Dr. Hiren Doshi
Director - PICU & NICU
Nanavati Super Speciality
Dr. Suresh Birajdar
Joint Director, PICU & NICU
Nanavati Super Speciality
Hope for the Premature
The curious case of the NICU Team saving a 23
Globally, approximately 10% of all pregnancies result in premature
delivery even after the best of efforts taken by Obstetricians. The
survival of extremely premature babies (those weighing less than 1 kg
or born after less than 28 weeks of pregnancy) is even more challenging
due to the incomplete development of body organs and functions.
Babies delivered at the gestational age of 23-24 weeks are considered
to have borderline survival potential as their organs are extremely
immature. Recently, the Neonatal team at Nanavati Super Speciality
Hospital was presented with a challenging case of a neonate who was
born prematurely after 23 weeks of pregnancy (i.e. less than 6 months
of pregnancy). A team of highly dedicated Neonatal specialists and
state-of-the-art technology are essential for the nurturing of such
delicate lives. The NICU team at Nanavati is used to such challenges,
having managed to discharge babies as small as 550 gms (26 weeks of
It is a herculean measure to manage babies as small as the palm of
our hand. There are only a few case reports in our country where
babies born before 24 weeks have survived. This unique case of 23-
week old gestation baby who was discharged successfully signifies a
new milestone and sets the bar even higher for the future.
Mrs. & Mr. Kujur are residents of Tarapur, Palghar in Maharashtra.
The mother, Sunita, a 35-year-old woman with premature onset of
labour after 23 weeks of pregnancy was referred to Nanavati. This
was her second pregnancy with the previous child being 10 years old.
She had received a single dose of IV steroid for maturity of the foetal
lungs. The baby boy weighing 650 gms was delivered spontaneously
in the emergency department. The baby cried after birth, but the
breathing was laboured. He was intubated and put on a mechanical
ventilator for breathing support wherein he received two doses of
surfactant for lung maturity.
The baby boy responded to an initial management of surfactant
therapy, ventilation and intravenous fluids. Total parenteral
nutrition was administered through a central catheter. Maintaining
metabolic milieu and preventing infections are the biggest challenges
in micro-preemies. Early enteral nutrition with exclusive breast milk
was administered through a feeding catheter which was gradually
increased over the next few weeks. The parenteral nutrition was well
Mrs. & Mr. Kujur with Nanavati Hospital team
There is always a very fine balance to be maintained in these babies,
because of the high risk of Necrotising Enterocolitis (NEC) that can
be precipitated because of enteral feeds. Over the next 30 days, feeds
were gradually increased and breastfeeding was started by 35 weeks
of gestational age. In addition to two doses of surfactant, the baby boy
required a mechanical ventilator for 30 days due to premature lungs.
Post ventilator, he required non-invasive CPAP for around 60 days. At
the end of 3 months, the baby was breathing on his own with minimal
intermittent oxygen requirement administered intra-nasally.
Regular ultrasonographic scans were performed satisfactorily on the
baby. A presence of Retinopathy of Prematurity (ROP) was found during
regular evaluation of eyes by Paediatric Retina specialist. The infant
underwent regular investigations for sepsis and electrolyte levels.
He received transfusions of packed red blood cells, iron supplements
and erythropoietin for anaemia. For the prevention of Metabolic Bone
Disease (MBD) of prematurity, calcium and vitamin D supplements
were given to the baby. Inspite of multiple catheters, central lines,
prolonged ventilation, the baby did not acquire any major hospitalacquired
infection (HAI). This is an important measure of the success
of infection prevention protocols, especially when dealing with a micro
At the time of discharge, the baby weighed 2.7 kg and was on
breastfeed. He maintained adequate oxygen saturation by breathing
normal room air.