26 March, 2021 - A baby girl with the gestational age of 24 weeks 5 days (4 months early) and with the birth weight of 550 grams born to a primi mother with gestational diabetes and hypothyroidism on 06/11/2020 by emergency LSCS. Appropriate resuscitation was done, intubated, surfactant (Curosurf) was given and she was connected to ventilator and shifted to NICU.
The baby was kept on ventilatory support and extubated on the 3rd day of life and kept on CPAP (Continuous Positive Airway Pressure). After few weeks, CPAP pressure support gradually decreased and started cycling with CPAP and HFNC (High flow nasal canula). Currently, the baby has been self ventilating on room air, and has not required ventilatory support after day 3 of life.
The baby was started on IV Fluids, TPN and IV antibiotics. Minimal tube feeds (milk) was started from day 2 of life and feeds were gradually increased. Baby developed abdominal distension and tenderness, greenish stomach aspirates and was diagnosed to have NEC (Necrotizing enterocolitis).
We have treated this infection with appropriate antibiotics and feeds were stopped. Baby improved clinically and feeds restarted and gradually increased. All feeds given via orogastric tube. Eventually baby was given paladai feeds and reached full oral feeds. Presently baby is accepting full oral feeds 3rd hourly. Baby has been passing urine and stools regularly.
On day 1 baby had signs of infection (CRP positive). CSF (Cerebrospinal fluid) analysis done and was suggestive of meningitis and treated appropriately.
In view of frequent regurgitation of feeds, anti reflux medications started and continued.
During the initial days there were metabolic problems like low calcium, low sodium which were treated accordingly. Jaundice was present during initial days and treated with phototherapy.
In view of low hemoglobin (Anaemia of prematurity), baby was given red cell transfusions during hospital stay.
Eye screening (ROP) was done at regular intervals as per protocol and was normal.
Neurosonogram initially showed grade I bleeding but in the subsequent scans this bleeding had resolved.
Echocardiogram and hearing screening were normal.
Received vaccination after reaching appropriate weight.
First and a maiden 24 weeks baby born at Medicover Woman and Child Hospitals. She was very challenging and every one in our team took great care in looking after this baby. Baby proved to be very strong and managed to pull through all the difficult days. She has no complications related to prematurity as of now and going home today successfully. Currently baby’s weight is 2.32Kg and 140 days old.
I thank all the doctors and nurses in my team who have a major role in this rare achievement and a great success.
I thank the Obstetric team, management, administrative staff, and personnel in the lab/blood bank services and all the employees in the hospital for their support and which proved to be invaluable.
Last but not the least, I thank this baby’s parents and family for entrusting us to look after this fragile baby and having confidence in our team. I also thank for their support throughout the stay.
MD (Pediatrics).MRPCH& FRCPCH (UK), CCT (UK)
H.O.D-NEONATOLOGY & PEDIATRICS
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