Baby born with Meconium Aspiration Syndrome saved using ECMO at Narayana Health City
Bengaluru, March 22, 2017: A newborn child, weighing 3.2 kilos, was delivered by cesarean section at a local hospital near Hosur and referred to Narayana Health City, with breathing difficulty. The baby had passed meconium (baby’s first stool) within the womb of the mother, and had inhaled this meconium into its lungs. This resulted in severe breathing difficulty in the baby, which is known as Meconium Aspiration Syndrome (MAS). Chest X-rays also showed features of severe meconium aspiration.
The baby was put on ventilator support immediately, and administered a gas called nitric oxide, to decrease the lung pressure. However despite maximal medical therapy, the baby’s condition continued to deteriorate, due to low oxygen levels and low blood pressure (a condition known as cardiorespiratory failure). On the fourth day, as a final life-saving measure, the newborn was supported by Extracorporeal Membrane Oxygenation (ECMO).
ECMO is the use of an artificial lung (membrane), located outside the body (extracorporeal) that puts oxygen into the blood (oxygenation) and continuously pumps this blood into and around the body.
ECMO is a very expensive treatment and the cost of ECMO for this child was subsidized at Narayana Health City. “We have a lot of experience at Narayana with cardiac patients and because we have that much of experience, we’re extending that expertise now to a second group of patients – that’s respiratory”, said Dr. Rajiv Aggarwal, Senior Consultant Neonatologist & Head of the Pediatric Department at Narayana Health City.“And because we have such a big cardiac unit, we can actually subsidize or take care of the cost, because if an individual centre was to be started only for respiratory indications, the cost of setting up an ECMO is horrendous. The only way you can set-up an ECMO is in conjunction with a cardiac centre and not in isolation”, he explained.
According to medical literature, 10-15% of all neonates are born through meconium stained liqour (MSL). 10-15% of them become critically ill, a condition called meconium aspiration syndrome (MAS). 10% of newborns with MAS, despite conventional management, have fatal outcomes. Internationally, in this sub group, by using ECMO the survival rate has been shown to be over 90%.
NarayanaHealth City has had experience with more than 500 ECMO’s in the past 10 years,out of which two-thirds have been pediatric ECMO’s.“We have successfullysupported many neonates with ECMO in the past, but all of them were forreversible heart failure, following congenital open heart surgery. Thiswas the first time a neonate had been supported by ECMO for respiratory failure,” saidDr. Riyan Shetty, Head of Extracorporeal Life Support (ECLS) at NarayanaHealth City.
ECMO innewborns is a high risk procedure. It requires a multidisciplinaryteam of highly skilled medical professionals. “In the case of ournewborn, after receiving parental consent, ECMO wasinstituted through cannulation of the neck vessels byan experienced pediatric cardiac surgeon. The lungs and heart wererested. The extracorporeal circuit maintained the baby’s heart,lungs and other organ functions. In 85 hours, the newbornslungs recovered, the ECMO was weaned and the baby wasgradually taken off of the ventilator”, explained Dr. Riyan. Thebaby continued to show improvement and was finally discharged withinthree weeks of being admitted.
As the ECMOis instituted using the neck vessels, the procedure is less invasive. Thelength of hospital stay, cost and morbidity to the newborn is less whencompared to opening the chest to cannulate. This kind of expertise isbrought in by Dr Sudesh Prabhu, who is a Consultant in PediatricCardiac Surgery at Narayana Health City in Bengaluru.
ECMO cantake over the functions of both the heart and the lungs, thus maintaining bloodand oxygen supply to rest of the body. “In the case of this newborn,he had very low levels of oxygen due to meconium aspiration into his lungs. Dueto low levels of oxygen, his heart was not working well either. As soon as weinstituted ECMO, both the oxygen level and his heart function improveddramatically. The lungs recovered after 3 days of rest, whilst on ECMO”, explainedDr. Riyan Shetty.
NarayanaHealth City has a level-4 NICU (neonatal intensive care unit), fully equippedto treat extremely small babies weighing up-to 600 grams including the mostcomplex cases of newborn surgery. “The NICU has an experienced team tomanage everything for a newborn. Managing a newborn baby has multiple aspectssuch as feeding, nutrition, infection and so on, which is very well handled byus. We have an A-grade team of doctors and nurses to give all the support roundthe clock throughout the year”, affirmed Dr. Harini, ConsultantNeonatologist at Narayana Health City.
NarayanaHealth City is well-equipped with the right infrastructure and a well- trainedmultidisciplinary medical team, to manage cases of meconium aspiration. Insevere forms, the standard treatment is artificial ventilation and nitricoxide. Nitric oxide is available in only a few hospitals in Bengaluru. One inevery 10 severe cases requires ECMO support, which is only offered at NarayanaHealth City in Bengaluru.