Doctors at Rainbow Children’s Hospital helped give a new lease of life to a baby named Lochen who underwent Bone Marrow Transplant for a rare genetic condition known as monogenic inflammatory bowel disease. The boy was put on extracorporeal membrane oxygenation (ECMO) support post the complications of BMT. It is the first case in India where ECMO CPR was performed on a child who underwent a bone marrow transplant and the first child to survive ECMO following a Bone marrow transplant.

 Case Details

A six-week old baby Lochen, the first surviving baby for a couple who already had a previous child death at 9 months of age, had his first admission to Rainbow Children’s hospital with diarrhoea and severe dehydration. The parents thought it would be a simple infection, but he was diagnosed to have a rare disease called monogenic inflammatory bowel disease due to IL-10 R deficiency, which is a genetic condition, whose only available treatment is to do an early bone marrow transplant (BMT). With the support from Tamil Nadu Chief Minister’s fund, bone marrow transplant was performed at 5 months of age in a reputed hospital. Post the transplant, he suffered severe complications due to infection, which damaged every organ in the body. His kidneys, liver, heart and lungs failed on the 14^th day of transplant and hopes were lost. The only option in this situation would be ECMO (Extracorporeal Membrane Oxygenation) for this baby. Even ECMO will not help to correct other failed organs and would be very expensive.

 Children who undergo bone marrow transplants do not survive ECMO due to various challenges. Hence the transplant is considered as a contraindication to ECMO support in children. The child was refused ECMO in the previous hospital owing to poor outcomes, and many other centres. Since this baby was diagnosed with a rare disease in Rainbow Children’s Hospital, they decided to transport him to their unit.

 On return, the baby suffered cardiac arrest. The activated ECMO team led by Dr. Karthik Narayanan, Senior Consultant Pediatric Intensive Care, Rainbow Children’s hospital performed ECMO CPR on the child. Following ECMO CPR, the baby’s heart was revived. ECHO of the heart revealed that the baby had a huge clot obstructing blood flow in the heart which has probably resulted in the heart-stopping suddenly. The blood clot was dissolved after starting appropriate medicines. The baby required ECMO for the next 20 days. After 20 days, Lochen was de-cannulated from ECMO and later dialysis followed by Plasma exchange was stopped. However, he continued to be on a ventilator for one more week.

 As ECMO increases the risk of bleeding, neurological ultrasound scans were serially performed, which revealed bleeding in the right side of the brain. Expert neurosurgical consultation was taken, and the blood clot was removed after the baby was de-cannulated from ECMO by Dr. Santhosh Mohan Rao, Consultant Neurosurgeon, Rainbow Children’s hospital, Chennai.  Consultant Pediatric Hematologist Dr. Dhaarani Jayaraman helped in post bone marrow transplant care.