An underweight, six-day-old baby girl weighing just 1.34 kg, was not passing urine since birth. The child, who lost her father to dengue while she was in the womb, was rushed to Amrita Hospital in Faridabad by the worried mother, where the doctors diagnosed her with severe acute kidney injury, also known as acute renal failure. To save the child, they decided to undertake a procedure that is rarely ever done for newborn babies – dialysis.
Dr. Hemant Sharma, consultant, department of Neonatology, Amrita Hospital, Faridabad, said: “Acute kidney injury is common among young babies in NICU, with almost 10-20% of them suffering from the problem. However, severe acute kidney injury that requires dialysis is extremely rare. Dialysis of such small babies is rarely done anywhere in the world and the success rate is extremely low.”
The doctors performed peritoneal dialysis on the baby girl. Dr. Urmila Anandh, Head, department of Nephrology, Amrita Hospital, Faridabad, said: “Kidneys are necessary to remove waste from the body. However, if they cease function for some reason, such as prenatal damage, the blood becomes clogged with waste. This interferes with the baby’s ability to eat and causes lethargy, bleeding, and swelling of the body. It can also affect other organs such as the brain, heart, and lungs.”
Sharma added “In the case of a newborn baby girl, her kidney function was severely damaged. We decided to use peritoneal dialysis to clean the waste from her body. A cleansing solution was slowly injected into her belly and then washed out, bringing the waste out of the body with it. Several in-and-out fluid cycles were conducted, spread across nine days till her kidneys got time to heal. The procedure was successful. There were very few such cases in India of dialysis being performed on a newborn. We opted for peritoneal dialysis instead of hemodialysis because the latter is generally not performed on such small children.”
Sharma said Dialysis in such a small child is not only technically difficult, but also associated with high rates of complications. The procedure is usually performed on children with at least 10 kg of body weight. “The baby in this case had low nephron reserve. There was also a high risk of infection of her abdominal lining. Despite this challenge, we maintained strict asepsis and did not use any higher antibiotics. The procedure was successful, and the baby is totally healthy now. She is being breast fed by the mother now and has gained weight. Her kidney functions are almost back to normal, and she is passing urine normally. She is now expected to grow up normally like any other healthy newborn.
The baby’s mother said: “She is a very precious child for me, since I lost my husband due to dengue when I was pregnant. I was devastated when I realized that there is something wrong with my daughter, as she has not passed urine since the day of her birth. I thank the doctors from the bottom of my heart for doing this difficult procedure on my newborn child and saving her life.”