Preterm babies are always a challenge as their systems are not fully developed for them to live on their own. It requires a very specialised team with a multi disciplinary approach to take care of the situation.

A baby girl with the gestational age of 24 weeks 5 days (4 months early) and with a birth weight of 550 grams born to a mother with gestational diabetes and hypothyroidism on 06/11/2020 by emergency LSCS. Appropriate resuscitation was done, intubated, surfactant (Curosurf) was given, and she was connected to a ventilator and shifted to Neo Natan Intensive Care Unit (NICU).

Respiratory System

The baby was kept on ventilator support and extubated on the 3rd day of life and kept on CPAP (Continuous Positive Airway Pressure). After few weeks, CPAP pressure support gradually decreased and started cycling with CPAP and HFNC (High flow nasal canula). Currently, the baby has been self-ventilating on room air, and has not required ventilator support after day 3 of life.

Digestive System

The baby was started on IV fluids, TPN, and IV antibiotics. Minimal tube feeds (milk) were started from day 2 of life and feeds were gradually increased. The baby developed abdominal distension and tenderness, greenish stomach aspirates, and was diagnosed to have NEC (Necrotizing enterocolitis). 

The team treated this infection with appropriate antibiotics and feeds were stopped.  The baby improved clinically and feeds restarted and gradually increased. All feeds given via an orogastric tube. Eventually, the baby was given paladai (Cuplike utensil used to feed babies who cannot breastfeed on their own) feeds and reached full oral feeds. Presently baby is accepting full oral feeds 3rd hourly.  The baby has been passing urine and stools regularly. 

Neurology
On day 1, the baby had signs of infection (CRP positive). CSF (Cerebrospinal fluid) analysis done and was suggestive of meningitis and treated appropriately. In view of frequent regurgitation of feeds, anti-reflux medications started and continued. 

Other Systemic Issues

During the initial days, there were metabolic problems like low calcium, low sodium which was treated accordingly. Jaundice was present during the initial days and treated with phototherapy. In view of low hemoglobin (Anemia of prematurity), the baby was given red cell transfusions during the hospital stay. Eye screening (ROP) was done at regular intervals as per protocol and was normal. Neurosonogram initially showed grade I bleeding but in the subsequent scans, this bleeding had resolved. Echocardiogram and hearing screening were normal. Received vaccination after reaching appropriate weight.

First and a maiden 24-week baby born at Medicover Woman and Child Hospitals. It was a very challenging case and everyone in-hospital team took great care in looking after this baby. Baby proved to be very strong and managed to pull through all the difficult days.  She has no complications related to prematurity as of now and going home today successfully. Currently, the baby’s weight is 2.32Kg and she is 140 days old. 

By

Dr RAVINDER REDDY PARIGE

MD (Pediatrics).MRPCH& FRCPCH (UK), CCT (UK)
H.O.D-NEONATOLOGY & PEDIATRICS
CONSULTANT NEONATOLOGIST 
MEDICOVER WOMAN & CHILD HOSPITAL