At Fortis Hospital Noida, a preterm (32 week) low birth weight baby (just 1.9 kgs) was born with a rare condition called Tracheoesophageal fistula (in which food and windpipe are abnormally joined together) and was having multiple associated life-threatening co-morbidities underwent corrective surgery to get new lease of life. His condition was part of an anomaly called Vacterl Anomaly, which is a rare condition. Pre-birth ultrasound revealed co-morbidities such as hole in the heart, right horseshoe kidney, neural tube defects in the spine and abnormal genitals.
Shortly after birth, the baby developed respiratory distress and was shifted to Neonatal ICU and was kept on oxygen support. The baby couldn’t be fed through a nasogastric tube as it got coiled in the upper food pipe (oesophagus). Initial Investigations – blood test, chest X-ray and 2D echocardiography confirmed Tracheoesophageal fistula and right horseshoe kidney (a condition when two kidneys are fused or joined together).
On the 2nd day after birth, the baby successfully underwent complex challenging surgery, considering prematurity, Low birth weight and associated multiple other congenital anomalies. However, the baby had a stormy postoperative period, wherein the patient developed pneumonia requiring prolonged parenteral nutrition and ventilatory support.
Dr Ashutosh Kumar Sinha, Director and HOD, Paediatrics, Fortis Hospital Noida said, “If such cases are not diagnosed and treated on time, they can have severe difficulties in survival and need to go for frequent hospital admissions for diseases like pneumonia. Apart from this, the mortality risk from infections is high if immediate medical intervention is not given.Tracheoesophageal fistula is a lethal congenital anomaly if the diagnosis is delayed. The incidence is reported in 1: 5000 births. Surgery and survival are challenging in these babies born with associated cardiac anomalies, pneumonia, and low birth weight. In our case, we opened the chest, divided the fistula (communication between the lower food pipe and the windpipe), and joined both the upper blind end and lower end together (Upper end of the food pipe was blind ending. Lower end of the food pipe was erroneously communicating with the trachea).”
“Survival of the baby would not have been possible without the coordinated and excellent teamwork of paediatric surgeons, specialised Anaesthetists, and Neonatology care. If these anomalies are not detected promptly or managed by inexperienced hands with suboptimal infrastructure, it may lead to an anastomotic leak, infection, and death, which can also lead to injury of the vocal cord leading to lifelong respiratory and feeding problems,” Dr Sinha added.
Talking about the case, Dr Dharmendra Singh, Paediatric Surgery, Fortis Hospital Noida said “The challenge in the case was to bridge the gap between the two ends of the esophagus after dividing the fistula, as the gap was quite wide and tissues were very fragile. It was only possible by complete mobilization of the upper end of esophagus and the support of our skilled anaesthetist team who remarkably managed fluctuating oxygen saturation during surgery. However, Considering the tension at the anastomosis ( joint between the two ends of esophagus) patient was electively ventilated with neck flexed to relieve the tension at the anastomosis and facilitate healing. Thankfully, we have a good infrastructure and team of skilled anaesthetists, neonatologists and dedicated nursing staff, to manage and save such challenging cases.”
Mohit Singh, Zonal Director, Fortis Hospital, Noida said, “It was a very challenging case considering the critical condition of the infant. Many risk factors made the infant’s chances of survival bleak, owing to the multiple comorbidities. Despite all the odds, the doctors at Fortis Hospital Noida under the guidance of Dr. Dharmendra Singh and Dr. Ashutosh Kumar Sinha gave a new life to the infant by adopting a multi-disciplinary approach.”
Under the clinical care of the Doctors’ team, the baby survived all odds and was discharged post 12 days of intense treatment and care.