Kochi: Parents from Ernakulam could not hold back their happy tears when their Baby boy cried for the first time in a year. cried This was the very first time they had heard their baby’s voice, a moment that brought immense relief and happiness. After enduring numerous hardships and challenges, this cry was most precious. This cry, filled with promise and life, was more than just a sound—it was the culmination of a heroic battle against the odds with Aster Medcity, Kochi playing a crucial role in this extraordinary journey.
Baby A’s (Imaginary name) story began with unimaginable challenges when doctors at a hospital in Kothamangalam discovered a large tumour obstructing the windpipe of the unborn child during a routine anomaly scan. Irrespective of doctors pointing out risks, and advising to consider termination, the resilient parents were not ready to give up and proceeded to continue with the pregnancy.
They decided to seek treatment at Aster Medcity Kochi. Here, Dr. Sindhu Pudhukudi, Consultant Fetal Medicine, Aster Medcity identified a 4.5-centimetre cystic hygroma, a condition that demanded delicate handling and expertise. As months passed and the tumour grew, the medical team faced a critical decision.
The primary concern during the delivery was to secure the baby’s airway while preventing the cessation of placental blood flow, essential for the baby’s oxygenation. The baby faced imminent danger due to airway obstruction caused by a large neck tumor, which could rapidly deteriorate his condition.
To navigate this critical situation, the medical team devised a unique plan: only bringing the baby’s head out during the Cesarean section, swiftly intubating the child, and then delivering the rest of the baby. The groundbreaking EXIT procedure (The EXIT or ex utero intrapartum treatment procedure, is a specialized surgical delivery procedure used to deliver babies who have airway compression) was chosen because immediate tracheostomy ( a procedure to help air and oxygen reach the lungs by creating an opening into the trachea (windpipe) from outside the neck.) was not feasible due to the tumor’s size and location.
Despite these hurdles, the team persisted with unwavering determination to ensure the baby’s safe delivery and subsequent care.
On March 7th, 2023, the doctors delicately brought Baby A into the world through the extraordinary procedure. As the incision was made, the baby’s head was delivered. Initiating a critical countdown the surgery was headed by Dr. Zareena A Khalid Senior Consultant – Obstetrics & Gynaecology, Aster Medcity-Kochi. A pulse oximeter monitored the newborn’s oxygen levels, while initial attempts to locate the airway were challenging. Intubation was an extraordinary challenge given the tumor’s extension into the baby’s mouth, making it incredibly difficult to locate the airway amidst tense conditions with limited visibility and the baby’s head resting on the mother’s amniotic fluid-covered stomach. Under intense pressure, after 14 suspenseful minutes, the EXIT procedure was conducted by Dr. Suresh G Nair, Senior Consultant – Anaesthesiology & Critical Care, Aster Medcity-Kochi, supported by Dr. Jyothi Lakshmi Nair and Dr. Kavitha Sadan, Consultants from the department of Anaesthesia. The airway was successfully identified, and an endotracheal tube was placed. The infant was swiftly transferred to neonatologists for ventilation support.
After a week, there was a debunking of the neck swelling performed by Dr. Ashok Rijwani and Dr. Kiran VR, Paediatric Surgery & Urology from Aster Medcity-Kochi followed by elective tracheostomy by Dr. Praveen Gopinath- Senior Consultant – ENT and Endoscopic Skullbase Surgery, Aster Medcity-Kochi. From March to December 2023, there were various stages of neck mass excision and Sclerotherapy, involving image-guided injections to shrink the tumor, conducted by Dr. Rohit Nair and Dr. Arjun .S. – Consultants – Interventional Radiology & Embolisation Specialist – Aster Medcity Kochi.
The combined expertise of doctors and the vital role of experience in ensuring the safety and well-being of precious lives is what created the magic,” said Farhaan Yasin, Aster India Vice President about the grand success of the rare procedure.
On January 1, 2024, the second stage of airway surgery was performed, specifically to further enhance the airway. During stage 4 airway evaluation, a satisfactory airway was confirmed without the need for further procedures. Finally, the child was successfully decanulated while awake in the mother’s lap, with the tracheostomy tube removed and the child experiencing comfort without breathing difficulty.
Over the ensuing months, Baby A underwent a series of intricate procedures, from neck mass excisions to sclerotherapy, each step meticulously designed to ensure a clear airway and a path towards a healthy life.
Today, Baby A’s story shines brightly—a testament to the enduring power of hope.
