After 23 weeks and three days gestation, the little girl was delivered by Cesarean section at Graz University Hospital in Austria. The decision to perform a C-section was made after the baby’s heart rate began to fall.
At a weight of 355 grams (0,78 pounds), she was small even in relation to her gestation. However, her condition stabilized over the next few days and although she needed a ventilator, she was able to receive enteral nutrition.
On her eleventh day, she took a turn for the worse. Her abdomen was swollen and she was sensitive to being touched. Blood tests showed a heightened level of white blood cells – a clear sign of inflammation. An x-ray exam also revealed that she may have been suffering from an obstructed bowel. And when her breathing began to decline, the medical team decided to operate on her immediately.
“It was a pressing situation, especially with such a tiny baby. What’s more, the surgery was to take place in the middle of the night,” anesthesiologist Dr. Bruchelt explains.
The OR team, comprised of four doctors and four nurses, had just over three hours to prepare for the procedure. They studied her charts, talked to her parents and ordered blood in case of the need for transfusions. During this time, the operating room was heated to a higher than normal temperature, to enable the baby to more easily maintain body temperature.
Dr. Bruchelt and her colleague Dr. Günter Baumann also prepared the girl's anesthesia. “It’s always more difficult to prepare the amount of drugs and volumes for small infants, and in this girl's case it was even more difficult than normal,” she says. “And most anesthesia units are not designed for children that small, making it difficult to set the respiratory volume.”
But Flow-i performed better than anyone could have hoped. The unit gave no false alarms and successfully ventilated and anesthetized her in the correct manner. “The Flow-i was completely new at the hospital, but proved to be highly reliable and easy to use,” says Dr. Bruchelt.
The level of carbon dioxide in the girl's exhaled air agreed well with the blood analyses that were routinely conducted throughout the operation to check that she was sufficiently ventilated. “It can be very stressful to continually check the unit and the child, especially if many alarms are triggered. It can also be difficult to see the chest moving when the patient is covered in heated blankets and sheets.”
The little girl's condition remained stable throughout the three-hour procedure. No problems were encountered, with her lungs or the unit. Quite the opposite, as shortly before surgery the intensity of the treatment could be lessened.
“Flow-i was very reliable, you could easily read the volumes involved and they correlated well with our analyses. I felt confident with the unit throughout the entire operation.”
Following the operation, the girl was returned to the neonatal intensive care unit (NICU). At the time, she weighed 395 grams (0,87 pounds) and was about 20 centimeters in length. She continuously needed help with her breathing, but otherwise, her condition was stable. “I really must emphasize the fantastic care she received at the NICU; it was completely decisive for her survival,” says Dr. Brucheldt.
The little girl's positive progress continued over the next few weeks and on her 37th day, she could breathe unaided. At about the same time, her body weight reached 1,000 grams and the supplementary oxygen she had been receiving could be discontinued.
“She will soon turn three years old, and that’s truly fantastic,” says Dr. Bruchelt. “She’s still small for her age, but otherwise she’s as healthy and sociable as any other three-year-old. The last I heard, she’d just started going to daycare.”