CK Birla Hospital for Women, becomes the first hospital in Gurugram to successfully deliver, nurture and discharge an extremely premature baby born at 24-weeks’ gestation. After spending only 86 days in NICU which is a record feat for a baby born so early. The baby girl born with a birth weight of 690 grams came into the world a little too early. She was discharged healthy and successfully from the hospital last week
Worldwide data puts the median length of stay for babies born at 24 weeks to be around 123 days i.e. 41 weeks corrected gestational age. In this case, the hospital could discharge this 24-week gestation baby in a record time of 86 days, i.e. at 37 weeks corrected gestational age.
The baby’s mother had severe oligohydramnios (very low levels of amniotic fluid) that resulted in the early delivery. She was admitted and treated conservatively for the first 3 days with round the clock maternal and fetal monitoring. Antenatal steroids as well as fetal neuro protective drugs were started as per the protocol. Antenatal counselling was done by the neonatologists to ensure the parents were prepared for the course of treatment for the premature baby and the associated risks.
“This case gives hope to thousands of parents with high risk pregnancy and subsequent risk of prematurity as most of the times babies born before 26 weeks are not even given a chance to fight for their survival. Delivering a baby at a tertiary care hospital with fully equipped infrastructure and antenatal preparedness increase the chances of survival manifold,” said Dr Saurabh Khanna, Neonatologist, CK Birla Hospital for Women.
The baby had several health challenges at the time of birth. Her lungs were immature. She was put on respiratory support from the delivery room itself. She was shifted to the ICU in an incubator which made sure that she had minimal exposure to noxious stimuli- Light, sound, temperature fluctuations. The hospital ensured developmentally supportive care to simulate the womb environment as closely as possible.
“The babyhad an incredible journey in our NICU and fought bravely against all odds posed by prematurity. Since she was extremely premature, she often forgot to breathe, a condition known as apnea of prematurity, so we had to be on our toes all the time. This condition requires immediate attention with the change in ventilatory settings and medications. Owing to the immature lungs, she required respiratory support, initially invasive for 7 days, and then non-invasive till 68 days of life.” Said Dr Shreya Dubey, Neonatologist, CK Birla Hospital for Women.
The baby also required multiple blood transfusions in view of the anaemia of prematurity. She also successfully underwent laser photocoagulation for Retinopathy of Prematurity. She was started on intravenous nutrition as her intestines were not fully developed. Only when she was 56 days old, she started tolerating full oral feeds.
The baby was discharged last week at 86 days of life at a weight of 1740 grams and a corrected gestational age of 37 weeks.
“Our Level 3 NICU with double walled incubators, state of art ventilators, 1:1 skilled nursing care and 24*7availability of trained doctors, is fully-equipped to handle extremely premature babies. Apart from providing protocol based individualised care to every extremely low birth weight baby(ELBW), we focus on developmentally supportive care and a family centred approach. It is not only integrated in the hospital care, but we continue to support the families, post discharge, as well. The hospital strongly believes that expressed breast milk and Kangaroo Mother Care as soon as the baby is ready are gold standards for ELBW management. We ensure transparency during our counselling sessions and try and make the parents comfortable in handling their tiny babies. Before discharge, we make sure the parents are confident enough to take care of their wards by giving them a 3-day transition by moving the baby with the parents in a hospital room,” continued Dr Shreya Dubey.
Dr Dubey further added, “The healthcare system in our country is so overburdened that the babies requiring such intensive care are often neglected but antenatal preparedness is half the battle won. Awareness about prematurity is the need of the hour. The chances of neurologically intact survival of an extremely preterm baby will increase only if we invest our resources and manpower into this.”
According to WHO, India tops the list of 10 nations contributing 60 percent of the world’s premature deliveries – 3.5 million babies, i.e. 24 % of the total live births are born before term gestation every year in India. While WHO defines ‘preterm’ any baby born before 37 weeks of completed gestation, in India, viability is defined beyond 28 weeks and the extremely premature babies (24-27 weeks) are not even counted by the statistics. The babies born before 25 weeks require the most intensive care in a well-equipped tertiary neonatal intensive care unit. The survival rate without disability for a baby born before 25 weeks in India is only 5%.