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Newborn is in deep coma. What are the treatment available for cure?

Answered by
Dr. Sanjay Sharma


Practicing since :1988

Answered : 236 Questions

Posted on Tue, 7 May 2013 in Child Health
Question: Dear doctor,

I am seeking help at the request of a desperate mum in China, whose 3 month old baby has been in deep coma for 45 days.

The baby, XXXXXX, was born in China on the 1st of XXXXXXX 2013. On 04 March 2013, he vomited a lot of milk and was choked, and immediately turned to be purplish and floppy. His heart beat had stopped when arrived at the local hospital, but was finally saved and kept alive on the respirator. Since then, XXXXXX has been in deep coma and has very weak spontaneous respiration. There was some improvement in his respiration from 18 March. On 20th of March, his spontaneous respiration was strong enough to take off the respirator, and he has regained a little bit muscle tone. However, good times didn't last long, his breathing became tight again at that night, and he was put on respirator again. Since then, he has never been able to take it off. It has been 45 days that XXXXXX has been in deep coma and living on respirator. His spontaneous respiration is getting worse, and, informed by his doctor, even disappeared in the last few days.

XXXXXX is in NICU, where his parents can only see him from windows. They are so heart-breaking, and are looking no more forward but to looking after XXXXXX by themselves. However, it's almost impossible without XXXXXX having spontaneous respiration. Under their request, I am helping them to seek some help here. Their main concerns are

1) Are there anything or any method that can help XXXXXX to regain spontaneous respiration? Any strategies the doctor and the parents could follow?
2) Is it possible to look after XXXXXX at home with a respirator? Are there portable respirators that can be used at home?
3) Any advice to help XXXXXX to regain consciousness?

XXXXXX parents and all the people who love XXXXXX appreciate your help so much! Thank you!

Kind Regards,


Here I attached the diagnosis from the hospital on 02/04/2013 (translated to English):

Age: 2 months

Physical examination:
Flat soft spot, low tension;
Equal pupils (diameter: 1.5mm), slow reflection to light;
Full body skin edema;
Symmetric but coarse breath sound from the lung, no rales were heard;
Normal apex-beat, no thrill or abnormal beating in precordium, no feeling of friction in pericardium;
Slightly increased limb muscle tension;
Primary reflex disappeared, pathologic reflex has not been induced;

Initial diagnosis:
Hypoxic ischemic encephalopathy?
The left frontal area subdural hydroma;
Moderate anemia;
Severe neonatal asphyxia;
Urinary tract infection
Answered by Dr. Sanjay Sharma 3 hours later

Thanks for placing your query here.

I really appreciate that you have taken interest & have volunteered to seek help for baby XXXXXX.
The case history of baby XXXXXX is really heart-braking & I deeply empathize with his parents who must be emotionally drained.

Unfortunately there is little that can be done medically & all efforts should be directed to provide palliative care to baby XXXXXX and mental & emotional support to the parents .

XXXXXX brain has suffered irreversible severe brain injury secondary to lack of oxygen.

There is no specific medicine or strategy that can bring back spontaneous breathing efforts or regain consciousness.

To be honest chances of his survival are very bleak & with such severe brain insult any survivor is expected to have severe neurological sequel.

Long term mechanical ventilation of children at home is feasible.

Early and careful planning leads to a smooth transition to home care.

Home ventilation may have psychological, social and economic advantages.

Not all children benefit from long term ventilation. In case of XXXXXX home ventilation will give parents opportunity to spend time with him & it should not be expected to do any miracle.

A child may be considered suitable for home ventilation if:
(1) The medical condition is stable.
(2) Parents understand the long term prognosis and are willing and capable of meeting the special needs of their child in the home setting.
(3) It is practical to provide the level of support and intervention that the child requires at home.

Hope I have answered your query.

If you have any further questions I will be happy to help.

Best regards.
Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Sanjay Sharma 16 hours later

Thank you for your honest answer. We actually know that the situation for XXXXXX is very very critical now, but just cannot accept the idea of giving up. I know even there's only 1% hope, their parents are willing to put in 100% effort. Their main concern now is XXXXXX respiration, and there's one more question they want to ask,

XXXXXX had always have weak spontaneous respiration until a few days ago, and once, he even had respiration strong enough to take him off ventilation. Although it didn't last long, but does it indicate that his brain part that controlling the breathing is not that much damaged? I personally think that it's the side effect of using ventilation that makes his respiration getting worse. Is it possible to reverse this side effect? You know, XXXXXX is actually at the edge of death, so any brave/extremely brave ideas would all be appreciated.I got some more information from XXXXXX mum. XXXXXX still has weak spontaneous respiration, not totally disappeared. His heart rate is 140 per minute, and blood oxygen saturation is above 90 with ventilation.

An abnormal thing: Today, when XXXXXX mum touched him, he had some slight movements in limbs and head, and his heart rate XXXXXXX to 200 per minute. Does it mean XXXXXX is still having reflection to the environment? The nurse there was amazed as well. Is XXXXXX improving? Any hope?
Answered by Dr. Sanjay Sharma 2 hours later

The fact that baby XXXXXX is having spontaneous respiration efforts & his vital parametrs are stable is definitely encouraging sign.
The second information that he seems to be responding to environmental stimuli is also very much encouraging.
To wean off the patient from full ventilation support the ICU doctors try "spontaneous breathing trials" to support his breathing through non invasive ventilation that means either through CPAP through nose or through T-piece. During such trial baby receaves a constant flow of air-oxygen with minimum pressure support I am sure the doctors in china will be trying them.
I am sorry if I sounded negative in my initial reply, the fact is survival in his case is not impossible.
The main cause of death in prolonged NICU stay is secondary infection & not the respiratory failure.
The third crucial aspect is nutritional support.
As long as his doctors can avoid infection from certain resistant bugs & his nutrition & electrolytes are taken care of there is always a XXXXXXX of hope that ultimately his breathing muscles will regain enough strength so that he can breathe with minimum or no support.

I salute your efforts & pray to God for baby XXXXXX.
Best regards.
Above answer was peer-reviewed by : Dr. Vaishalee Punj

The User accepted the expert's answer

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