Bravehearts of the Foundation: Baby of Omana
August 6, 2018 | Contributed by R Srivatsan
A 3 month old child from tribal colony of Wayanad was referred through Govt of Kerala to Amrita hospital for management of congenital heart problem. On arrival, the child was found to be tachypenic, Echo evaluation revealed a very large VSD. Child was in failure and required preoperative stabilization. Child was started on diuretic infusion and anti-failure medication. The most challenging aspect of this child was that the child was a case of extreme IUGR (Intra Uterine Growth Retardation). At three months of age, the child was only 1.6kg.
After initial stabilization, the child was planned for surgical closure. The challenging aspect of surgery was to do a congenital heart surgery using cardiopulmonary bypass in an extremely low birth weight child (1.6kg). The most challenging aspect in these low birth weight children is to safely conduct cardio pulmonary bypass. It requires tremendous skill from the Anaesthesiologist to obtain adequate invasive lines for surgery. Meticulous surgical techniques are required for surgical correction of VSD in these small children. Under cardiopulmonary bypass, VSD was closed using tanned pericardial patch with 7-0 prolene interrupted and continue sutures. Child was safely weaned off cardio pulmonary bypass and shifted to ICU.
In view of poor nutritional status, the child required prolonged C PAP support in ICU. The most challenging aspect in ICU is to prevent sepsis in these children with poor nutritional status as their immunity is extremely low. With good nutritional supplementation and good pulmonary toilet, the child made a safe recovery. Once the child stared taking direct oral feeds, the child was shifted to ward. In the ward, once child started gaining weight, the child was discharged and was transported back by government to their tribal colony.