Thursday, June 27, 2019

Fetal Medicine achieves a new milestone in India with successful Pulmonary Sequestration Treatment

Dr Jui Mandke, Consultant Paediatric Surgeon,Dr. Vandana Bansal- Director, Fetal Medicine Dept, Surya Hospitals, Dr. Bhupendra S Avasthi, MD & Founder, Surya Hospitals, Dr. Hari Subramanium


•          A multidisciplinary team of Surya Hospitals performed a complex surgery to save a Preterm baby suffering from a life-threatening Lung disorder  

Mumbai, June 27, 2019 :Fetal Medicine in India achieved a new milestone with a successful surgery to save a preterm baby who suffered from life-threatening lung abnormality- Pulmonary Sequestration. A 36- year old woman with 27-weeks of pregnancy was admitted at the Fetal Medicine Department of Surya Hospitals after having diagnosed with serious fetal complications. A multidisciplinary team of experts swung into action and performed one of the most complicated procedures to save a newborn who is now responding well to the treatment. Experts are monitoring his health closely for the last six months.
Detailed fetal ultrasound evaluation revealed generalized swelling around the fetus with severe fluid accumulation around the left lung. The condition was severe enough to displace the heart to the right side of the chest. The fetal lung abnormality was diagnosed as extralobar pulmonary sequestration (PS) which is a mass of non-functional lung tissue separate from the normal lung inside the pleural cavity and having a distinctive blood supply. A large mass can often cause severe heart failure, hydrops (fluid accumulation in the fetus), mechanical compression on the heart and major blood vessels and could result in stillbirth.
Talking about the complexity of the case, Dr. Bhupendra S Avasthi, Founder & MD, Surya Hospitals said, “Pulmonary lobectomy is surgical removal of the sequestrated lobe of the lung and it is a treatment of choice. The chance of survival in a preterm baby with a large PS is reported to be as low as 20-25%. Most of them may not even survive to undergo definitive surgery.”
The family was explained about the prognosis for survival and long term outcomes. The worst prognostic marker In-utero in this fetus was a large lung lesion and the presence of hydrops. Urgent drainage of the pleural fluid was considered necessary to relieve the mechanical compression of the heart and attempt to salvage the fetus In-utero for longer period of gestation. 
After a detailed joint consultation with the feto-maternal medicine specialist and neonatology team, a shared decision for pleural fluid aspiration was undertaken and 90ml of pleural fluid was tapped under ultrasound guidance. However, the pleural fluid re-accumulated within 24 hours of the fetal intervention and hence it was planned to deliver the infant by cesarean section before further fetal compromise.
“After a series of discussion over choosing the right procedure, we zeroed down on repeating the procedure of pleural tapping just prior to delivery. We very carefully took this call in order to improve the neonatal resuscitative measures and provide time for the neonatal intubation and inter-costal drain placement”, said Dr.Vandana Bansal, Director, Fetal Medicine Department, Surya Hospitals.
On 2nd December 2018, the patient underwent an elective cesarean delivery after a repeat procedure of pleural tapping. The patient gave birth to a male child weighing 1.675 kg (of which 600 gms was estimated to be fluid related weight) with generalized swelling all over the body. The baby did not cry immediately after birth and was ventilated in the delivery room and immediately transferred to the neonatal intensive care unit (NICU) at Surya Hospital for further management.
According to Dr. Nandkishor Kabra, Director NICU, Surya Hospitals, “The infant required high-frequency ventilation, surfactant and insertion of chest drains within the first 30 minutes of age to expand the lungs. We conducted a CT scan of the chest as required to confirm the abnormality and also to establish the location and blood supply of the mass prior to surgery. After initial stabilization in the NICU, the baby underwent surgery (thoracotomy) on the 8th day of life for resection of the sequestrated lung mass.”
Dr. Jui Mandke, Paediatric Surgeon, Surya Hospitals states, this baby require a timely thoracic operation with removal of the abnormal lobe of the lung. This requires a highly skilled, precise surgery because if the delicate blood vessels of the lobe get avulsed, there is a torrential blood loss, resulting in loss of life in such a precariously placed baby. Equally important is the paediatric anaesthesia team (CAS). 
 A multidisciplinary team comprising of neonatologists, feto-maternal medicine specialists, paediatric surgeon, radiologist, cardiologist, and physiotherapist were involved in the treatment and care of the infant. He needed ventilator support for a period of 7 weeks in NICU. Full oral feeds were achieved by 8 weeks of age. Meticulous monitoring and management of infections, feeding, and nutrition was also undertaken. Follow up ultrasound of the brain, lung, and heart was found to be normal. The baby was finally discharged on 4th Feb 2019 (65th day of life) with a weight of 2 kg. The infant’s growth and development are normal.
The case highlights the enhanced capabilities of Indian experts in dealing with complex and critical diseases. The breakthrough offers hope for better paediatric treatment and care. PS account for 1-5% of all congenital lung malformations. Large sequestrations are mostly symptomatic and present in the fetal or new-born period. Expert antenatal surveillance and delivery in a centre with level 3 NICU, paediatric surgery and specialty services will be extremely essential to save such newborns.

About Surya Hospital
Surya Hospitals, India’s leading super specialty hospital chain for women and children presently operates three state-of-the-art hospitals in Mumbai, Pune, and Jaipur. Surya Hospitals has a capacity of over 400 beds across its network of hospitals.  Established in the year 1983 by eminent paediatrician Dr. Bhupendra S Avasthi, Surya Hospitals offers one of the largest NICU facility in private sector and has become a center of excellence for high-risk pregnancies over the last 3 decades of offering clinical excellence.
With successful outcomes for the highest risk babies and numerous first to its credit, Surya Hospitals is a fully integrated women and child care facility with Level 3 NICU and experienced team of paediatricians, paediatric super-specialists, paediatric surgeons, fetal medicine experts and reputed gynaecologists & laparoscopic surgeons. Surya Hospitals is one of the few NICU in India that accepts pre-term babies less than 24 weeks of gestation. 
Surya Hospitals is also one of the reputed leading hospital recognized by National Board of Exams for paediatrics, neonatology, and paediatric intensive care for the last 10 years.

30 comments:

  1. Defending champions West Indies will play their first Super 12 group stage match against New Zealand on October 25 in Melbourne. Windies had won the competition in 2016, held in India, after beating England in the final in dramatic fashion. Watch Live Cricket

    ReplyDelete
  2. Australia, Pakistan, West Indies, New Zealand and two qualifiers make up Group 1 of the Super 12s. India, England, South Africa Afghanistan and two qualifiers make up the other group. SportsALA


    The first semi-final will take place at the SCG on November 11, with Adelaide Oval hosting the second semi-final the following night. The final will be played at the MCG on November 15

    ReplyDelete
  3. Surya Hospitals, India’s leading super specialty hospital chain for women and children presently operates three state-of-the-art hospitals in Mumbai, Pune, and Jaipur. Surya Hospitals has a capacity of over 400 beds across its network of hospitals.Smartcric

    ReplyDelete
  4. This comment has been removed by the author.

    ReplyDelete
  5. Established in the year 1983 by eminent paediatrician Dr. Bhupendra S Avasthi, Surya Hospitals offers one of the largest NICU facility in private sector and has become a center of excellence for high-risk pregnancies over the last 3 decades of offering clinical excellence.Smartcric IPL 2020

    ReplyDelete
  6. A very good and nice Article, We appreciate your hardwork and passion. If any cricket fan is looking and waiting for Live Cricket Streaming, you can watch Smartcric Live Streaming for free from anywhere on your smartphones & Tablets.

    ReplyDelete
  7. HP Service Center in Noida - Do you have HP Laptop and facing any problems then you can Contact Now +91-8527118177.

    ReplyDelete
  8. HP Service Center in Ghaziabad - Do you have HP Laptop and facing any problems then you can Contact Now +91- 9899772714.

    ReplyDelete
  9. HP Service Center in Ghaziabad - Do you have HP Laptop and facing any problems then you can Contact Now +91- 9899772714.

    ReplyDelete
  10. HP Service Center in Delhi - Do you have HP Laptop and facing any problems then you can Contact Now +91- 9899772714.

    ReplyDelete
  11. Thanks for your page! Your share information it helped me alot! Lenovo Service Center Ghaziabad

    ReplyDelete
  12. Lenovo Service Center in Noida - If you are find lenovo laptop repair service center you can call us 8527118177.

    ReplyDelete
  13. Chez Fécamp Services, nous fournissons non seulement de nombreux services à la personne, mais nous travaillons également avec un réseau d'entrepreneurs réputés lorsque l'ampleur d'un projet dépasse nos capacités.

    ReplyDelete
  14. Un expert electricien est à votre services 24h/24

    ReplyDelete
  15. House Design and build your own custom design, graphic or website from scratch. The web designer uses a lot of Google tools for this purpose Home Renovation

    ReplyDelete

  16. Watch T20 World Cup Live Streaming Online In High Quality.
    T20 World Cup Live


    ReplyDelete


  17. Watch GoGoAnime With English Subtitles Online In High Quality.
    GoGoAnime


    ReplyDelete
  18. Family law is a legal practice area that focuses on issues involving family relationships such as marriage, adoption, divorce, and childFamily Law​ ​in Lahore

    ReplyDelete