Complex surgical intervention followed by neonatal ICU care saves life of baby in a rare case of Congenital Pulmonary Airway Malformation (CPAM)
Navi Mumbai, 27 June 2023: Apollo Hospitals, Navi Mumbai has successfully treated a preterm baby with a rare lung disorder, Congenital Pulmonary Airway Malformation (CPAM). The hospital's multidisciplinary team navigated the complexities of this case with exceptional skill, ensuring the baby's survival and a promising future. The complex case involved a 35-week gestation baby 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 faced by the medical team. However, the comprehensive care provided by the multidisciplinary neonatal team ensured that the baby made a remarkable recovery.
This remarkable case began when Dr. Omprakash Jamadar, Consultant, Neonatologist & Pediatrician, Apollo Hospital Navi Mumbai, received an emergency call for 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 Hospital 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 Hospital 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 supramajor neonatal surgery involving thoracotomy and lobectomy - in a preterm baby. It was a challenging task, given the complexities involved due to the pre-term birth and underweight baby," said Dr. Ashwini Khanolkar."However, with a highly skilled team and the cutting-edge modern facilities at our disposal, we were able to successfully perform a left posterolateral thoracotomy and left lower lobectomy under general anaesthesia." 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. The baby reached full oral feeds by postoperative day 10 after birth and was discharged on day 23, showing steady weight gain.
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."
"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. AHNM does 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."