Birth weight is only 115kg, only a little larger than ** palm. Recently, Xinyang Central Hospital admitted a 30-week pregnant premature baby, the child is in a very critical condition, waiting for him lungs, heart, brain, gastrointestinal, kidney, infection and other related complications of premature infants.
Because of Bao's mother's "severe preeclampsia", the baby was forced to break the uterus early, and because of premature birth, the weight was only 115kg, after birth, weak breathing, apnea, before he could see his parents and was admitted to the intensive care unit of the neonatal department of Xinyang Central Hospital.
While receiving respiratory support in the intensive care unit, the baby had abdominal distention, blood in the stool, and elevated infection indicators, and after consultation with Guo Jintao, director of pediatric surgery, it was determined that he was suffering from neonatal necrotizing enterocolitis (NEC). According to Director Guo, the disease is a serious complication of premature infants, which is prone to intestinal perforation, intestinal infection, intestinal stenosis, intestinal obstruction, etc., and has a greater risk of death.
Under the careful monitoring and ** of the medical team of the neonatal intensive care unit, the child finally avoided the occurrence of intestinal perforation through conservative **, but after more than 10 days of feeding, the baby's weight did not increase and decreased, and the symptoms of nausea and vomiting appeared again, the vomit contained intestinal contents, the abdomen was extremely distended, the whole body was cyanotic, and there were signs of shock. The NICU contacted the Department of Pediatric Surgery for emergency consultation again, and Director Guo Jintao considered that the sequelae of neonatal enterocolitis caused by intestinal stenosis and shock, which required immediate surgery**, and a delay would lead to the child's life.
Considering that the child is the anesthesia and surgical child with the lowest weight, the smallest gestational age, and the most complications encountered by the hospital in recent decades, in order to ensure the safety of the surgical process. Director Guo Jintao is actively communicating with his family, and at the same time contacting anesthesiology experts to urgently formulate a detailed and precise plan. There are several contingency plans around possible changes in the condition and problems. For example, to prevent intraoperative hypothermia, maintain intraoperative respiratory and circulatory stability, deal with intraoperative or postoperative respiratory and cardiac arrest, and solve intestinal diffuse lesions.
Anesthesia is one of the most difficult hurdles to overcome in this operation, because the weight of the child is less than one-third of that of a standard birth, and the structure and function of the heart, lungs, liver and kidney are not fully developed, so the selection of anesthesia method and the adjustment of anesthesia depth are very important in the operation. To this end, Director Mei Lei of the Department of Anesthesiology immediately organized experts from the Anesthesiology Center to conduct a surgical safety assessment for the child, and dispatched the capable physician Ma Hui from the department to jointly escort the operation, and successfully completed the steps of femoral artery catheterization, intubation, intraoperative respiratory management, and postoperative analgesia after the operation, so as to provide safety guarantee for Director Guo and his team to perform the operation on the child.
During the operation, a narrow intestinal tube about 1 cm long was found at the end of the small intestine, which was as thin as a pen, resulting in the entire small intestine dilating, gas and effusion, and the intestinal tube was filled with undigested granular milk flaps. This disorder is thought to be intestinal stricture due to the sequelae of neonatal enterocolitis. Is it a one-stage surgical resection of the diseased bowel and intestinal anastomosis, or is it a first enterostomy and another operation to anastomosis the baby 3-6 months later? Obviously, the second option is the safest for doctors, but the need for multiple surgeries can have a significant impact on the child's life later in life. However, in the first option, there is a possibility of serious complications such as anastomotic leakage and anastomotic stenosis, and the chance of reoperation is slim. But if the baby recovers well, one operation will solve all the problems. In the end, Director Guo Jintao and his team immediately decided to carry out the first-stage intestinal resection and intestinal anastomosis for the child without hesitation. Fortunately, the child has lived up to everyone's expectations and is now recovering well, with all physiological indicators exceeding expectations.
The baby's operation went very smoothly, but the infection, respiration, and nutrition after the operation are still the three mountains in front of the baby.
After the surgical removal of the necrotic intestine, coupled with the precise anti-infection against the infection bacteria in the abdomen**, the baby's infection has been effectively controlled, and with the strong support of the medical team of the neonatal intensive care unit, the baby has been taken out of the ventilator one after another, and the vital signs have gradually stabilized, and the infection and breathing have been successfully passed.
Next, the saddest thing is the "nutrition off", in the early stage, because the intestinal function has not recovered, and feeding intolerance and other reasons, can not carry out total enteral nutrition, can only provide nutrition for the baby through intravenous infusion. After the abdominal infection is controlled, the baby faces problems such as short intestine and immature sucking and swallowing function after ostomy surgery. In order to provide your baby with the nutrients and energy to grow smoothly and fight off illness, their health care provider gave them a deep venous catheter (PICC) to provide nutritional support through deep veins**. In the case of abdominal infection under control, gradually exercise the baby's sucking and swallowing functions, slowly increase the amount of milk, after careful **, the milk volume increases to be able to get rid of intravenous nutrition, and the weight is gradually increased.
The lucky and strong baby experienced the first 20 days of his life in the hospital. In the past 20 days, the medical staff of the pediatric surgery and neonatal intensive care unit accompanied the baby through five levels and six generals, and the weight increased from only 115kg to 2kg, from "slap big" to "meaty", from not being able to breathe spontaneously to being able to take a big mouth and be strong**. Recently, the child was finally discharged from the hospital and went home to reunite with his parents.
Author: Chen Jing, Xinyang Central Hospital Editor: Wang Pengfei Editor: Yang Hua).