Rare Feet: Born At 23 Weeks, Pre Term Baby Of 380 Grams Saved By Cloudnine Hospital

Baby also needed special catheters called central lines to be put in tiny blood vessels to give nutrition and monitor blood pressure.

At 23 weeks of life, most of the organs of a fetus are not properly developed and as the chances of survival of such premature babies are very slim.
At 23 weeks of life, most of the organs of a fetus are not properly developed and as the chances of survival of such premature babies are very slim.

After suffering through multiple pregnancy failures, Shalini & Rahul (name changed owing to confidentiality) believe they have a miracle in hand. Their son, Aman (name changed), born prematurely at 23 weeks was finally discharged after a 120 days (4 months) of stay in neonatal intensive care unit at Cloudnine Hospital, New Delhi, Punjabi Bagh. At birth, Baby had breathing difficulty for which baby needed ventilatory support. Baby also needed special catheters called central lines to be put in tiny blood vessels to give nutrition and monitor blood pressure. Baby remained in the NICU for 120 days since his birth in February 2022.

The baby was born to 32 year old primigravida mother with birth weight of just 520 grams through an emergency C-section because of maternal bleeding and hence no steroids could be given to mother (23 weeks of gestation is at 5 and half months of pregnancy). However within 2 weeks, the weight of the baby dropped to 380 gram. Steroids help baby to breathe better and reduces risk of infections.

A team of doctors at Cloudnine Hospital, Punjabi Bagh led by Dr Abhishek Chopra, Consultant Neonatologist and Pediatrician along the NICU team managed the baby throughout the 120 day stay at the NICU.

According to Dr Abhishek Chopra, Consultant Neonatologist and Pediatrician, Cloudnine Group of Hospitals, Punjabi Bagh, “32 year old Shalini (name changed) 23 weeks pregnant came to the hospital in an emergency, with bleeding. This was a very early pregnancy, but parents were keen to continue despite the fact that survival at such low extremely gestational age is very rare. After the birth of baby, as per the NICHD calculator which is currently one of the best available tool to predict outcomes in such small babies, the chances of survival of such a baby is only 10%. After counselling the family all the necessary intervention was given to the baby. At 23 weeks most of the child’s organs were not formed properly. B/O of shalini at birth was received in plastic bags to prevent baby from becoming cold and later was put in an incubator which is a closed acrylic cabinet where circulating warm air helps to maintain normal temperature and prevent excess weight loss. But still the weight dropped to as low as 380 grams. Baby spent only 18 days on ventilation through the tube in wind pipe and rest of the days through ventilation through nose. This was a big achievement as western research data shows that nearly 90% of such babies remain on ventilator through tube for average duration of at least 4 weeks.”

Giving the details says Dr Chopra, “Nutrients like dextrose, fat, proteins, minerals and vitamins were given through the central catheters. Baby was also started on feeding through a tube put into the stomach. Immune system of these babies is very weak and so extra care was needed to prevent infections. Kangaroo care is a care in which baby and mother are in continuous skin to skin contact with each other. This helps to increase mothers milk production, decreases risk of infections, helps in weight gain and improves long term neurologic outcomes. Average duration spent by mother doing kangaroo care was 6 hours a day and was done even when the baby was on ventilator. Repeated brain scans were done to look for bleeding in brain and also repeated eye examinations were done to look for normal retinal development.”

Adding further “Baby was started on oral feeding through spoon when baby was 10 weeks old and baby was shifted from CPAP (positive pressure given through nose) to simple oxygen 15 days before discharge. Baby was discharged after 20 weeks of stay in the Neonatal intensive care unit (NICU) due to utmost maternal dedication, team effort by doctors and excellent nursing care with nurses being the backbone of any intensive care unit.

Infections in blood, in the lungs and bleeding in brain are immediate threat to life for which bundle approach which is combining many good evidence based practices was successfully implemented. At discharge, baby weighed 3.2 kg, was on minimal amount of oxygen 0.1l/min given through nasal prongs. Baby will be closely followed up to look for developmental mile stones and stopping of oxygen therapy.

While cases related to extreme premature birth have been reported earlier, the successful result in this case is wholly credited to the hospital’s systematic clinical expertise, pediatrics and fetal medicine and the advanced medical care at Cloudnine Hospital.  At 23 weeks of life, most of the organs of a fetus are not properly developed and as the chances of survival of such premature babies are very slim, many parents and even doctors believe that these babies cannot survive. But with advancement of medical science, such micro preemies can be offered care.

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