Revival of Heartbeat In Preemie Pronounced Dead

Reversal of cooling effect of hypothermia on heart (arrest) when placed in polythene bag may have led to miraculous revival of preterm baby thought to be dead.

Highlights:

A baby who was declared dead and placed in a polythene bag in an Indian hospital was found moving hours later by family members
Placing premature infants in polythene bags has been used to treat hypothermia
Hypothermia (low body temperature) is a common complication in premature infants and may depress cardiac activity

Miracle Of The Newborn Coming Back To Life – Grief To Ecstasy For Family

In a shocking incident in one of Delhi’s major hospitals in November 2017, a premature newborn baby boy born at 23 weeks (5 months) of gestation was declared dead after unsuccessful resuscitative measures. Incidentally his twin sister was declared stillborn.

After trying unsuccessfully to resuscitate him, doctors declared the boy dead and handed over both bodies in polythene bags to the grieving family members. As the family was preparing for the last rites of the babies, one of the family members felt a wriggling movement within one of the bags and found the boy to be moving and breathing.

The family rushed the baby boy named “Champ” to a nursing home where he sadly succumbed after fighting for his life for nearly five days.

Hypothermia - Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Prevention
Hypothermia occurs when body temperature drops to 35 degree Celsius or 95 degree Fahrenheit and below. It is a medical emergency and requires immediate care.

‘Incident underscores the need to follow established guidelines in management of preterm infants as well as being cautious in declaring death in hypothermia patients.’

Gross Medical Negligence Or Genuine Mistake?

This incident in a major hospital in India’s capital has sparked serious public outrage against the medical fraternity in general and in the hospital in particular.

Both the hospital and the Indian Medical Association (IMA) have ordered separate inquiries into this incident.

KK Aggarwal, the head of the IMA, said the episode was a tragic mistake. “The difference between a mistake and negligence is deliberate action. I don’t think any doctor will do it willfully,” he said.

Therapeutic Hypothermia
Therapeutic hypothermia involves the lowering of the body temperature to 350C or less to limit brain damage after cardiac arrest or trauma.

Problems of the Preterm Infant

Any baby born before completing 37 weeks of gestation is considered preterm. Babies born less than 32 weeks are considered very preterm.

The earlier the babies are born, the less ready they are to face the challenges of the outside world and they need specialized care to overcome these. With a greater degree of prematurity, the chances of complications and mortality are also higher.

Some of the complications associated with prematurity include the following:

Respiratory distress due to immature lungs
Increased susceptibility to infections due to immature immune system
Risk of hypothermia due to immature temperature regulatory mechanisms
Hypoglycemia (low blood sugar) resulting in convulsions and longterm brain damage
Severe neonatal jaundice and risk of brain damage
Increased incidence of intraventricular hemorrhage with serious longterm complications

Although the survival of babies born between 22-25 weeks gestation has improved, it remains a huge challenge for both parents and health care professionals with increased risk of mortality and morbidity and other longterm complications.

In fact, the Royal College of Obstetricians and Gynaecologists (RCOG) has published new guidelines stating that resuscitation in babies of birth weight less than 500 gms must be performed only after careful consideration.

Quiz on Hypothermia
Hypothermia is a condition in which core body temperature is lowered to 35℃ or lower. The body loses heat a lot faster than it can produce it, leading to loss in body temperature that affects the functioning of the various metabolic systems in the body. Severe hypothermia can lead to the death of the individual.

How to Prevent Hypothermia in Premature Infants?

Premature infants are at an increased risk of hypothermia. They should be protected against hypothermia by the following measures:

Maintaining an appropriately warm environmental temperature in the labor room and newborn care area
Drying the newborn immediately after delivery
Swaddling full-term neonates or placing premature infants in a polyethylene bag

Neonatal Jaundice - Overview and History
Yellow colouring of skin in newborns, a condition called Neonatal jaundice. , Neonatal jaundice is caused by presence of excessive serum bilirubin.

Following Established Norms and Protocols in Preterm Births

The WHO has established certain protocols to ensure optimal outcome in preterm births and these must be strictly adhered to by all health care professionals and establishments. This will be one of the angles of inquiry that the investigating committee will look into in this case.

According to Dr Agarwal, IMA head, the inquiry committee set up has been asked to investigate if

If the attending doctor was competent
If the baby was really premature and what his weight was
Was the baby in hypothermia
Did he have a cardiac arrest?
Was the counseling given to the relatives
What were his chances of revival?
Were the World Health Organisation (WHO) guidelines followed
Did the relations sign for the resuscitation?"

In fact Dr Agarwal has issued an advisory to doctors and hospitals across the country not to declare a person dead in the presence of hypothermia since it is possible to revive the person even after a few hours.

Hypothermia - Double Edged Sword

Hypothermia is not always undesirable or bad. It has also been shown to have potential benefits in clinical practice.

For decades, it has been shown that therapeutic hypothermia can improve the chances of survival in cardiac patients. It is believed that the cold reduces the body’s (especially the brain cells) need for oxygen and reduces the buildup of toxic chemicals that would otherwise occur when the heart is beating and oxygen is utilized. The cooling decreases the amount of oxygen utilized, and slows down the heart rate and basal metabolic rate.
When the temperature is appropriately controlled, it could help keep a person alive while doctors try to resuscitate the heart. The body is then rewarmed gradually over several hours.
This procedure is also employed for full term babies who have hypoxic–ischemic encephalopathy, a condition in which they suffer a lack of oxygen and blood supply to the brain. However it is not recommended in preterm infants.
However hypothermia is a double edged sword - if uncontrolled or used inappropriately, it can kill, as it is thought to disrupt the body’s enzyme systems and clotting mechanisms.

There are many controversies regarding the safety and efficacy of this procedure with many scientists questioning its use in practice.

In conclusion, incidents such as these will hopefully serve as eye openers both to health professionals and clinical establishments to ensure that prescribed norms and guidelines are being followed in neonatal units, to employ skilled personnel well versed in neonatal care and to educate the public on the health issues and challenges surrounding preterm births and the increased risk of mortality and complications.

Source-Medindia