In a first for an Indian hospital, the Rainbow Children’s Hospital in Hyderabad has come up with something called an ‘advance high frequency ventilation’ (HFOV) with nitric oxide gas inside an ambulance, so as to save critically-ill newborns.
This is pioneering, because neonates have to sometimes be shifted from one hospital to another higher centre for advance care. To ensure that babies do not get sick during transport, newborn emergency transport service ‘ICU on Wheels’ is needed, so that they have access to doctors, nurses and all ICU equipment including a ventilator in the ambulance.
According to a press release shared with indianexpress.com, until now, critically-ill babies with low oxygen levels, who are not able to maintain it with normal ventilators, were not transported. These babies would need high frequency ventilation and inhalation of nitric oxide.
Per the release, Rainbow Children’s Hospital is the first in the country to have established HFOV and nitric oxide support systems in ambulances to move such babies.
The release says that one Mehreen Fatima, a healthy 2.7 kg baby, was born at a district hospital. But, she developed breathing problems a few hours after birth. Doctors suspected a heart problem and sent the baby to a cardiac centre in Hyderabad, where cardiologists found the right side of the baby’s heart to be poorly functioning, causing a drop in oxygen levels.
The baby was then found to have a serious condition called persistent pulmonary hypertension of the newborn (PPHN). There were ‘holes’ in both of the baby’s lungs.
The release explains that PPHN is a common problem in neonates that makes them “very sick”. Sometimes, they do not recover with normal (conventional) ventilators, and need special HFOVs and nitric oxide.
For the unversed, a normal ventilator gives 40–60 breaths per minute, while a high frequency oscillation ventilation machine gives 600–900 breaths per minute. There, however, aren’t many NICUs in India that have these life-saving tools.
In Mehreen’s case, she needed an advanced level 4 NICU unit, along with round-the-clock neonatologist support, which was provided to her at the hospital in Hyderabad’s Banjara Hills. Fortunately for her, after the successful transportation, she was treated with surfactant, HFOV, given nitric oxide for 3 days with two chest drains to help her lungs.
She started showing improvement, while also needing critical care monitoring, regular cardiac assessment and multiple inotropes (to maintain normal blood pressure) for the next 5 days.
By day 8, she had recovered, and on the 11th day, she left the hospital as a healthy baby.
The hospital’s biomedical team and doctors assembled ventilators and nitric oxide delivery systems for ambulances. Later, they received calls for transfer of babies over long distances, too. One such case was that of a newborn with PPHN who was treated in a local ICU by a pediatrician in Nanded, Maharashtra. A road transport ambulance facility with HFOV and nitric oxide was initiated which, according to the release, became the world’s longest travel with HFOV and nitric oxide support in an ambulance for around 5 hours, from Nanded to Hyderabad.
Rainbow Children’s Hospital Neonatal team has now done as many as nine such transports — six from outside the city and three within the city.