Rare surgical procedure performed on 2-day-old baby at Institute of Child Health

The last surgery for the treatment of the disorder was performed eight years ago on a five-day old child under the Chief Minister’s Comprehensive Insurance Scheme at ICH. In the most recent case, the child born with persistent low blood sugar levels also called hyperinsulic hypoglycaemia nesidioblastics underwent a complete removal of pancreas for the surgical management of the disorder. The case study was also presented at the Indian Association of Paediatric Surgery conference held in Chennai recently.

Nesidioblastics, which is caused by a solitary tumour of the pancreas secreting excessive amount of insulin, was identified as the reason behind the persistent hypoglycaemia in the child. The child was admitted to neonatal intensive care unit at the hospital after suffering from repeated seizures.

The child with blood sugar value below 40 mg/dL was identified to be suffering from hypoglycaemia with seizures, lethargy and jitteriness. While hypoglycaemia is usually treated with oral glucose feeds and infusion, infants with persistent hypoglycaemia occurs in 1 in 50000 live births and is not usually treatable by oral feeds. However, the child did not respond to glucose infusion and continued to have episodes of seizures and persistent hypoglycaemia.

“If IV fluids are disconnected, there can be a condition when the child can die because the sugar levels are too low. Despite trying oral fluids and medication, surgical treatment was required along with round-the-clock monitoring at the intensive care unit. The islet cells in pancreas forms a tumour-like structure which continuously produces insulin and causes low blood sugar,” said paediatric surgeon at ICH, Dr Mohan Kumar.

“As the proliferated structure is in pancreas, the removal of pancreas stabilises the child, or the chances of survival are low. The surgery was performed successfully, and the child was discharged after recovery,’ adds Dr Mohan. Doctors say that an increase in the incidence of diabetes in women, increases the risk of nesidioblastics in children born to them. A follow-up assessment and screening should be performed on all new-borns to prevent deaths due to nesidioblastics.

Only five surgeries have been performed for hyperinsulic hypoglycaemia nesidioblastics in last ten years.