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Tiny Miracles
1. Baby Appu: A Second Chance At LifeBaby Appu Just Born
When Baby Appu was brought to our hospital in December 2009, he had less than a slim chance of survival. Born prematurely at the rare age of 23 weeks and one of twins, the infant’s parents had all but given up hope.

But his arrival at Holy Family Hospital, Mumbai, was the beginning of hope. For 48 hours before that, Baby Appu (named by the nursing staff at HFH) and his twin had gone through an ordeal that could have cost both heir lives. The premature twins were born to a couple from suburban Borivali, Mumbai, at a nursing home in neighbouring Kandivali. However, the nursing home did not have any neonatal intensive care facilities.

The desperate search for a facility with ventilators led the parents to a nursing home in nearby Malad, whereBaby Appu One Year Old only one ventilator was available. Baby Appu’s twin, who weighed less of the two babies, was put on the ventilator there. Frantic phone calls and inquiries for a second ventilator finally led the parents to our hospital.

By then, Baby Appu had already suffered two episodes of cardiac arrest and had been declared nearly dead. He was immediately admitted to the NICU at HFH, where our senior paediatric specialists and nursing staff toiled round the clock and used their collective strength and wisdom to stabilise the neonate.

Surfactant treatment was administered to rescue the baby from respiratory distress. The paediatricians also used minimal intervention as the baby was in precarious condition. Ten days later, Baby Appu was handed over to his parents, who could scarcely believe their eyes. Baby Appu was alive and well and ready to go home!

Rarely does a neonate born in the sixth month of pregnancy survive. But this miracle of life, which grabbed media attention, is a testament to the exceptional skill, perseverance and commitment of our paediatric consultants, who never once gave up.

2. All he really needed was Vitamin B12
The Case
Baby Karthik (name changed) was far from your typical one-year-old. He was pale and listless, he had a persistent fever, suffered from constant loose motions & vomiting, had developed a rash on his face and scalp, and he seemed far less active than he should have been for his age. In fact, the child seemed to have even regressed a little!

The baby’s parents were growing increasingly distraught. The loose motions and vomiting were a recent development as was the appearance of a scaly rash on his scalp and face and the darkening of his skin on his trunk and knuckles.

Due to his persistent pallor and anaemic appearance, a local practitioner in Gurgaon, where the family lives, had administered a blood transfusion. But the symptoms refused to clear up.

The Examination
What Baby Karthik’s mother hadn’t noticed was that the child was also experiencing fine tremors and that he was also mildly malnourished. A detailed case history revealed that baby Karthik also had an enlarged liver.

The Diagnosis
The child’s apparent lack of activity was a manifestation of neuroregression or a regression in his developmental milestones, which means his functions were returning to an earlier stage of development.

With an expert clinical eye along with a series of diagnostic tests, our experienced paediatric specialists soon realised that Baby Karthik was suffering from Infantile Tremor Syndrome (ITS). Though a serious condition, the cause of this condition is fairly simple – a Vitamin B12 deficiency!

ITS is a common disease in the Indian sub-continent and Baby Karthik displayed all the classical signs and symptoms. But it wasn’t all that easy. Through a thorough clinical diagnosis and after running several tests, we had to rule out various other conditions whose symptoms are similar to ITS, such as Kahn’s nutritional recovery syndrome, Central Nervous System infections, chronic liver disease and heredofamilial degenerative diseases, among other things.

The Treatment
Treatment consisted mainly of administering fluids and antibiotics intravenously. He was also given haematinics (substances which increase the production of blood cells and haemoglobin) rich in Vitamin B12 and folic acid.

With an accurate diagnosis, treatment began immediately and within hours, Baby Karthik began to show improvement. His tremors stopped, rash receded and appetite improved and a sense of well-being prevailed. The child was discharged in just 4 days.

Treatment for ITS is usually empirical, symptomatic and supportive. Iron and calcium, magnesium and injectable vitamin therapy helps.
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