Rare Cyst was removed from One-day old Neonate's Left Lung

Pune: A team of Paediatric Surgeons at Motherhood Hospitals Kharadi successfully operated upon a 1-day-old baby.

The child was born with a congenital defect, wherein there were fluid-filled cysts being formed in the lung cavity. It was a delicate and critical condition wherein the survival and later the prognosis of the baby could have been compromised.

The doctors at the hospital helped a new-born baby girl breathe freely by initially removing fluid from the cyst that was present in her left lung by aspiration process and later performing a lung lobectomy (surgery to remove one of the lobes of the lung) immediately 1 day after birth. The baby is now home and doing well.

Dr Rajeshwari Pawar, Gynaecologist -Obstetrician, Motherhood Hospital Kharadi, Pune highlighted, "The foetus was diagnosed to have a type 1 Congenital Cystic Adenomatoid Malformation (CCAM), and it is a developmental defect where there is a benign lung lesion that appears before birth as a cyst or mass in the chest. It is also known as Congenital Pulmonary Airway Malformation (CPAM). The macro cyst present on the left side of the segment of the lung affected the lung tissue pressed the heart vessels and shifted the heart from its normal position, thereby occupying a lot of space in the chest. This type of CCAM happens 2 to 3 in 1, 00,000 live births. If left untreated, it would have compromised the growth of the underlying healthy lungs and would have become unusable. Likewise, heart compression could have invited fetal heart failure. A decision was taken to operate upon the baby immediately after birth and the couple was referred to Dr Pranav Jadhav, Paediatric Surgeon, for further counseling."

At the 6th month of pregnancy i.e 24th week, old fetus and the sonographic weight estimated of the fetus at this time was 964 gms, a decision was taken by the fetal medicine consultant Dr. Rajeshwari Pawar to aspirate the fluid from cyst by a fine needle through a sonographic guided procedure after anesthetizing the fetus with an intramuscular injection in the fetal thigh muscle so that she(fetus) doesn't move.

"It was a delicate procedure which posed a high risk to the life of the baby. The procedure was successful and was done thrice and substantial fluid from cyst was removed. But the cyst recurred, and then Shalini was continuously monitored from 6th to 9th month of pregnancy, every week by Dr. Pranav and me," said Dr Pawar.

Dr Tushar Parikh Chief Neonatologist at Motherhood Hospital Kharadi, Pune added, "A multidisciplinary counselling was given to her and after that, a baby girl Ruchika, weighing 2.5 kg was successfully delivered on December 13, 2019. The baby was shifted to the NICU as she encountered difficulty in breathing and had to be given continuous positive airway pressure therapy (CPAP), to help her breathe easily, and expand the lungs! Once, the baby was stabilized, a lung lobectomy surgery was performed on 2nd day of birth by Dr Pranav Jadhav and Dr Kalpesh Patil (Paediatric Surgeons). The surgery took around one hour.

"It is a delicate and complicated procedure to remove the lobe of the lung that is the portion of the diseased lung. The baby was growing well and accepting feeds very soon after surgery", added Dr Pranav.

Dr Tushar Parikh added, "Post-operatively, the baby quickly stabilized, and required oxygen therapy in the NICU. Once, the baby was shifted in the normal ward, her mother has explained the right way to feed the baby. The mother was discharged on December 25, 2019. and the baby was discharged on January 1st, 2020"