"Every day was a bonus. We would count days by the number of days she had survived. The biggest joy was when the baby reached one kilogram," said Dr Sachin Shah, Director, Neonatal and Paediatric Intensive Care Services in Pune's Surya Hospital, on behalf of his team.
A team of doctors and nurses, under Dr Shah's leadership, helped Anjali Pawar (name changed), a baby girl born 24 weeks into her mother's pregnancy, weighing just 400 grams – possibly the smallest premature baby in the country – survive and have a chance at life.
Today, Anjali is a healthy six-month-old baby, weighing 2.13 kilogram. But her journey was unlike any other baby.
'Had a Gut Feeling She Was a Girl, Wanted to Meet Her'
Long before 27-year-old Ujjwala Pawar, Anjali's mother, was rushed to the emergency room in May 2022, she knew that this was going to be a difficult pregnancy.
She had been diagnosed with 'Bicornuate Uterus' — a rare congenital condition when the uterus is heart-shaped, appearing to have two sides instead of being one hollow cavity. Speaking to FIT, she said:
"During my first pregnancy, the baby was conceived in the left uterus – and I did not have any trouble through the pregnancy or delivery. But this time, the baby was formed on the right side, and this is how complications began. I was advised complete bed rest – I wouldn't move my arm or foot. I would be just static. I had a gut feeling that she would be a girl, and I could not wait to meet her."Ujjwala Pawar
When she reached 16 weeks of pregnancy, the doctor advised that she does not move herself even for meals — if Ujjwala and her husband wanted to go ahead with the pregnancy. At 24 weeks, she went into emergency labour.
"When she was born on 21 May 2022, she looked at me with the tiniest eyes imaginable – and she gave me hope that she would survive. She was not even the size of my palms," Ujjwala told FIT.
What Went Behind the Scenes
As soon as the baby was born, she was was whisked away on a mobile ambulance, from the nursing home to the NICU inside Surya hospital.
The team of neonatal intensivists including Dr Amita Kaul, Dr Jayant Khandare, Dr Ganesh Shiwarkar and Dr Deepak Singh, along with a nursing team comprising Rajni Londhe, Swapnali Kapare, Shobha Dongre and Nikita Khekare, immediately sprung into action.
Ujjwala with her husband and baby daughter.
(Photo: Special Arrangement)
"The moment the baby was delivered, we put a breathing tube on the baby and quickly got her to the NICU. These 15 minutes was the golden hour period we had. She was immediately put on ventilator support, and a catheter was inserted in her in belly button to feed her. Stabilising her vitals immediately after birth was of importance."Dr Sachin Shah to FIT
The Big Challenges
While the doctors expected that the pre-term baby would not be weighing much, the 400 gram weight also indicated that there were more challenges than what they expected.
"Her skin was fragile and was breaking down. We had kept her in an incubator to promote healing of the skin. But we also could not provide the human touch, or lift her – because that might make her more susceptible to infection. So we had to make sure that no one handled the baby, or went near the baby," Dr Shah said.
But, getting the right kind of equipment was also a challenge.
"Getting the right equipment was the challenge - even something as simple as getting a mask for the baby. All pre-term baby equipments are designed for babes above 500 grams - and if we use that mask, it would keep sliding off the baby. The infrastructure and equipment at hospitals are mostly designed for babies born at 40 weeks. Therefore, in extreme-premature delivery, line of treatment becomes a challenge."
Anjali's Progress – Baby Steps
Anjali was on complete ventilatory support for over 30 days – she was also given medicines for lung functioning.
For the first few weeks, she needed advanced mode of high-frequency ventilation. Later, she was doing okay with non-invasive respiratory support. 88 days after she was born, she was breathing normally," Dr Shah said.
"She was fed through a tube for the first 75 days of her life, with the quantity increasing as per her tolerance level. I was allowed to hold her when she reached 1000 grams, 51 days after she was born. It was a very emotional moment for me,” the mother said.
Anjali was discharged from the hospital on 23 August last year – 94 days after she was admitted – and has been hitting all her growth milestones since. The last time such a case was reported was in Ahmedabad in 2019, where a baby was born at 22 weeks and weighed 492 grams.
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