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Rare Dialysis in a 7.5 kg Infant After Undiagnosed Metabolic Crisis
india
healthysoch
New Delhi, August 22, 2025:
In one of the most time-sensitive paediatric emergencies managed in recent months, a 9-month-old infant was clinically stabilised and discharged within four days after being admitted to Rainbow Children’s Hospital, Malviya Nagar, in a deeply comatose state. The child was suffering from a rare metabolic disorder that had gone undiagnosed and had escalated rapidly, leading to severe respiratory failure, liver enlargement, and a life-threatening drop in blood pH.
The baby arrived at Rainbow’s Emergency Department with a five-day history of poor feeding and increasing breathlessness. On examination, she was non-responsive, with dangerously abnormal blood gas levels and signs of multi-organ stress. The medical team identified a potential inborn error of metabolism and moved swiftly to initiate critical interventions.
The child was transferred to the Paediatric Intensive Care Unit (PICU) where she was intubated and placed on mechanical ventilation. A decision was taken to initiate dialysis — a rare and high-risk intervention in infants of this size. Rainbow’s paediatric nephrology team, with specific expertise in infant dialysis, successfully performed continuous renal replacement therapy (CRRT), helping to rapidly clear the metabolic toxins from her system.
Within 24 hours of admission, the child showed significant neurological recovery, stabilised respiratory function, and improving lab parameters. A confirmed diagnosis of Long-Chain Fatty Acid Oxidation Defect (LC-FAOD) — a rare genetic disorder that affects the body’s ability to break down certain fats during illness or fasting — was made. She was discharged on the fourth day, fully conscious, feeding well, and neurologically intact, and continues to do well on follow-up with specialised dietary and metabolic care.
Performing dialysis in such a small infant is extremely rare. It required immediate multidisciplinary coordination, and we are relieved she made a full recovery,” said Dr Chandarshekhar Singha, Senior Consultant- PEDIATRICS (HOD PICU). Rainbow Children’s Hospital, Delhi, remains one of the limited facilities in the region with full-spectrum paediatric emergency services, round-the-clock PICU, and the capability to perform renal replacement therapy in infants weighing less than 8 kg. This case underscores the value of timely referral, specialised paediatric infrastructure, and clinical expertise in managing complex, life-threatening presentations in children.
