A tale of courage & fight by a 4 days old extreme low birth weight baby (weighing only 645 grams), created a new milestone in medical history as the baby successfully responded to a critical stomach surgery at Jivanta Children’s Hospital, Udaipur.

INSIGHT:

For Madhu and Rajkumar Rajput  it’s the greatest gift from God to see their three month old survive the odds and come home from the Neonatal ICU at Jivanta Children’s Hospital, Udaipur.

Born  to a couple married for 14 years. Her pregnancy was carried upto 29 weeks  when her blood pressure was uncontrollable  and the ultrasonography revealed  reversal of  blood flow to fetus. Because the blood flow to the baby was decreasing, she was taken up for emergency caesarean section.

Baby boy was born premature just at 29 weeks of pregnancy (Normal pregnancy duration 40 weeks). This baby was very precious and the only hope for the family.  The baby was handled and looked after in the Jivanta Children’s Hospital – Neonatal ICU with precise care under Chief Neonatologist Dr Sunil Janged, Dr. Nikhilesh Nain and their trained nursing team.  He was struggling to breathe, so was immediately put on  ventilator and given medicines to expand his tiny, immature lungs. He could not be fed adequately due to immaturity of  gut.

 WHY SURGERY:

Dr Sunil Janged elaborated, “on day 4 of birth, the child’s health deteriorated badly.  The baby developed tense abdominal distention, skin of abdomen was turning bluish, heart beats and blood pressure started dropping.  Investigations showed intestinal perforation with infection. His body system was shutting down. We knew that baby won’t give us much time, so operation was the only resort  left to us. Major surgery on such a tiny baby with such poor condition was very much difficult and challenging scenario for our team  . But this baby was the only hope for the family. Our Pediatric surgeon Dr Shailendra Singh, Anaestheist Dr Ajaysingh Chundawat and OT staff  carried out emergency abdominal surgery under general anaesthesia, the procedure lasting for 1 ½ hours.

Dr Shailendra Singh said, “He was smaller than my hand when we operated on him.  There was a big tear – approx 6cm on the stomach wall. The stomach tissue was extensively damaged and started turning black. His organs were so delicate and fragile that as soon as we started operating, even with our small instruments, everything started to bleed and fall apart. Stomach wall was not able to take the sutures.   Dead tissue was removed, abdomen was thoroughly washed and stomach wall closed  with lot of difficulty.”

Dr. Sunil Janged further said that the baby would have been dead without surgery.  Its very tedious job to operate such small baby weighing only 645 grams as babies born this small have extremely poor function of all body organs like heart, lungs, brain, and kidney. It’s like walking on a two edge sword.

POST OPERATIVE  HEALTH BULLETIN OF BABY:

Dr. Sunil Janged informed “post-operative course  was like rollercoaster. During this period, utmost care was taken to avoid any stress on sutures, baby had a tube passed through his nose to drain off the contents of stomach. Baby feed was kept nil by mouth for 15 days. We had to start the baby on total parenteral nutrition, which basically means giving all the essential nutrients such as amino acids, lipids, carbohydrates, minerals, multivitamins and trace elements directly into blood circulation. There have been lot of hurdles, infections, blood transfusions along the way. Regular screening of heart & brain were performed to rule out any bleeding in brain.

Gradually, the baby feed was started with few drops of milk through tube and slowly feeds increased. This small baby required respiratory support  for a period of about 20 days. He was able to start drinking from spoon only after about  2 ½ months  of birth.

In all, he was in the NICU for almost 90 days and  on 24 September he is being discharged. When discharged, his weight was close to 2110 grams. Honestly I was walking on ice throughout but he is a fighter and is improving brilliantly.  By far the progress and clinical course in the NICU was very satisfactory for a baby of his weight and gestational age. His brain is structurally normal and eyes are also developing normal.”

Expert comments-

Senior Professor & Head  Neonatology, Pune  Dr Pradeep Suryawanshi has examined published literature and spoken to pediatric surgical colleagues and says he believes he is the smallest baby to survive major stomach surgery in the world. His story and recovery has been really remarkable. He said Gastric perforation is a rare entity with just over 200 cases reported in literature and even with all care it entails a very high mortality ranging from 50-60% . As this baby was weighing only 645 grams , chances of survival were less than 10% in this case.  Previously 730 grams baby with stomach perforation was the smallest baby to survive  from Seoul National University Children’s Hospital , South Korea.  From India there are no survival reports of  baby so tiny.

He further congratulated  Team Jivanta children’s hospital & parents of baby for this amazing achievement.

Reference –  World Journal of Gastrointestinal Surgery- Neonatal Gastric perforation: A single centre experience, World J Gastrointest Surg 2014 August 27; 6(8): 151-155

Dr. Sunil Jangid                                                         

Director & Chief Neonatologist

Jivanta Children Hospital , Udaipur

Mob :09460891442

Email- jangidsunil1@gmail.com