Mumbai, April , 2019 : Born prematurely during the 26th week of pregnancy with a birth weight of 600 grams, Rudransh (now 10 months old) got a new lease of life with Intra-pulmonary stem cell therapy. The Micro Preemie newborn, who developed severe broncho pulmonary dysplasia (BPD) was saved by a multidisciplinary team of experts at Surya Hospitals. The baby presented as one of the most complicated cases to the team, which successfully performed Intra-pulmonary stem cell therapy to save his life. Rudransh – the micro-preemie, after going through all critical health problems, finally emerged as a superstar.
The infant was delivered by emergency lower (uterine) segment Caesarean section (LSCS). Pregnancy was complicated by severe intrauterine growth restriction. There were severe abnormalities in the umbilical vessel on Doppler studies that necessitated urgent preterm delivery at 26 weeks. Infant was suffering from the severe respiratory distress, infections, anemia, and low platelet counts. It was a big challenge for the medical team to save the micro preemie as he had already developed severe BPD / chronic lung disease (CLD) of prematurity.
With bleak chances of survival, the infant was transferred to Surya Hospital, on 24th July 2018, on day-27 of life on request of parents as the baby could not be weaned off from ventilator (artificial respiratory support), in spite of repeated attempts, because of severity of BPD.
“To best of our knowledge, this is the first report of the use of the therapy in an established case of BPD in a micro preemie newborn” informed Dr.Nandkishor Kabra, Director, NICU, Surya Hospitals who led a multidisciplinary team.
“After controlling infections, Rudransh was started on DART regimen of systemic steroids to facilitate weaning from ventilatory support on day 33 of life (30/07/2018). The infant was gradually weaned from ventilator to non-invasive support of high CPAP with a higher PEEP of 9 cm of water and oxygen concentration of 60% on 2/8/2018, but the baby had to be put on to ventilator again with very high pressure settings because of severity of BPD” added Dr. Hari Balasubramanian, Consultant, Neonatologist, Surya Hospitals.
The critical condition continued. Parents and extended family members were counselled about the baby’s condition. The infant had completed 43 weeks CGA and achieved 2 kg weight by October 24, 2018. For the family, it was a very tough time and they looked for any miraculous intervention. Parents were told about the option of stem cell therapy for the management of severe BPD as a last possible option by Dr. Nandkishor Kabra.
“At this point of time, after counselling with parents, we decided to go ahead with therapy of stem cells given in the lungs through a breathing tube for treatment of BPD. Infant tolerated the procedure well. The infant was monitored for any anaphylactic reactions and an increase in ventilatory settings followed by administration of stem cell therapy. His overall condition was examined through various tests which started giving signs of improvement,” explained Dr. Bhupendra R Avasthi, Pediatrician, MD and Founder of Surya Hospitals.
“Caring this child was a herculean task. This was only possible because of a team of dedicated doctors and nursing staff. Multidisciplinary management in the form of heart scans, brain scans, bone integrity checks, hearing assessments, skin care, physiotherapy, and maternal lactation support was also required,” added Dr. Avasthi.
After 8 ½ months of birth, the infant was finally discharged home with home oxygen therapy on 11th March 2019 with a weight of 4.67 kg. The infant is being followed up in OPD regularly by the multi-disciplinary team and appears to be improving with each passing month.
Rudransh’s case highlights the fact that infant’s with severe BPD can survive in sophisticated neonatal care and good teamwork could make that happen said Dr Nandkishor Kabra . Surya Hospital has served as a standalone newborn hospital in the heart of Mumbai city for the past 35 years. The country’s first surviving 24 week newborn baby SURYA was discharged from Surya on March 2011. Following this we have managed to save 60 babies born at ≤ 24 weeks, who are enrolled in our long term follow-up program, added Dr Kabra. Most of them have pleasantly surprised us with near normal neurodevelopment, explained Dr Balasubramanian. SAKSHI – India’s first surviving 23 week preterm newborn was also discharged from the same hospital in 2015. GOLDEN -another 23 week preterm newborn was discharged home healthy in 2016. NIRVAAN – India’s first surviving baby born at 22 weeks was also discharged from this hospital in 2017.
According to experts, the use of stem cell therapy in extremely premature human newborns was reported from Seoul in South Korea in 2014. It was used as a preventive measure in a very high-risk population of infants born at 24 to 26 weeks of maturity. There are no reports of its therapeutic use in human newborns after the establishment of BPD disease in India or elsewhere in world.