Rare Surgery On Premature Baby
By P Marilyn & Narissa Noor

Bandar Seri Begawan - Nurulain Afiqah was born premature at 27 weeks and weighed one kilogramme at birth. Her weight dropped down to 900 grammes and surgical measures had to be taken.

Being only 27 weeks old, she is considered to be the youngest patient ever to undergo surgery in Brunei Darussalam, and the surgical procedure is a major milestone.

She was born prematurely because an emergency caesarean operation had to be performed on her mother to save both their lives.

The baby was born with a breathing problem and was diagnosed with a very large patent ductus arteriosus (PDA), which in laymen's terms mean an abnormal communication between the heart and aorta. The baby had to be put on a breathing machine, and a lot of medicines were needed to help her heart to clear water from the lungs.

The following day after the operation, the baby was removed from the breathing machine and she no longer required medicine for her heart.

Since then, he has streadily gained weight and is now about 1.2kg. She is currently being monitored at the Neonatal Intensive Care Unit of RIPAS Hospital, as she is still susceptible to infection. Her mother is also recovering at the Intensive Care Unit.

In an exclusive interview with the Borneo Bulletin, Dr Isham Jaafar, the local cardiac surgeon who performed the operation, said that although the condition was common in premature babies, it had never been done on a baby of her size in RIPAS Hospital before.

He explained that the PDA should be closed when the baby was born but because she was born prematurely, there was too much blood going from the aorta into the lungs and heart.

"This makes the lungs 'flooded' with water," he said, adding that heart also becomes distended, which makes it difficult to contract properly.

"A few years ago, we would have sent the patient to a specialised cardio thoracic unit in Malaysia," said Dr lsham. However, the problem with a baby this small though is the risk that comes with travelling.

On the success of the operation, Dr Isham said, "It is very exciting for us, as this was the first time we carried out such a procedure on a baby that small in Brunei."

The whole team feels fantastic, he said, adding that this would not have been possible without the hard work and dedication of the whole team.

Dr Suresh (neonatologist), Dr Yew and Dr Rohayati (paediatric cardiologists), Dr Zulaidi and Dr Nandini (anaesthetists), nurses and paramedical staff worked hard to ensure the success of the rare operation.

"It has to be a good team to do the job," he told the Bulletin.

The father of the baby, Mohd Erwan bin Jumat, expressed his happiness to the Bulletin on the success of both his wife's and daughter's surgery.

"I prayed during the surgery hoping that everything would be fine and my prayers were answered, thanks to the team of medical staff at RIPAS," he said.

When asked of other remarkable surgeries that he had done, Dr Isham, 36, spoke of a pacemaker he had implanted in a newborn baby.

According to the doctor, the problem was found on routine antenatal check up. The foetus was noted to have a slow abnormal heart rate and if left untreated the foetus might have died because of heart failure.

The date of delivery was planned via caesarean section and the pacemaker was implanted a few days later.

Because of the small size, the pacemaker had to be placed near the baby's stomach to allow the coil attached to the pacemaker to stretch as the baby grows. And now the baby is doing very well.

The baby will have regular follow up with local paediatric cardiologists, Dr Rohayati and Dr Yew, to ensure the pacemaker is working well.

"In about five years' time, we will have to change the pacemaker because the battery doesn't last that long," Dr Isham explained.

Dr Isham's career began as a general surgeon before he specialised in cardiac surgery after he went to medical school in Dundee, Scotland, under a special scheme from His Majesty's Government.

When asked what made him choose to specialise in cardiac surgery, Dr Isham replied humorously, "If you see the heart beat and then (it stops)... and then (you) make it beat again. It's amazing and not many people can do that."

The premature baby will be at RIPAS Hospital until she weights 2kg. "Her condition is looking good though," commented Dr Isham. -- Courtesy of Borneo Bulletin

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