Successful management of 26-week-old premature infant with multiple complications at Jehangir Hospital

Pune (Maharashtra) [India], August 2: This case study examines the remarkable journey of a 26-week-old premature infant, weighing a mere 760 grams, who received exceptional medical treatment at Jehangir Hospital. Known for its specialised multidisciplinary team and advanced tertiary care unit, the hospital successfully addressed multiple complications faced by this vulnerable baby. The couple came all the way from Bihar and the mother was at 26 weeks of gestation with twin pregnancy for correction of blood vessels which were interconnected resulting in one baby being growth restricted. The second baby also had a very rare abnormality called Fetal Acadia where the baby did not have a heart and the upper part of the body starting from the chest, upper limbs, neck and head were not formed. Along with this there was also a big fluid filled swelling at the place where the chest was to be formed. Dr Jyotsna Angom, Consultant Obstetrician and Gynecologist at Jehangir Hospital said “There was excessive fluid accumulated in the uterus causing overdistention and extreme discomfort to the mother. When she reached the hospital she was in advanced stage of labour and immediately delivered the 1st baby. The 2nd twin was stuck because of the large swelling.

Decompression was done under the guidance of ultrasound and an extremely abnormal babywas delivered.”
The baby was born extremely prematurely and exhibited unstable conditions upon admission. The initial challenge was the underdeveloped lungs, leading to difficulty in breathing. To address this issue, the medical team initiated ventilator support and administered surfactant medication to expand the airways and improve respiratory function. However, the baby continued to experience intermittent symptoms, requiring ongoing ventilator support for survival.
After one month, the baby’s health showed significant improvements, as evidenced by a normal X-ray. At this point, the medical team transitioned the baby to CPAP support, which was provided for the next 2-3 weeks. Oxygen support remained necessary for an extended period of approximately two months, starting from admission.

Dr Sagar Lad, Consultant Senior Paediatrician and Neo-Natal intensivist added, “One notable complication that arose during treatment was Patent Ductus Arteriosus (PDA), a heart defect commonly observed in premature infants. Our team attempted to administer medication to close the duct, but the baby’s low platelet count posed challenges in completing the course of treatment. However, towards the end of the second month, conservative measures, including medication to reduce fluid buildup and alleviate pressure on the heart, were successful in achieving closure of the duct. Another challenge emerged when the baby developed feeding intolerance due to gastroesophageal reflux. However, the medical team successfully addressed this issue.”

Additionally, due to the prolonged period of oxygen support, extreme prematurity and low birth weight the baby developed retinopathy of prematurity (ROP), a condition affecting the eyes. The condition was promptly identified and treated with medication to prevent further complications. Adding to this condition of ROP in the infant, Dr Vrushali Athawale, consultant ophthalmologist at Jehangir Hospital said, “Because of the need for oxygen the baby developed retinopathy of prematurity (ROP) which is a potentially a blinding disease of the retina occurring in premature infants. The baby was screened and was given timely treatment in the form of retinal laser in both the eyes and intravitreal injections, given twice in both the eyes. After the treatment the retinopathy of prematurity regressed and the baby is expected to have good vision in the future.”

After three months of meticulous care and treatment, the baby underwent a series of examinations, including X-rays, brain function assessments, sensory evaluations, and ultrasound scans. The results were encouraging, revealing no signs of complications. Furthermore, the baby’s weight had increased to 1.9 kg upon discharge.
The successful management of this extremely premature infant with multiple complications required exceptional medical care, innovative interventions, and the support and understanding of the parents. The multidisciplinary team at Jehangir Hospital demonstrated unwavering dedication and expertise in providing the necessary medical support throughout the treatment process.

This case study highlights the successful treatment and recovery of a 26-week-old premature infant with multiple complications at Jehangir Hospital. “The hospital’s specialised team, equipped with advanced facilities, demonstrated effective administration and provided meticulous care, resulting in improved health and favourable outcomes for the baby. The case emphasises the importance of comprehensive and compassionate care in managing complex medical conditions in premature infants.” said Vinod Sawantwadkar CEO Jehangir Hospital.