Preterm infant in Nagpur survives 3 cardiac arrests in 90 days

Nagpur: A three-month preterm baby survived three cardiac arrests in three months while being treated for respiratory distress likely caused by the rare cytomegalovirus (CMV) infection at the neonatal intensive care unit (NICU) of Government Medical College and Hospital (GMCH), Nagpur.

Thanks to special care and intense monitoring by the NICU team, the baby recovered and was discharged recently. The baby was put on ventilator for two weeks with both her lungs severely infected due to viral pneumonia.

Another two-and-a-half-month preterm baby with similar respiratory illness needed 20 days on CPAP (continuous positive airway pressure) machine, a step-down equipment compared to the ventilator. This baby too recovered after a 75-day stay in the NICU.

Preterm babies in NICU can be either congenitally CMV infected or they can acquire infection after birth.

Given the shortage of resources and drug procurement delays, GMCH doctors relied on point of care lung ultrasound in both cases for precise diagnosis.

GMCH Nagpur is one of the few medical colleges in the state to have the high-end ultrasound equipment for babies.

"Broad spectrum anti-biotics were not resolving the baby's condition, as shown by the lung ultrasound. She was on ventilator for two weeks. Next step was to go for CMV test. As it is not available right now, we took parents' consent to start glanciclovir injection. Within a week, the baby responded to the treatment and was weened off the ventilator," said Dr Abhishek Madhura, in charge, paediatric respiratory clinic and associate professor, department of paediatrics at GMCH.

Routine medications are available at government hospitals but special drugs like glanciclovir require approval, for which a positive CMV test result was needed. As parents couldn't afford the costly CMV test, doctors didn't insist for it.

Parents of both babies saved around ₹8 lakh in the treatment. The same treatment at a private hospital would have cost them ₹8,000-10,000 per day.

Dr Madhura said the lung ultrasound gave them documentary evidence of bilateral pneumonia. "This is typical viral pneumonia, which completely spreads to both lungs. During the baby's treatment, she suffered three cardiac arrests. Our team was alert and responded in a timely manner with CPR to revive the baby each time," he said.

Dr Madhura added that head of the department Dr Saira Merchant and dean Dr Raj Gajbhiye are working to upgrade the NICU and PICU. "The department has also requested to start CMV testing and hopefully it will start very soon."

Dr Madhura, assistant professor Dr Sandip Manwatkar, senior residents Dr Kalyani Kadu and Dr Pooja Dixit, and the nursing staff took care of the babies in the well-equipped NICU.