A Milestone in Medical History "Heart surgery of world’s smallest baby"

Udaipur, A neonate of age only 15 days and merely 470 grams weight. He is almost the size of a palm. This pre-mature tiny toddle, born after a gestation period of 28 weeks seven months; pre-term delivery suffered from a very challenging & complex heart disease. He survived fighting all odds to be the first case in Medical History of the world. He being the lightest and youngest Indian underwent a successful heart surgery in Neonatal Intensive Care Unit (NICU).

S.P. Jain and his wife, Udaipur resident conceived after many years of marriage through IVF procedure from a nearby hospital. Fortunately she delivered by Lower Segment Caesarean Section (LSCS) procedure, in her 28th week of pregnancy. The baby developed breathing difficulties immediate after his birth. The baby was placed under the expert care of Neonatologist, Dr. Sunil Jangid of Jeevanta Hospital, in the state-of-the-art Neonatal Intensive Care Unit (NICU). The care of pre-term baby was really critical, especially as young as of 28 weeks of delivery and weighing only 470 grams. On initial investigation of Echo-Cardiography by cardiologist Dr. Ramesh Patel of Geetanjali Hospital, it confirmed that the baby suffered from a condition in which the two major blood vessels of heart- aorta and pulmonary artery were connected. The connection between the two arteries is present till the fetus is inside a mother’s womb. It automatically stops after the birth. If it doesn’t then is being treated with the help of medicines. But in this case, heart surgery was the last option available since it didn’t responded with medicines.

With the permission from parents’ as it was really a precious child for them, Jeevanta Hospital’s team decided to call Geetanjali Medical College & Hospital’s Cardio Vascular & Thoracic Surgeon Dr. Sanjay Gandhi who have already performed such operation of a neonate weighing 700 grams at GMCH and Jaipur’s Cocoon Hospital. Timely intervention and immediate assistance was required so Executive Director Ankit Agarwal, permitted their cardiac team to perform the operation in Jeevanta Hospital to save infant. Dr. Gandhi took only 30 minutes for the completion of successful surgery which further avoided the complications. With the help of cautery machine and surgical instruments, the connection was stopped using a clip and surgical sutures. The surgery also assured no internal bleeding.

It was the baby’s low weight that prompted doctors to operate in NICU only as the shifting from one hospital to another or from NICU to an operation theatre could be life threatening. “The journey from NICU to the operation theatre could be fatal for such micro-preemies as of tender weakness and low weight,” said Dr. Gandhi. Hence the team of surgeons and anesthetists, including Dr. Sanjay Gandhi, Dr. Ankur Gandhi, Dr. Kalpesh Mistry, Dr. Manmohan Jindal & Dr. Dharamchand; gathered in NICU to treat this condition. “It’s really a very difficult procedure because very small & specific instruments are needed to operate on such small children and resuscitate from a complex heart disease.”

“Nowadays, most PDAs closures are done with medicines, but only in rare cases heart surgery is required. It’s really encouraging that children so young and measly weight of less than 500 grams can be operated,” said Dr. Gandhi & Dr. Jangid. Dr. Sanjay Gandhi also claims and says, “It’s difficult to say off-hand, but he is the smallest baby to have undergone this heart surgery with the lowest weight in India as well as world.”

The surgery so operated need to be spread as a message that weight or a place like Udaipur, needn’t be the criteria for performing heart surgery on a neonate. For the parents, it’s not more than a miracle for their child being survived out of all the odds she had been through. “Thanks to God and doctors, my son survived though he had such low birth weight and a pre-term neonate”, said the parents for their prayers being answered.

Baby’s Health:

Born at 28 weeks of pregnancy and weighing 470 grams, is possible the lightest baby to survive in the world. He had weak muscles, rib cage and immature lungs. Brain, kidney, liver, heart etc. were weak. No immunity, more chances of infections and internal bleeding (due to noise/injecting doses with force) which may cause sudden death. He was supplied the essential nutrients and glucose through central line drip. The medicines given as surfactant may result in delay in growth, lungs diseases, brain development problems, hole in intestines, enlargement of liver etc.

Tiny toddle miracle the surgery:

He became the lightest in the world to undergo a PDA corrective operation. The previous cases so registered claims to operate on neonates weighing 550 grams, 580 grams & many in India. Out of every one thousand babies only 3 or 4 have a complex heart disease like this. The tiny toddle is recovering well and will grow like normal babies.