Columbia Asia Hospitals, Kolkata, encountered a unique case of a 27week old male baby, Baby of Boby Kundu Saha, suffering from multiple health complications. On 10th June 2021, the baby was delivered with a weight of 1.05 kgs. The new-born suffered from intense bleeding under the skin as well as in the mouth and stomach. Due to the extremely poor condition of the infant, he was given resuscitation with positive pressure ventilation, aiding the infant to breathe.
He was also given surfactant (a complex with a unique phospholipid and protein composition) and kept on ventilator for the next 6 days due to severe respiratory distress. Post this, the infant was kept on continuous positive airway pressure therapy (CPAP) for 29 days because of Apnoea of prematurity (a condition where a premature baby pauses breathing for significant duration resulting in slow heart rate and low oxygen level). Due to his frail condition and bleeding disorder, the infant was given Fresh Frozen Plasma (FFP) transfusion and concentrated RBC transfusion by the medical team. Additionally, as his mother had a history of dribbling and bleeding before delivery, the doctors suspected sepsis and gave the infant IV antibiotics for a period of 14 days.
Elaborating on the case, Dr. Pallab Chatterjee, Consultant Pediatrician, Columbia Asia Hospitals, said, “The baby suffered from Acute Kidney Failure (AKF) in the first week of his life, resulting in an imbalance in the level of electrolytes in the body, such as sodium, potassium, calcium and magnesium in the blood. These complications were conservatively managed and resolved. Furthermore, it was noticed that insufficiency of Vitamin D led to severe hypocalcemia, which was controlled with IV Calcium and IM Vitamin D injections. The medical team also observed anaemia of prematurity and jaundice, which were treated with blood transfusions, iron supplementation, and phototherapy respectively.”
Sharing her thoughts, Dr. Antara Biswas, Consultant pediatrician and NICU in-charge, Columbia Asia Hospitals, said, “Trophic feeds were started in the first week of life with expressed breast milk. Feeds were built up gradually, initially via an orogastric tube, and subsequently orally, with no feed intolerance. Kangaroo mother care was given several times daily from an early stage and was quite beneficial. Breastfeeding was also established successfully. Additional supplements like multivitamin, iron, calcium and vitamin D were also provided to augment the nutritional value of feeds.”
Serial echocardiogram was done, and the baby was found to have Patent Ductus Arteriosus (a persistent opening between the two major blood vessels leading from the heart), which was resolved medically. Additionally, the baby was given inhaled steroids, along with diuretic and Vitamin A, E supplements to prevent broncho-pulmonary dysplasia. Retinopathy of prematurity (ROP) screening was done serially and he was detected to have Stage 3 ROP in both eyes on the 39th day of life, which was then treated with laser photocoagulation and anti-VEGF injection. The hearing screening was normal in both ears. Cranial ultrasounds were also normal.
The baby was successfully discharged on 53rd day of life in neurologically normal and stable condition, with consistent weight gain (1.39 kgs at discharge), thanks to the able treatment and care provided by Consultant Pediatrician Dr. Pallab Chatterjee, along with the NICU (Neonatal Intensive Care Unit) team headed by in-charge Dr. Antara Biswas.