Baby 'Shivansh,’ Undergoes 3.5-hour-long Surgery For Rare Birth Defects At Nanavati Max Hospital
A baby boy, born with a rare congenital defect that displaced his internal organs including intestine, heart and lungs underwent three-hour-long life saving surgery at Nanavati Max Super Specialty Hospital, Mumbai recently. After seven days of ventilator support and 23-day long around-the-clock neonatal care, baby ‘Shivansh,’ is now healthy and recovering well.
The baby boy was detected with extremely large Congenital Diaphragmatic Hernia (CDH)—a rare condition in which the fetus’s diaphragm (thin muscle layer that separates the chest from the abdomen) develops a gap during its antenatal development. The condition was detected during sonography, done in the 24th week of pregnancy at a primary nursing home.
Being a rare condition, CHD is associated with a high mortality rate. The incidence rate for CHD is about 2.6 per 10,000 births with over 30%-40% mortality.
“Considering the fetal complications and need for advanced obstetric and neonatal care, we were advised abortion or transfer my wife to a tertiary care medical facility. We were relieved upon visiting Nanavati Max Hospital as, after primary diagnostic tests, doctors explained to us the mother and baby’s condition and the well-defined line of treatment,” said Krishna Singh, baby’s father.
Dr. Suruchi Desai, Senior Consultant, Gynaecology and Obstetrics who treated the mother and child said, “CDH caused fetus’s bladder, intestines, spleen and even part of liver to shift and occupy the chest cavity, pushing heart and lungs to the right side. The condition often results
in the underdevelopment of lungs and affects the functioning of the heart, liver, and intestine. Moreover, we had an obstetric challenge as the mother had undergone two cesarean section surgeries in the past.”
Dr. Desai, along with Dr. Tejal Shetty, consultant neonatologist and pediatrician, and Dr. Kant Shah, consultant pediatric surgeon, started monitoring the fetal growth to ensure safe delivery. Dr. Desai’s team successfully delivered the baby boy, weighing 3.1kg through a cesarean section in the 38th week of gestation.
“We intubated the baby immediately after the delivery and used mechanical ventilation to support its compromised heart and lungs. Within 24 hours, the child’s health parameters stabilized and he was fit to undergo the surgery,” said Dr. Shetty.
Dr. Shah’s team then performed a complicated three-and-half-hour long, minimally invasive, ‘thoracoscopic repair of diaphragmatic hernia,’ surgery. “We first repositioned the internal organs such as bladder, intestines, spleen, and liver to their ideal anatomical positions. Followed by repairing the diaphragm by attaching it to the rib cage as a permanent solution. In order to achieve faster recovery and minimize possible complications, we opted for minimally invasive surgery, performed through three small incisions measuring just 3mm each,” said Dr. Shah.
After the successful surgery, the baby returned on ventilator support, and his vitals were closely observed for possible signs of complication. A day after the surgery, the baby developed respiratory distress and his oxygen saturation dropped. “We immediately performed an X-Ray and detected Pneumothorax—a serious lung condition that forces the lung to collapse. Pneumothoraxes are more likely to occur in neonates with CDH associated with a large defect of the diaphragm due to the excessive pressure on the lungs by other abdominal organs. We successfully managed the condition and the baby was weaned off the ventilator in five days and was put on Continuous Positive Airway Pressure (CPAP) machine,” said Dr. Tejal Shetty.
After 23 days of constant monitoring, the baby’s breathing, heart rate, digestion, and all other vital functions returned to normal and he was fit to be discharged.
The Baby’s parents Juhi and Krishna were ecstatic with the recovery of their child. “We never lost hope, even when we were informed about the condition of our child the first time. The team of doctors and nurses tended to our baby with unparalleled dedication. We are thankful,” said the duo.
Dr. Deepak Patkar, Director (Medical Services) and Head Imaging, said this was the first thoracoscopic surgery on a newborn baby performed at Nanavati Max Super Specialty hospital. “Seamless inter-departmental coordination between obstetrics, neonatal intensive care, and neonatal surgery enabled us to save the life of the baby boy, detected with a rare congenital anomaly. The advent of advanced minimal access surgical interventions such as robotic and laparoscopic surgery has made it possible to save many young lives, with complicated birth defects. We wish the baby boy a healthy life ahead.”
