A complex surgical intervention treats a preterm baby with rare lung disorder.

About the patient and condition

A complex case which involved a baby of 35-week gestation was delivered through emergency C-section due to foetal distress and meconium-stained liquor. The mother was infected with Hepatitis B Virus, adding to the challenges.

Case Scenario

Dr. Omprakash Jamadar, Consultant, Neonatologist & Pediatrician, Apollo Hospitals, Navi Mumbai, received an emergency call regarding a 35-weeks pregnant mother with foetal distress and meconium-stained liquor. An earlier antenatal scan had shown a 50 x 30 x 40 mm lesion in the left lower lobe of the baby’s lung, indicative of CPAM.

A “NICU on Wheels”, i.e. Ambulance with Transport incubator, ventilator and a trained doctor for attending the delivery was immediately dispatched by Apollo Hospitals, Navi Mumbai to help with the delivery. Upon delivery, the baby initially cried well but gradually developed cyanosis and respiratory distress. The Neonatal team at Apollo Hospitals Navi Mumbai immediately responded, the baby was immediately put on CPAP and transferred to Apollo Hospital for intensive care and further treatment. Upon admission, the baby was in severe respiratory distress with significant oxygen requirement, warranting immediate intervention.

Dr. Omprakash Jamadar, Consultant, Neonatologist and Paediatrician, Apollo Hospital Navi Mumbai said, “This was a critical case due to the baby’s preterm birth and the underlying lung condition. The chest X-ray showed gross mediastinal shift & a lung cyst. The baby was immediately intubated and started on mechanical ventilation and gradually stabilised. We initially tried to manage the baby’s condition without surgery, considering the high risks involved in operating on a 35-week preterm small baby, but it soon became clear that surgical intervention was necessary, as breathing support could not be stopped due to the compressed lung and shift of the heart to the right side due to the big cyst in the lung.”

A CT scan confirmed the presence of a multi-cystic lesion symptomatic of CPAM in the baby’s lung. The multidisciplinary team, including Dr. Ashwini Khanolkar, Consultant, Paediatric and Neonatal Surgeon, Apollo Hospital Navi Mumbai, decided to surgically excise the affected lung lobe. This decision was a critical turning point in the baby’s treatment journey.

The surgery was a supra-major neonatal surgery involving thoracotomy and lobectomy in a preterm baby. Post-operatively, the baby showed signs of steady recovery. The baby was weaned off the ventilator on post-op day 2 to room air. By day 5, chest X-ray showed significant signs of improvement.

Worldwide Scenario

Congenital Pulmonary Airway Malformation, also known as congenital cystic adenomatoid malformation, is a rare lung disorder that occurs in about 1 in every 30,000 pregnancies. In CPAM, an entire lobe of the lung is replaced by a non-working cystic piece of abnormal lung tissue that will never function as normal lung tissue. In most cases, the outcome for a fetus with CPAM is positive, but the condition can be life-threatening if the cystic mass grows large enough to restrict the growth of surrounding lung tissue and exert pressure on the heart.

Expertise at Apollo Hospitals

It was a challenging surgery, given the complexities involved due to the pre-term birth and underweight baby. However, with a highly skilled team and the cutting-edge modern facilities, at Apollo Hospitals, Navi Mumbai, the team was able to successfully perform a left posterolateral thoracotomy and left lower lobectomy under general anaesthesia.

Dr. Kanchan Singh, Consultant, Anaesthesiologist, Apollo Hospital, Navi Mumbai, who was a part of the clinical team, added, “This successful surgery underscores the value of a multidisciplinary approach, where different specialists come together to work for the best possible outcome for the patient.”

Apollo Hospital, Navi Mumbai team’s success in this case provides new hope for babies with congenital conditions. With advanced facilities, skilled professionals, and a dedication to patient care, Apollo Hospitals continue to lead the way in healthcare in India and beyond.

Apollo Hospitals – Touching Lives

“This case is a testament to the quality of care and the multidisciplinary approach at Apollo Hospitals,” said Mr. Santosh Marathe, Regional CEO Western Region, Apollo Hospitals. ” We are extremely proud of the dedication and expertise of our teams, working together seamlessly across departments to save a life and give this child a chance at a healthy future. We do a significant volume of high-risk deliveries as well as deliveries done through IVF. We have a state-of-the-art NICU manned by competent neonatologists and paediatric intensivists along with well-trained nurses for 24-hour care of infants and babies. The successful treatment of the baby, with minimal complication and a satisfactory recovery, is a testament to the hospital’s commitment to providing the highest quality healthcare services, especially in cases involving unique challenges like prematurity, sepsis, and complex congenital conditions.”

Patient’s Testimonial

The baby was completely on oral feeds by post-operative day 10 after birth and was discharged on day 23, showing steady weight gain. The family was thankful to the entire team at Apollo Hospitals, Navi Mumbai.