Navi Mumbai: Premature Baby Boy With Neonatal Diabetes Discharged After 25-Day Hospital Battle

In an exceptional medical achievement, a team of expert doctors at Medicover Hospital, Navi Mumbai, led by Dr Tanmesh Kumar Sahu, Consultant Neonatologist and NICU In Charge and Dr Rachana Keshwani, Consultant Pediatric Endocrinologist successfully managed a premature baby born at just 30 weeks with neonatal diabetes, saving the baby's life and marking a historic milestone in neonatal care.  

A young couple, Shamita (name changed)* and Raj Sinha (name changed)*, residents of Navi Mumbai, excitedly awaited the arrival of their first child when unexpected complications arose. The mother, a case of gestational diabetes, had to undergo an emergency C-section at just 30 weeks of pregnancy due to leaking of amniotic fluid from the sac. The baby, weighing only 1.1 kg, was born with respiratory distress and was immediately admitted to the  Neonatal Intensive Care Unit (NICU) for specialized care.

Dr Tanmesh Kumar Sahu, Consultant Neonatologist and NICU In Charge, said, "As per NICU protocols, the baby was provided with the necessary respiratory and nutritional support. As premature babies at 30 weeks have immature lungs, they usually have respiratory distress syndrome, which is confirmed by clinical parameters of fast breathing and difficulty breathing. The baby was managed by a noninvasive mode of ventilation and later through CPAP( Continuous positive airway pressure). Nutrition requirements were fulfilled by total parenteral nutrition, and gradually, mother's only milk was started. Routine monitoring revealed persistent high blood sugar levels of around 300 mg/dL, contrary to the hypoglycemia commonly seen in infants of diabetic mothers. Unfortunately,  sugar levels remained uncontrolled in the baby."

Dr Tanmesh Sahu added, “We suspected transient hyperglycemia or neonatal diabetes, likely linked to mutations in the KCNJ11 and ABCC8 genes.  Early-onset diabetes is mostly due to genetic mutations in newborns. KCNJ11 AND ABCC8 mutations lead to the disruption of glucose-stimulated insulin secretion, leading to either permanent or temporary inability to produce sufficient insulin that ultimately leads to high sugars. The parents were counseled regarding the condition, and genetic testing was planned. Blood samples were sent to Exeter Medical School in the UK for confirmation. Meanwhile, the baby was gradually introduced to full feeds by day 7, but the blood sugar levels spiked further to around 400 mg/dL despite regular insulin infusion.  NPH insulin was found to be more effective in stabilizing the baby’s blood sugar levels."

After days of diligent monitoring and expert medical intervention, the genetic test results confirmed the presence of the same gene mutations suspected by the doctors. Genetic testing was planned, and blood samples were sent to Exeter Medical School (UK). "This rare diagnosis was a breakthrough moment, and the team successfully managed the condition, ensuring the newborn’s stability. The baby was managed by the oral anti-diabetic drug Glibenclamide. The baby was discharged after 25 days and is growing well, accepting feeds, and achieving developmental milestones as per his age.   The NICU team not only controlled the baby’s sugar levels at such a premature age but also trained the parents on monitoring and administering insulin at home," underscored Dr Tanmesh Sahu.

“Neonatal diabetes is an extremely rare condition, and its diagnosis in a premature baby requires precision and expertise. Our team at Medicover Hospital worked tirelessly to ensure the best possible care for the newborn. Early genetic testing played a crucial role in identifying the exact cause, allowing us to tailor the treatment effectively. We are proud to have set an example in Navi Mumbai by successfully managing this case and training the parents to continue care at home. This achievement showcases the advanced neonatal care available at our hospital,” said Dr Rachana Keshwani, Consultant Pediatric Endocrinologist. 

“This was our first pregnancy, and we were shattered when complications arose so early. We thank Dr Tanmesh, Dr Rachana , and the entire NICU team for saving our baby’s life. From the initial critical phase to ensuring we could confidently care for our child at home, they have been our guiding light,” underscored Shamita Sinha (name changed)*, mother of the baby.