Doctors at MacKay Children’s Hospital on Tuesday held an early birthday party to celebrate a former patient turning three, as well as the publication of their paper describing her treatment in the journal Urology in May.
Hsu Chyong-hsin (許瓊心), who led the medical team, said that the baby, known as Hsiao-ying (小縈), was in 2015 transferred to the hospital’s newborn infant intensive care unit after she was born prematurely at 28 weeks and weighing 1.152kg, as she showed symptoms of abdominal distension, vomiting and anuria.
She was diagnosed with systemic fungal infection with complicated obstructive uropathy, Hsu said, adding that sonography showed that fungal balls filled her entire pelvis, causing hydronephrosis — the swelling of the kidney due to a build-up of urine.
Photo courtesy of Mackay Children’s Hospital
Fungal balls were also found in her heart valve, eyes, bones and bloodstream, she said.
While it is common for premature babies to contract fungal or viral infections, as they are connected to many tubes for treatment and life support, it was rare to see a general infection like Hsiao-ying’s, Hsu said.
Pediatric nephrology department director Tsai Jeng-daw (蔡政道) said that Hsiao-ying’s anuria could not be treated with percutaneous nephrostomy, as she was extremely underweight, even for a premature infant.
Senior attending surgeon Sheu Jin-cherng (許錦城) said that the hospital had been at a loss for what to do and finally settled on performing retrograde ureteral catheterization to decompress the pelvis.
The procedure is extremely difficult, especially when performed on underweight premature infants and had never been documented, Sheu said.
With the aid of cystoscopy, the team introduced a 1mm tube into Hsiao-ying’s pelvic area via the urethra, identified the precise location of infection via X-ray and pumped amphotericin B into the area, achieving a therapeutic concentration while avoiding damage to her kidneys.
Hsiao-ying began urinating the next day, with her kidney functions gradually returning to normal, Sheu said, adding that the tube was removed after one month, when sonography confirmed that there were no traces of fungal infection.
Hsiao-ying’s parents signed seven or eight agreements for surgeries and the baby remained in intensive care for more than seven months, Tsai said.
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