Abdul, 17 month old, Male child was transferred to our Institute from Mombasa through air transport. While he was in Mombasa, Abdul had high grade fever, cough and breathing difficulty before he was admitted in Intensive Care for complicated pneumonia (lung infection). He was also diagnosed with pneumothorax (abnormal collection of air in the lung cavity) along with pneumonia. He required ventilator support as he was not able to breathe properly because of his poor lung condition. He also required a tube in the chest (intercostal drainage tube) to remove the air surrounding the lung and allow the lung to expand.
With ventilator support, he got better with time and started breathing better. He was eventually weaned off the ventilator. However fever spikes, fast breathing and air collection around the lung persisted.
Abdul took treatment for one month in Mombasa. However, since he was not improving further, his parents were asked to shift him to a higher center. That’s when Abdul’s mother decided to bring him to Zydus Hospital.
His transfer from Mombasa to Ahmedabad was an arduous journey. You have to complete many formalities to transfer a sick child in airlines. And to make matters worse, having a poor lung condition, as in Abdul’s case, makes air travel even more difficult. Because there was a tube attached to his chest to drain the air, he was transferred with under the care of a nurse after taking high risk consent from his parents. He landed in Mumbai and came to Ahmedabad by the next flight. His underlying condition, the stress of travel and the tube that got displaced during travel, made it more difficult for him to breathe.
On his arrival to Zydus Emergency, a new tube was inserted. Post stabilization, a CT scan was done. The suggested a necrotizing pneumonia with multiple pneumatocele, hydro-pneumothorax and bronchopleural fistula . Basically it meant that his lung was dying at certain places because of the infection, and it has destroyed many air cavities. Because of being ill for a long time, Abdul had also become malnourished. He had lost 2 kg weight in the last one month.
We first enlisted many of the challenges which are seen in Abdul, than we sought the best way out to help him in this situation. He required help of intensive care, pediatric surgeon, dietician, radiologist and health care back bone nurses. His main issues were despite tube in chest cavity the air around the lung was not getting drained, his fever was persisting, he was losing weight.
With the help of appropriate antibiotics his condition was not improving. As dead tissue doesn’t allow antibiotics to penetrate appropriately, we need remove dead tissue and collected pus in the cavity.
Dr. Parthiv shah operated on him, explaining to parents to remove a part of dead necrotic lung and to heal the bronchopleural fistula. After surgery Abdul fever reduced over 72 hours, however the air persisted in the cavity but his lung expansion was better than before and requirement of oxygen was not there after 3 days of surgery.
His air in the cavity got drained over next 7 days and chest tube was removed on day 10 after operation. Mother and grandmother were very happy as he after 6 weeks he did not have chest tube for last 4 days. However on day 14 he again developed air in the chest cavity secondary to break in one of the pneumatocele for which he required again an reinsertion of chest tube. We as clinical team were very hopeful that this will also heal. After few days complete resolution of air in the chest cavity was resolved, he started eating well. He gained weight and after few days chest tube was removed. After a year they ping me from Africa sending his photo. I couldn’t recognize him. He has grown well and is as normal as any other healthy baby.
Hope he stays blessed.
Necrotizing pneumonia is the complicated pneumonia which is commonly caused by bacteria. It has a very difficult and stormy course. 7 out of ten children recover from this eventually. It takes 6-8 weeks to recover from such illnesses.
- Dr. Ankit Mehta
DM Pediatric Critical Care and Critical Medicine (PGIMER Chandigarh)