How a team of Pune doctors ensured survival of a baby born at 24 weeks, weighing 400gms

Dr Sachin Shah, Director, Neonatal and Paediatric Intensive Care Services, Surya hospital, Wakad, told The Indian Express that this was possibly the first such case in the country where a premature baby weighing 400 gms and 30 cms in length was salvaged and, after a 94-day stay, discharged.

The last such case reported in the country was from Ahmedabad in 2019, where a baby was born at 22 weeks and weighed 492 gms. Applauding the efforts of the team of neonatologists who saved Shivanya, Dr Umesh Vaidya, regional medical director, neonatology, Cloud Nine Hospitals, said survival alone is not enough and long-term follow up of such babies is also very important.

Soon after her birth on May 21, 2022, Shivnaya was shifted to the tertiary care level III neonatal intensive care unit at Surya hospital. The team of neonatal intensivists which worked with Shivnaya included Dr Amita Kaul, Dr Jayant Khandare, Dr Ganesh Shiwarkar and Dr Deepak Singh along with a nursing team comprising Rajni Londhe, Swapnali Kapare, Shobha Dongre and Nikita Khekare.
Babies like Shivnaya are extremely fragile and require intensive care, including oxygen at home apart from regular medication and nebulisation to ensure survival, said experts. Shivnaya’s case was a unique one for Surya hospital, which is used to handing premature birth cases and boasts of a 97 per cent survival rate, considering the gestational age, baby’s weight, immature organs and several other critical conditions that affected her including respiratory distress syndrome, anaemia and others, said doctors. The infrastructure and equipment at hospitals are mostly designed for babies born at the right gestation period – of 40 weeks – and hence, in cases of extreme-premature delivery, the line of treatment becomes a challenge, they added.

Dr Shah, though, was positive about the baby’s survival chances, recalled Ujwala who along with her husband Shashikant underwent counselling on how to feed the child.
The biggest challenge was of immature organs, which needed artificial support to help the baby recover. Authorities at Surya hospital had to modify the equipment available to help in organ support to suit the baby’s light weight and fragile skin.

On artificial life support, the baby was connected to a ventilator and given medications for lung functioning. For the first few weeks, she needed ventilation, including advanced mode of high-frequency ventilation. She also needed non-invasive respiratory support. But after 88 days, she was breathing normally. Special catheters were inserted into her belly button for sampling and administering nutrition. “Feeds were started through a specially designed tube inserted from mouth to stomach and increased slowly depending on the tolerance level. The baby reached full feed on day 16 via a feeding catheter. Oral feeds were initiated on day 76. The baby slowly started putting on weight and reached 1000 grams on day 51,” said a doctor. Since her skin was fragile, she was kept in a special incubator to prevent breakdown and fluid losses.

“We are ensuring that the baby meets all her growth and developmental milestones,” said Dr Shah.
Shivnaya was discharged from the hospital on August 23 last year.