A tale of courage & fight by extreme low birth weight baby ( weighing only 520 grams), 12 days old who underwent a critical abdominal surgery at Jivanta Children’s Hospital, Udaipur. Her name is Jhanvi and she is the smallest baby ever operated and survived not just in India but in the whole South Asia.
INSIGHT: The baby girl, Jhanvi, was born to proud parents Umesh and Madanlal Arya, hailing from Nijampur Magrouni , Dist- Shivpuri, Madhya Pradesh. It’s the greatest gift from God to see their four months old survive the odds and come home from the Neonatal ICU at Jivanta Children’s Hospital, Udaipur.
Conceived after 29 years of marriage by IVF technique . Her pregnancy was carried upto 26 weeks when her blood pressure was uncontrollable and the ultrasonography revealed severe growth restriction and reversal of blood flow to fetus. Because the blood flow to the baby was decreasing, she was taken up for emergency caesarean section.
Jhanvi was born premature just at 26 weeks of pregnancy (Normal pregnancy duration 40 weeks) on Feb 13, 2018. At birth, she was just about the size of your palm. This baby was very precious and the only hope for the family . The baby was handled and looked after in the Jivanta Children’s Hospital- Neonatal ICU with precise care under Chief Neonatologist Dr Sunil Janged , Dr Nikhilesh Nain, Dr Kapil Shrimali and trained nursing team. She was struggling to breathe, so was immediately put on ventilator and given medicines to expand his tiny , immature lungs.
WHY SURGERY: Dr Sunil Janged told “ There was progressive distention of her abdomen along with greenish aspirates and we were not able to start feeds. We tried all sorts of medical therapy , on day 12 of life baby deteriorated so badly, developed tense abdominal distention , skin of abdomen was turning bluish, heart beats and blood pressure started dropping. Investigations showed grossly dilated intestines with infection . Her body system was shutting down. We knew that baby won’t give us much time, so operation was the only resort left to us. Major surgery on such a tiny baby with such poor condition was very much difficult and challenging scenario for our team . But this baby was the only hope for the family . Pediatric surgeon Dr Praveen Jhanwar, anaesthetic Dr Suresh and OT staff carried out emergency abdominal surgery under general anaesthesia which lasted for 1 ½ hours.
Dr Praveen said –“ She was smaller than my hand when we operated on her. The intestines were grossly distended and started turning black. Majority of intestine was filled with thick meconium [stool] . The meconium was so thick and organised [Meconium ileus] causing intestinal obstruction . We could not remove it out by milking the intestines. So we had to cut the intestine and remove it. Her organs were so delicate and fragile that as soon as we started operating, even with our small instruments, everything started to bleed and fall apart. Intestinal wall was not able to take the sutures. Dead tissue was removed, abdomen was thoroughly washed and wall closed with lot of difficulty.”
Dr. Sunil Janged further said that she would have been dead without the surgery. Its very tedious job to operate such small baby weighing only 520 grams as babies born this small have extremely poor function of all body organs like heart, lungs, brain, and kidney. It’s like walking on a two edge sword.
POST OPERATIVE HEALTH BULLETIN OF BABY: Dr. Sunil Janged informed that post-operative course was like rollercoaster. During this period, ,baby had a tube passed through his nose to drain off the contents of intestines. Baby kept nil by mouth for 10 days. We had to start the baby on total parenteral nutrition, which basically means giving all the essential nutrients such as amino acids, lipids, carbohydrates, minerals, multivitamins and trace elements directly into blood circulation. There have been lot of hurdles, infections, blood transfusions along the way. Regular screening of heart & brain were performed to rule out any bleeding in brain. Gradually started with few drops of milk through tube and slowly feeds increased. This small baby required respiratory support for a period of about 54 days. She was able digest milk after 1 month and started drinking from spoon only after about 3 ½ months of birth.
In all, she was in the NICU for almost 117 days and today her weight was close to 2110 grams. By far the progress and clinical course in the NICU was very satisfactory .Her brain is structurally normal and eyes are also developing normal. Expressing her joy, Jhanvi’s mother, Umesh exclaimed, “We had completely lost hope until we met the doctors at Jivanta Hospital.But we had full faith on the team as previously Jivanta Hospital had saved baby weighing just 400 grams. After going through so many odds, she finally is coming home. I am extremely thankful to the team of experts at Jivanta Hospital who took immense care of her.
Expert comments- Senior Professor & Head Neonatology, Pune Dr Pradeep Suryawanshi has examined published literature and spoken to pediatric surgical colleagues and says he believes she is the smallest baby to survive major abdominal surgery in India and the whole of South Asia. In the whole world only 4-5 babies weighing less than 500 gms and who underwent major abdominal surgery have been survived till date. He said even with all care it entails a very high mortality ranging from 60-80% . As this baby was weighing only 520 grams , chances of survival were less than 10% in this case.