and the plan is to take him to Leeds.

All right? Tired?

I know, I know, are you coming with us?

-Yeah.

-Yeah.

'They're so traumatised by what's going on we have to build up

'a relationship with them very quickly.'

You know, we're going to move their baby, they may come with us

or they may not so there's a lot of trust there.

-Ann?

-Yeah.

-Can we agree a plan, then?

-Yeah, OK.

So...

-Tube, tube's well secured and in the right spot.

-OK.

He's critically ill needing intensive care.

He's just at that point where he could just continue to improve

and have a relatively straightforward stay in

intensive care or things could get complicated for him

particularly with his blood pressure at the moment.

That's my main worry. How much support is he going to need for that?

Before Eddie can be moved into the Embrace intensive care cot,

the team has to get his blood pressure up by giving him

some drugs.

So, it's six milligram per kilogram so...

-We're going for peripheral...

-To start with.

-Dopamine.

-Need to get this pressure up...

-Yep.

We'll swap to a central line if necessary.

BEEPING

..7.5, so there's just a chance we might be...

The blood pressure is low, so we're just working on that at the moment.

Er, but in the last five minutes it has improved again, so,

I'm hoping we can just keep it to fine tuning

cos all the major stuff's been done.

All right.

When you think of what he's had before and the surgery and

that he's been on intensive care, at least they've seen

him on a breathing machine before and they've seen all the tubes

and all the wires so they've got quite a good understanding.

It's not like it's the first time they've seen him wired up

so I know they're still very stressed and very anxious,

understandably, but actually visualising this is not as horrendous

for them as it would be to a new family coming and

seeing it for the first time.

He's bigger than I thought, he just fits in.

Does he just fit in?

-He's bigger than he looks!

-He is a big boy.

-His knees are a bit bent.

I'm just connecting him all up and making him

look less like a bomb's hit him

and then you can have a proper look at him.

Just a bit of a plumbing exercise.

Just 18 hours ago Eddie's parents saved their son's life when

he stopped breathing at home - but their ordeal is far from over.

So, were you doing the breathing and the heart massage?

It was kind of between us.

I started doing it and Charlie was on the phone

and then Charlie just gave me the phone and I just did the breaths.

ANN: Yeah, fantastic. It's a horrible experience to go through, isn't it?

I just keep playing it in my head is that scene...

ANN: Yeah.

That image I can't get rid of, to be honest.

ANN: It will lessen, it will stay with you

but it's fantastic that you did what you did,

it's made all the difference.

The combination of infection and a fragile heart means Eddie's still in grave danger.

If he's got bronchiolitis which we think he may have, OK,

I was always tend to say to parents,

have in your mind that he's going to be in for, perhaps,

a week in intensive care.

But particularly if it's bronchiolitis

often they can get worse

before they get better.

But he's going to a unit where they deal with it day in and day out

over the winter. All right?

I've been nursing a long time, but I think, knowing the

emotions of a parent with a poorly child

helps you to understand.

I think, part of it's nursing and the training and

I think part of it is just life experience in dealing with

lots of people over the years.

All right, little man.

If you could hop into your new bed I'd be very grateful.

I know. He's so cute, isn't he? Look at him.

He's had a good journey. Numbers on his monitor are better.

The only thing that's changed is his temperature's gone up

so indication that there is some infection somewhere.

But his blood pressure's improved

so one of the drugs that we've given him to keep

his blood pressure up, we've managed to stop, so that's in his favour.

He was in about 40% oxygen

when we set off and he's now in air, so that's a good improvement.

Yeah, he's pretty stable.

Sweetie pie. But nice and settled.

Not only does Leeds have a large paediatric intensive care unit,

it's also home to Yorkshire's only children's heart centre.

One, two, three. All right, that can just drop down. Come on, sweetie pie.

-Got him?

-Yeah, got him.

-Yeah? Good lad.

Eddie didn't have his life-saving operation here

but at a similar unit in Leicester

because, at the time, there wasn't a surgeon available in Leeds.

Both centres have been fighting NHS plans

to close their operating facilities.

If Eddie's illness is due to complications

arising from his heart operation then Embrace will probably

transfer him to Leicester for follow-up surgery.

At the Jessop Wing Hospital in Sheffield, baby Amelia,

born ten weeks premature, is about to be moved by the Embrace team

for the second time in two days.

It's large, distended and full

but not tense.

She was brought to the neo-natal unit from Grimsby

because doctors were concerned that she hadn't had a bowel movement

since she was born five days ago.

This baby's abdomen got more distended than it should be

and it looks like when they've put some food down,

it's not completely being absorbed.

She's getting a lot of bile coming back up the tube

so there is a concern that there's a bit of a blockage.

Just based on this X-ray, we can't tell where the problem is

but it certainly looks like there is an obstruction at some point.

Amelia needs a more detailed X-ray and this can only be done

in the radiology department at the next-door Children's Hospital,

a short journey but still dependent on scrupulous preparation.

It's pretty short. You sort of just get your seat belt on

and you get everything up and then, "Oh, we're here.

"Seat belt off." But they don't have a bridge,

they don't have a tunnel so we've got to drive.

But short or long transport, you need the same preparation

and the same handover at the end,

so they're the hardest bits, really.

Amelia's mum also has the extra worry of knowing that her other

newborn daughter, Amelia's twin, has had to stay in an incubator

70 miles away in Grimsby Hospital.

She has been ever so good with everything that they've done to her

-so far, bless her.

-Yeah.

-So...

-She's chewing on her fingers now.

Oh, is she? Poor kid's had nothing to eat!

We'll count her fingers when we get there.

Just as Amelia and the team get to the Children's Hospital,

they are joined by Dad.

The contrast is like a dye which just shows up on plain X-rays

so what he'll do is place a small tube in the back passage

and then inject the dye just prior to taking the X-rays

and we'll take a series of films which should give us

some good pictures of exactly what's going on in the bowel.

Mum can't bear to watch this bit

so Dad is staying with his new baby girl while a test is done.

I think it was because I didn't want to be in there

and I just thought, "Oh," cos I didn't know what

they were going to do and Amelia being so tiny, I just thought,

"Oh, I can't. I can't stay in there."

And he didn't want to leave her on her own

so he stayed and that's very brave for Mark.

Then something amazing starts happening.

The dye that's put into Amelia's digestive system for the test

appears to be unblocking her bowel.

The radiologist explained there was a bit of a blockage

just where the large bowel meets the small bowel.

He feels that it's a plug of meconium

and meconium is just the first bits of poo that baby produces.

And just by pushing through some of the contrast

and releasing that plug,

it may be enough just to release everything

and keep everything flowing, so the radiologist is just having

a chat with the surgeon, explaining what he's found.

We should just be going back as normal

but it may mean that we avoid any further...

having to do anything further but we'll just have to wait

and see, really.

And the radiologist is right.

Amelia's blockage is cleared.

As soon as the Embrace team gets her back to the Jessop Wing Hospital,

she has her first bowel movement.

When we'd opened the nappy, she'd pooed and it was everywhere

and I thought, "Oh!" I'd never been so relieved to see a dirty nappy!

And then she continued to do it so it was excellent, but I wasn't very...

Obviously, inexperienced at doing the nappy.

She put her foot in it, it was all over.

And there's me trying to mop her up. But yeah, I couldn't moan at all.

It was brilliant.

Amelia doesn't have to have surgery.

But because she and her twin Arrianna were born ten weeks early,

the worry will continue for some time as there may be other

undetected health problems.

Back in Alicante, at the hospital intensive care unit,

baby Ellizeah is recovering from her third operation.

She was born 13 weeks prematurely and has a perforated bowel,

a defective heart and a bleed on her brain.

But now there's some good news for Mum and Dad.

After three months in Spain, an anonymous donor has given them

the final £5,000 of the £12,000 they need

for the team to fly their tiny daughter home.

They donated the rest of the money and obviously,

when you need that extra kind of miracle to get you home,

then your mum rings you and says, "You're coming home,"

and you're like, "I'm not, don't be silly,"

and then it actually hits you, it's a reality,

you are coming home, you're bringing your daughter home.

Now the funding is secure, Embrace advanced nurse practitioner Karen

and nurse Ian are setting off from the UK to pick her up.

Mobile phone, drugs, to go.

The paperwork, all your fax forms are there that you need.

This has been a very sick baby.

She has been needing to come back since day one, really.

Blue, red section, one, two, three bags.

'The reason she hasn't come back yet has been a mixture of the medical

'and the financial.'

Just yesterday, really, was the coming together of the two,

in that she was fit to fly and the money was available to fly her.

The money raised by the family has paid to charter the plane.

The intensive care equipment

and the Embrace staff costs will be picked up by the NHS.

That wasn't bumpy at all.

No, but the stronger the wind...

Because they take off into the wind, if you got a strong wind,

they just go, woof!

That's just...

Er, invasive pressure monitoring kit.

The team has transformed the plane into a mobile intensive care unit.

We don't do many of these,

because it's not a common thing for little babies to get stuck abroad.

But it's important to us that when they come up,

and when it is a Yorkshire baby, they are able to respond.

We have got the longer route.

We are doing all right.

After four hours in the air,

the team starts the descent into Alicante.

Karen, you see how much it wobbles at this speed?

So, when you're sitting with the incubator,

you've almost got to put a hand on it, just to dampen it down a bit.

HE SPEAKS IN SPANISH

Upon landing, it's another 10 miles by private ambulance from

Alicante Airport to the hospital,

where baby Ellizeah and her parents are waiting.

As soon as I seen them, I shouted,

because I just noticed the English nurse uniform, it was great.

I felt like I had won the lottery.

She is quite feisty, but we're hoping she will have a sleep.

She has settled down now, looks like she likes to be swaddled,

she likes to be wrapped up.

Ellizeah is leaving the hospital

where she has been cared for for the whole of her short life.

There's no question that the treatment she's had in Spain

is as good as she would have had in the UK.

The challenge, I think, for the family, is around the unknown,

so it would have seemed very different.

The language barriers, of course, and the isolation

from the family, which I think was probably the biggest challenge.

In only five more hours,

Ellizeah will finally be in her home city of Leeds.

Meanwhile, back in the UK, Embrace patient baby Eddie is

fighting for his life after open-heart surgery.

When he was admitted to Bradford Royal Infirmary six days ago,

doctors thought he had a severe case of bronchiolitis,

or that his heart was in difficulty, following an operation.

Embrace moved him to Leeds, where tests carried out by cardiologists

revealed that the arteries leading to Eddie's heart had collapsed

and he was in heart failure.

The thing they didn't want to find, they found,

which was that the coronary arteries had narrowed, in a very unusual way.

So, I think as soon as they established that had happened,

it was a case of, it needs fixing,

it's not something that is going to fix itself.

This narrowing is a rare complication

arising from an operation Eddie had

at the Children's Heart Unit in Leicester

to switch his arteries over.

This was done six weeks ago, when he was just five days old,

and had appeared to be successful.

Well, they sent me the pictures of the coronary arteries

and they were narrow.

And I was quite surprised that they were,

because the operation seemed to be so successful before.

This is something that can happen after this surgery,

but it's quite unusual.

We always had the niggling feeling that it would be his heart

that would be the problem.

We wanted to kind of sideline that as much as we could, but ultimately

there's no such thing as coincidence when it comes to a heart patient.

The Embrace team was drafted in to move Eddie to Leicester

to have his second major surgery.

As they travelled the 100 miles from Leeds,

the surgeon who did Eddie's original operation cut short

a conference in America and was flown back specially.

They know what the problem is and it needs correcting as soon

as possible, so, let's get him over there as quickly as we can.

As soon as the surgeon arrived, he made the decision straightaway.

Didn't want to run the risk of him having a heart attack in the time

that they were waiting, so he called the team in and they got to action.

These pictures recorded by the surgeon's head camera show him

opening up Eddie's collapsed arteries.

It's quite an unusual operation, quite complicated, so,

as the senior surgeon, I thought it was right that I came back to do it.

Yeah, I think Giles is one of the five surgeons in the UK that

could have done this operation, so, very lucky that he was here in time.

His coronary arteries had reduced to pinhole size.

If your coronary arteries are blocked,

then you have a heart attack.

The operation is successful,

but three days later, Eddie remains critically ill.

I think we are just worried that...

-with his lungs, obviously, the heart could be the problem.

-Yeah.

That's why they are doing the echo, just to check that.

Eddie's attached to an ECMO machine -

a complex piece of equipment

which acts as an artificial heart and lungs

outside his body, giving his own fragile heart a chance to recover.

Seeing her baby back on life support

when he has been at home with her for weeks

is of course traumatic for Mum.

He's a kind of angry...little boy!

SHE LAUGHS

He likes to eat a lot.

He likes bath time.

You all right?

If he was awake, he'd be letting us know he was hungry. He'd be starving.

He hasn't eaten properly in days, really. What?

-What does he do when he's hungry?

-He does that...

He does that. Yeah, he's cute.

But no-one can say how long it will be before Eddie is back

to his old self.

A thousand miles away at the Spanish resort of Alicante,

the Embrace team is preparing to fly baby Ellizeah home to Yorkshire.

After 12 weeks of waiting, finally there.

-Been a long time coming, but we are there.

-But it's been worth it.

I mean, she's got her health, so... it's worth it.

Ellizeah was born prematurely while her parents were on holiday.

She's spent three months in intensive care

and is still very sick.

We do international transfers about three to four times a year.

It has become a regular part of what we do now.

It's not always straightforward, follow a guideline and do things

the same way in a regimented way - you have to be a bit more flexible.

You know, be prepared to change things as you go along,

depending on what happens.

Ellizeah will be going straight to Leeds General Infirmary

after landing.

Like many premature babies, she has multiple health issues,

some of which may cause her problems in the long term.

She might have a limp, she could be dyslexic,

she might end up in a wheelchair, she might not be able to walk,

or use her little finger, that kind of thing.

Literally, we don't know.

She was just beginning to...

wriggle about a bit, the incubator started rocking a bit,

so I'm just steadying it.

We're just going through the clouds, it's a bit windy in Yorkshire.

So, hopefully she won't notice. She looks pretty settled now.

And when the aircraft makes its final approach,

the winds sweeping across the runway at Leeds Bradford Airport

make for a very bumpy, but thankfully safe, landing.

THEY CHEER

Another Embrace team has come from Barnsley to collect baby Ellizeah

and ensure she safely completes the final ten miles of her epic journey.

She was better than we hoped.

She was a little bit grumpy in Alicante, and we feared that

would last five hours, but actually, she's been an absolute delight.

What's the temperature in there? Perhaps leave her on it.

It's bitterly cold,

but the temperature in Ellizeah's incubator has stayed the same.

Mum and Dad said she liked the top of her foot stroking,

and as soon as I did that, she settled down and went to sleep.

So, she's caused us no bother whatsoever.

Within half an hour, Ellizeah is almost at her final destination,

Leeds General Infirmary.

Oh, hi, it's Karen here again. Hello. We are just driving an LGI.

Landing! Right. Yes, we are landing, in the ambulance.

It felt like she was home, it's the hospital that

I wanted her to be born in, it's where I was born.

Just to have that support as well, of the people, to say,

"Welcome back home, I can't believe what you went through!"

It's just nice.

Hello! Thank you.

But it's still a long road to recovery.

Ellizeah's had surgery on both her heart and bowel

and doctors are also concerned that she's not feeding well.

These notes that were given us are a more detailed history

of things like blood results, operation notes, that sort of thing.

They are in Spanish, but they will get translated.

I'm sure she'll get used to broad Yorkshire accents, being here!

Yeah.

For the next six weeks, Ellizeah remains on the neonatal

high dependency unit at Leeds General Infirmary.

It's OK. Shh, shh. Oh, dear!

A feeding tube has been inserted into her stomach

and she has had surgery to treat her persistent reflux.

It's not quite the speedy recovery her parents were hoping for.

But finally, after three months in a Spanish hospital and nine weeks

in a hospital in Yorkshire, Mum and Dad can take her home.

She's very cheeky.

She likes to do fake coughs and fake cries.

She's really smiley on a morning.

She has a bit of a temper as well, so, if you don't give her

attention, that's it, she'll go in a mood with you.

I think it's just amazing, how big she has got.

I mean, with all the milk that she's taking as well,

she's getting right heavy, aren't you? Yes, you are!

At Grimsby Hospital,

another Embrace patient with bowel problems is recovering well.

She says, "I'm not waking up!"

Four days after she was born here, baby Amelia still hadn't had

a bowel movement, so the specialist transport team moved her

to the neonatal unit at the Jessop Wing Hospital in Sheffield.

Are you going to open your eyes and have a look at everybody?

-She won't have anything to eat...

-I know.

A test she had while she was there loosened a blockage

in Amelia's bowel and three days later,

she was able to return to Grimsby.

But on the day that Amelia was travelling back, Embrace was

called out to transfer her twin sister from Grimsby to Sheffield.

So now, the twins have swapped hospitals.

It was awful.

I think that is anybody's worst nightmare, just for them

to be separated again, and when you think, oh, great,

Amelia's coming back, you didn't expect them

to say that Arrianna was going. I really didn't.

Arrianna also has a blocked bowel, but it turns out to be

a far more serious obstruction than Amelia's was.

Her digestive system didn't develop properly in the womb,

and she will need surgery to remove a section of bowel

which is stopping waste from passing through.

The twins have been apart for more than three weeks,

and Mum is struggling to spend time with them,

especially Arrianna, who is in a hospital 70 miles from home.

25 days, and I've seen her 12 times.

So, she won't recognise me soon.

It's really strange, because they both do this thing where

they lift both of their eyebrows.

I just said, for them not to be together,

they've got very similar characteristics.

But Amelia tends to laugh a lot more,

she lifts her little lip up when you say something to her,

she seems to be a lot more alert than what Arrianna is at the minute.

Three months on and it's the morning of what's hoped to be

the final operation on Arrianna's bowel.

She's already had a section of damaged intestine removed.

Today, the surgeon is hoping to reconnect her bowel

so Arrianna will no longer need a colostomy bag.

Worried sick. If it was straightforward it'd be an hour and a half.

But because of all the scar tissues and adhesions,

they've told us about three and a half hours. But they also know what Arrianna's like.

So, it's the thought of her being under that anaesthetic

when she's only just had one two weeks ago as well.

But we can only pray that it goes according to plan, can't we?

And you be a good girl. Yeah.

Arrianna is now 18 weeks old and has spent nearly her whole life

in hospital, separated from her twin sister, Amelia, and her parents.

If Arrianna asks me, "When was my first smile?"

I can't tell her that, because it happened in hospital.

And although they do keep a diary for me,

I can't tell you an awful lot about Arrianna's developments or anything.

So that's upsetting, because you just don't feel you can bond with her.

This operation is turning out to be more complicated

than the surgeon first thought.

He'll have to remove another piece of damaged intestine

before he can join the bowel back up again.

But I suppose we need to unravel it all to see.

I never got down to...

But the surgeon needs to make sure that he doesn't cut out

too much of the intestine, otherwise Arrianna won't be able

to absorb the nutrients from her food properly.

This is where the problem is, so we need to take this loop off.

So we're looking at how much length of bowel she has got.

And this is all small bowel. It looks like she's has got ample small bowel.

Approximately there is 90cm, which is good.

This piece of bowel will now be tested to try and establish

why it was damaged.

Yeah, I don't know here, what's happening here.

It's all... We'll have to look at it oestrologically when they take it out. OK.

Basically we have disentangled all the bowel.

And there's 90cm of small bowel.

Someone her age should have about 200, 250.

But that's not too bad.

And then we're going to join these two ends together now.

She has more than a 50% chance of feeding normally and growing.

But she's in a grey area, so we'll have to see which way she goes.

I suspect she is going to be in the hospital for a good few weeks

while we get her to start feeding orally and bring the TPN down,

which is the nutrition we gave her through a line into her heart.

And we'll have to see how she goes.

But I think she's got a much greater than 50% chance of doing well.

We found some bit of the bowel was quite strictured

and damaged, so we had to remove it. But we did manage to join the two ends together.

-So she hasn't got another stoma?

-No, she hasn't.

So it might be a good few weeks before

we can think about getting her home etcetera.

What we need to do now is to get her to recover from this

and then feed, and we'll watch her very closely.

It's absolutely fabulous. I can't believe that

they've actually managed to put it all back together

without creating another stoma. Brilliant.

I'll go and see Arrianna first of all, spend a bit of time with her,

make sure she's all settled. and then we've got to go and pick Amelia up,

who's been very, very naughty at my sister's!

Apparently she's been resisting sleep and being a bit vocal.

But never mind! So that's us spent time with both of them. Lovely.

Arrianna will be prone to infection after this operation.

And it may be several weeks before she can join her sister at home.

Let's leave this trolley on just for the time being,

because there's two options. I don't think this little one needs an incubator.

Of the 2,300 children and babies the Embrace team transfers

every year from hospitals in Yorkshire, it takes 200 of them

to the children's heart unit in Leeds.

In 2012, an NHS review recommended that it and two other

specialist heart centres in England should stop operating on children.

Supporters fought these plans hard.

But then the Leeds unit suffered a setback

when NHS bosses temporarily suspended children's heart surgery,

while its mortality rates were looked at.

It's now three weeks since operations resumed in Leeds

after reassurances were given about safety.

And two week-old baby Zakaria is about to have complex open-heart surgery.

-I just want to check he's got his name bands on, OK?

-Yeah.

And his date of birth, 20th of April, yeah?

Zakaria was brought here by the Embrace team

when doctors at Bradford Royal Infirmary

suspected he had a fatal heart condition called TAPVD.

Cardiologists confirmed he needed urgent surgery.

They said to us he needs to have it. It is dangerous what he's got,

The wrong blood's going in the wrong place. It's not supposed to. So...

So, as he gets older, summat's going to happen to him.

So, the quicker we act on it, the better for him.

Operating on a baby who's 13 days old and weighs just 2.6 kg is far from ideal.

But surgeons can't risk waiting any longer.

They said that because of his condition, he wouldn't grow

any bigger, so it would be best for him

to have the operation as soon as.

We'd prefer this child to be a bit bigger

but we're not going to get that luxury.

This child will rapidly go into very severe heart failure and die.

Simple as that.

Now as soon as he goes floppy, I'm going to ask you to put him on the table for me.

Now that pudding is his head ring.

So his head goes there, toes go there.

I remember putting him down. I was shaking, thinking,

"I don't really want to let him go."

So I just put him down and just said goodbye to him, just gave him a kiss goodbye.

And it just makes you feel, when she said that, it just...

I don't know, it just makes you feel...

Is this, "Goodbye forever", or is it, "Goodbye, I'll see you again"?

So, I mean, you just don't know.

The surgery in this condition is at the back of the heart so

we have to lift the heart up

and find these abnormal blood vessels that are draining from the lung

and they're draining into the wrong side of the heart.

So we have to plumb them back in to where they should be.

Before the surgeon can start repairing Zakaria's heart,

he must be attached to a bypass machine...

..which takes over the work of his heart and lungs.

Down to ten, please.

We cool the baby right down.

We hibernate the baby, if you like, and that's to protect the heart,

the brain and all the different organs, etc.

His heart's just so small. How's he going to survive?

It all runs through your head. You just don't know what to do.

No matter how much someone tells you, "Oh, he'll be OK,"

no, it's just not...

It just doesn't register.

This is a rare condition and surgeons in Leeds only do

this type of operation three or four times a year.

I asked him, "Have you done it before?" And he said, "Yeah."

He was one of the few doctors that had and I asked him,

"Was it a success?" And he said,

"Yeah, you know, it was 100 per cent success."

It went very well.

He's doing very well. His haemodynamics are stable.

He is very stable. It went very well.

Baby Zakaria has been on the operating table for six hours.

For Mum and Dad, it's been an eternity.

I kept saying, "There's something wrong.

"There's something definitely wrong cos they're not calling us.

"If it was all OK, they would have called us."

Gosh, getting through that last half an hour, it was horrible.

I was just like, "We've got to go up.

"Let's ring them." He kept telling me, "No, it's all right.

"It's just protocol.

"That's what they do." It was horrible, that last half an hour.

Most importantly, the chest is still open.

The skin is closed, the sternum is still open.

What I would suggest is running some sedatives

and I would paralyse him as well just until the chest heals.

-Hello. How are you doing? You OK?

-Yeah.

Finally, the surgeon breaks the good news to Mum and Dad

that their tiny baby has pulled through.

So, Zakaria's back and he's fine. He's done well.

-Everything OK?

-Yeah, he's doing well.

Then we knew he was going to be all right. Even when they said

the next 24-48 hours are going to be quite critical,

-we thought, "If he's done that, he's..."

-Through the worst.

-'He's going to be all right.'

-'Little soldier.

'He'll definitely pull through.

'I touched him. I knew I couldn't pick him up.

'I just wanted a cuddle but I couldn't.

'I just put his little teddy bear near him

'and, yeah, just stood there, staring at him.'

After a major operation like this, it's impossible to predict

how long it will take a child to fully recover.

But baby Zakaria does

so well that he's back at home in Bradford in just five days.

Now, five months on, he's continuing to thrive.

-He's...

-Still likes his food.

-Still, yeah.

-He's really good.

He's like my other children, like any normal baby.

I mean, you wouldn't be able to tell he's had a heart surgery.

I mean, the scar - apart from that, nothing. I mean,

towards the start, when he did come home, I felt I didn't know how...

I didn't want to pick him up in case I hurt him or anything.

But after, within a week or so, it was no different.

Like any other children and, yeah, bonded fine with him.

Yeah, you think about, "What if?"

In the future, every time there's an appointment or a scan,

what will they tell you?

But you try to just be positive cos thinking he's gone through so much,

the rest is nothing for him.

So, of course, he's a happy baby.

You wouldn't think there's something wrong with him.

He's smiling, he's always doing what he's doing now.

He just wants to get down and explore everything.

In Grimsby, six months after the Embrace team transferred her

to Sheffield, baby Amelia is back home.

BABY BREAKS WIND Oh, that was lovely!

Amelia and her twin sister Arrianna were born ten weeks prematurely

and both have had problems with their bowel.

Standing up.

But Amelia's bowel unblocked itself during a test

and she's been home for five months.

There she goes. She looks beautiful. Pretty lady.

Come on, then.

She's moving into three to six,

whereas Arrianna's still in...she's in newborn and up to zero to three,

so she'll have to wear them and just roll them up. Won't she?

Got to accommodate you, haven't we?

We can't squeeze you in small sizes. No.

For the last few weeks, Amelia and her mum have had to

travel 70 miles to Sheffield to visit Amelia's twin sister Arrianna.

Arrianna's still in hospital after having three operations

to unblock her damaged bowel.

Where's Arrianna?

'The nurses, they just can't do enough for you.'

They do get them out and they do give them cuddles which, obviously, me

being so far away, it's nice to know that they do care.

-Thank you.

-We've washed her, haven't we? Got you dressed.

-Had some cuddles cos you were a bit sad.

-Aw.

And then she went to sleep about 11.

She was awake quite a lot of the night.

I said, you're going to be really chuffed with me waking her up now!

Aren't they?

Although Arrianna is improving every day,

she weighs nearly three kilos less than her twin.

I just hope that when she does come home that they have got that

twin bond and that they do get along and don't...don't fight. Don't we?

Eh?

I hope they do remember that they are twins

cos they've never been together, really.

Come on, Tubbs.

Who's that?

Perhaps the best test of any twin bond is seeing

if they can share a single cot.

Oh, Amelia. Amelia, what's this?

Hello, Arrianna. Hi, gorgeous girl.

'Getting Arrianna home, that would be truly wonderful.

'I can't wait to get them both out and running around together.

'I really can't.

'I think that's going to be the best feeling ever, just to see them

'both and actually have them together all the time.'

-I can't wait.

-We're having a big christening, aren't we? Yes.