PNN
Pune (Maharashtra) [India], December 11: Caring for extremely preterm babies requires exceptional teamwork and expertise. A 26-week baby, weighing 990 grams at birth, had a challenging journey but made an excellent recovery due to coordinated efforts of medical experts at Jehangir Hospital, Pune.
The mother was admitted on July 13, 2024 under the antenatal care of Dr. Nina Mansukhani. The patient went into preterm labour which was managed conservatively but emergency caesarean section was performed due to labour progressing and extreme prematurity. As the baby was born prematurely, complications started immediately after birth.
The baby was placed on a ventilator to support breathing, and a dose of surfactant was administered to help with lung maturity. Gradually, the ventilator support was weaned, and by day 5, the baby was transitioned to CPAP. However, on day 5, the baby developed renal failure due to immature kidneys, resulting in complete shutdown of urine output. Peritoneal dialysis was initiated, a highly challenging procedure for an infant. Under the guidance of Dr. Manoj Matnani, Pediatric Nephrologist, dialysis was performed for 5 days.
With excellent nursing, constant care and proper management, there were no infections, and the baby's kidneys eventually started functioning. However, the journey remained a rollercoaster. The baby also had a patent ductus arteriosus (PDA), which caused oxygenation issues. PDA is a condition where a fetal blood vessel connecting oxygenated and de-oxygenated blood remains open. Due to the renal issues, medical management of PDA was risky as the medications used for closure can worsen kidney function. Despite this, the ductus closed with conservative management after 10 days.
The baby remained ventilated but was extubated on day 23. Oxygen was gradually reduced and completely weaned off by day 34. The baby's feeding started slowly and was fully established by day 20. After 2 months and 11 days of hospitalization, the baby was discharged in good health on September 24, 2024.
The baby also developed retinopathy of prematurity (ROP), a common condition in preterm infants. This was successfully managed by Dr. Vaishali Athawale, and the baby now has normal vision. Despite a stormy course in the hospital, the baby achieved intact survival, with no infections, no major complications involving the lungs, heart, or brain, ensuring a healthy developmental outcome with no anticipated long-term problems.
"This rewarding result is a testament to the excellent NICU care, multidisciplinary super speciality care and the dedication of the nursing team in preventing infections. Our NICU at Jehangir Hospital is well-equipped to handle such challenging cases," said Dr. Sagar Lad.
Dr. Mansukhani further added, "There has to be a total coordinated effort between Obstetricians and Neonatologists while managing such cases. Timely administration of antenatal steroids for lung maturity together with medications for neuro-protection of the brain was prudent in adaptation of the baby from intrauterine environment to external environment. Dr Sagar's vigilant care played an extremely important role in the baby's survival together with constant commitment on part of the parents."
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