When week-old Jeslyn Lim arrived at KK Women's and Children's Hospital (KKH) on Dec 1, she had a tumour extending from her tailbone that was larger than she was and doctors doubted her chances of survival.
The Batam-born Indonesian suffered multiple organ failure as a result and was in a critical condition.
Associate Professor Low Yee, 47, the chief surgeon during the operation to remove her rare tumour, known as sacrococcygeal teratoma (SCT), yesterday revealed that Jeslyn is now on the road to recovery. She should be discharged soon if no complications occur.
Prof Low usually sees SCT cases, which occur in one in 35,000 to 40,000 live births, once or twice a year. But never in her 18-year career in paediatric surgery had she come across a tumour as big as Jeslyn's, which stretched to 25cm.
WHAT IS SACROCOCCYGEAL TERATOMA (SCT)?
• SCT is an unusual tumour that develops before birth and is located at the base of the newborn baby's tailbone.
• It is more common in female than in male babies.
• It occurs in one in 35,000 to 40,000 live births
When she was born on Nov 23, she weighed 7.3kg, more than twice the weight of an average newborn baby.
"When she came to us, she was in heart failure and her liver was not functioning," said Prof Low, who heads the department of paediatric surgery at KKH. "She was dehydrated and critically ill in the emergency department and our doctors had to intensively resuscitate her within the first 24 to 48 hours."?
Doctors in Batam lacked the resources to help Jeslyn and she was transferred to Singapore with the help of humanitarian organisation the Rotary E-Club of Singapore .
"The surface of her tumour was ulcerated... and there had been an obvious infection," said Prof Low.
Jeslyn also had a heart condition known as patent ductus arteriosus (PDA) involving a blood vessel linking the aorta to the lung vessels in a developing foetus which should have closed up soon after birth.
Her infection re-opened this vessel, resulting in increased blood flow to the lungs and consequent breathlessness. The increased blood flow also exacerbated a valve problem, causing an abnormal backflow of blood and decreasing supply to the rest of her body. Her heart had also been abnormally enlarged to cope with the demand for blood.
There was a 50 per cent chance that the four doctors involved in the operation could have run into trouble during surgery to remove the tumour on Dec 4.
Prof Low said: "She might not have made it through the operation due to the risk from the anaesthesia or blood loss. The trauma from the operation could also cause her to succumb soon after."
The tumour was removed after a seven-hour operation.
The PDA has since closed and her condition has stabilised. Her heart failure condition improved significantly, though she still needs oxygen support for now.
Doctors still face a "minor obstacle" as Jeslyn's surgery wounds became infected after the operation. She has to be kept under observation until it heals. "When we took the tumour out, it was full of bacteria. Some of it went into the wound despite our best efforts to control it with antibiotics," said Prof Low.
Apart from a scar that will stay on their back, most SCT patients can live a normal life.
There are two main risks that Jeslyn now faces: the possibility of a tumour recurrence, which could turn malignant, as well as continence issues that affect her bowel and bladder functions as the nerves in the region had been stretched by the growth of the tumour.
This risk of recurrence is the highest in the first five years, and Jeslyn will need to return to KKH for follow-ups at regular intervals.
Jeslyn's father, storeman Junaidi Lim, 28, told The Straits Times yesterday that well-wishers and charities in Indonesia had raised over $100,000 for Jeslyn's hospitalisation and surgery expenses, which are currently over $78,000.
He said through a translator: "We are grateful to all who have stepped in to help, and to those who helped to bring Jeslyn to Singapore."
WATCH IT ONLINE
See how baby Jeslyn is doing at the hospital http://str.sg/ZKww