Dr. Gaurav Agrawal
BLK Heart Centre
BLK Super Speciality
Hospital, New Delhi
“I am very grateful to NICU
and CTVS team for their kind
support in managing the baby’s
condition from admission till
discharge” . - Dr. Agrawal.
Bringing Back A Hearty Smile
An Untiring Team Effort Cures A Cardiac
Hole in a Low Weight Pre-term Baby
A 27-week, 2 days pre-term male baby with extremely low birth weight was
referred to BLK Super Speciality Hospital. The baby was on oxygen support
and had been diagnosed with acyanotic congenital heart disease (large Patent
Ductus Arteriosus). His weight was 1.2 kg at the time of admission. Before
being brought to BLK Super Speciality Hospital, the baby had received a
dose of surfactant for respiratory distress syndrome in another hospital. On
examination, the baby was found to be suffering from Tachycardia, Tachypnea
with 96% saturation on room air on oxygen support. The baby had bounding
peripheral pulses. The baby was admitted in NICU and was started on nasalCPAP.
Later, the baby was shifted to heated, humidified high-flow nasal
cannulae. Oral furosemide and oral caffeine along with tube feeds were also
started. Sepsis screen test was also done which showed negative results.
Bedside ECHO showed a large PDA of 3.6 mm, shunting left to right with
hugely dilated LA / LV. LA-aorta ratio was 3:1. CTVS reference was taken,
and after careful planning, the baby was prepared for a surgical ligation
for PDA correction. Double ligation of PDA was done via left postero-lateral
thoracotomy with controlled hypotension on day 28th of the baby’s life.
Post-operative echo showed no residual PDA with good LV / RV function. After
the operation, the baby was continued on mechanical ventilation (PCV-VG)
along with antibiotics and inotropes, which were gradually tapered off. Blood
gases showed worsening respiratory acidosis, hence the baby was shifted to
high frequency ventilation. Chest X-ray also showed bilateral infiltrates that
were also worsening. Tracheal secretions culture were sent, and antibiotics
were upgraded. Gradually, the baby improved both clinically and radiologically,
and was weaned off and extubated on day 33. Tracheal secretions culture was
found to be sterile, and later antibiotics were stopped.
On day 38, the baby again started showing signs of worsening respiratory
distress and therefore was shifted to a non-invasive mode of ventilation
(nIMV). Later, chest X-ray was taken; however, the result was unremarkable;
subsequently, he was again weaned off to heated, humidified high-flow nasal
cannulae on day 40. Over the course, the baby had intermittent episodes of
desaturations and persistent oxygen requirement that gradually decreased
over time and therefore the baby was weaned off to room air on day 57. The
baby continued showing signs of improvement, and as a result, caffeine was
discontinued on day 62.
At the time of discharge, the baby’s weight was 1.87 kg, and he had good
acceptance of palade feed. There were no further episodes of apnea and
bradycardia. His follow-up checks have been promising, and the baby is
doing well and gaining weight.