The surgical competence of the doctors of Tirunelveli Medical College Hospital has saved a one-day-old baby from getting its right limb amputated due to thrombosis.

According to Dean, TVMCH, Revathi Balan, a multiparous diabetic mother from Thoothukudi district delivered a preterm female child with birth weight of 3.50 kg by normal delivery on March 1 at Government Thoothukudi Medical College Hospital.

On examination, the baby was suspected to have right upper limb ischemia and hence was referred to Tirunelveli Medical College Hospital for vascular surgery opinion on the same afternoon – after almost 8 hours of postnatal life.

When the baby was received at the emergency department of TVMCH at 4.30 p.m., the newborn was found to have right upper limb bluish discolouration with reduced upper limb movement with the limb feeling cold on palpation. On the right side, brachial, radial, ulnar pulsations could not be felt. Right upper limb doppler showed subclavian and axillary vessels with triphasic flow. Brachial, radial and ulnar vessels had no flow at all.

After the vascular surgery team of TVMCH assessed the baby, CT angiogram was done. A team of specialists from Departments of Paediatric Medicine, Paediatric Surgery, Plastic Surgery, Anesthesia, Neurology and Orthopaedic Surgery examined the baby and gave their opinions.

While echocardiography showed no obvious congenital anomaly, CT angiogram showed abrupt cutoff of right axillary artery – 3 cm from outer edge of first rib for a length of 1.8 cm – suggestive of thrombosis.

The baby was taken up for an emergency exploration by vascular surgery team headed by Professor K. Rajesh and Assistant Professor G. Navaneetha Krishna Pandian, along with plastic surgery team Professor T. Chenthil Sivamuthu, Assistant Professor M.J. Felix Cordella, paediatric surgery team led by Head of the Department V.V. Kannan, and anaesthesia team, led by Head of the Department of Anaesthesia R. Amutha Rani, and Professor Selvaraj, Assistant Professor Shenbagarajan.

High Precision Microscope for vessel anastomosis was provided by ENT Department of TVMCH.

The 5-hour-long surgery went on well and intra-operative period was uneventful. Post-operatively, the baby was shifted to sick neonatal care unit under the care of Professor C. Krishna Moorthy and Professor R. Venkata Subramanian. The baby was treated with intravenous antibiotics and regular dressing of the wound.

The child also had urogenital sinus and Grade IV HUN, for which paediatric surgeon opinion was obtained and treated conservatively. Post-operatively, the limb became pink, capillary refill time improved and shoulder, elbow and finger movements recovered.

“It is a landmark achievement that first time in the history of Tamil Nadu Health Services, a vascular surgical procedure has been successfully done on one-day-old newborn at Tirunelveli Medical College Hospital. It is a very rare phenomenon and the baby might have had an underlying hypercoagulable disorder. As the child is hemodynamically stable, baby was discharged on Saturday,” said Dr. Revathi, who felicitated the specialists along with Medical Superintendent Balasubramanian.

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