SQU Med J, February 2011, Vol. 11, Iss. 1, pp. 124-126, Epub. 12th Feb 11
Submitted 22nd Oct 2010

This article is based on an interview with the parents 
of the child conducted in August 2010 by Theo 
Poulton, a Year 12 student at The British School 
Muscat, on placement at Sultan Qaboos University 
Hospital. It was edited by Dr Prakash Mandhan, his 
supervisor and the neonatal surgeon in charge of the 
patient.

“having children is not only a blessing, but also a joy for parents and grandparents” said Mrs. A. Her son AH, now an eight 
month-old boy, has spent almost 90% of his life in 
Sultan Qaboos University Hospital (SQUH). AH 
and his twin brother were to be the couple’s first 
children so, naturally, they were very excited as 
they awaited the birth of their sons. However, this 
excitement was dampened when they learnt that 
their son, AH, would need an operation.

AH was born at SQUH in January 2010 and since 
then has undergone three major and several minor 
operations. He was born prematurely as the second 
twin; this meant that he not only weighed less than 
a normal newborn, but was also more susceptible 
to infections. Any procedures he underwent would 
be higher risk to him compared to a full-term baby.

When he was 12 days-old and in the incubator 
in the Neonatal Intensive Care Unit (NICU), the 
nurse noted that his abdomen was enlarged and 
soon green coloured bile started pouring from 
his mouth. A quick assessment by doctors in the 
NICU together with X-ray and blood test findings 
suggested that he had an intestinal infection. The 
neonatal surgeon on duty was called and AH 
immediately underwent an emergency operation to 

save his intestine. “When the neonatal surgeon told 
us about AH’s condition, the necessity of urgent 
operation and the expected outcome, we were very 
worried and prayed to Almighty God to save his 
life” said AH’s parents. “I was so worried because 
as it was such a big operation for such a small baby 
(1.4 kg). I wondered, how can surgeon operate on 
such a small baby?”, added AH’s mother. While the 
senior neonatal surgeon, two senior anaesthetists 
and a couple of senior nurses were trying hard to 
save AH’s life, his parents and family members 
were praying and waiting for news about the baby. 
Nearly 95% of his small intestine was seriously 
infected and the germs had already affected his 
whole body. The neonatal surgeon had to remove 
his dead small intestine and then tried to save some 
of other affected parts of intestine in order to give 
AH a chance to live and grow unaided. After the 
operation, AH was given very strong antibiotics and 
full intensive care support to give him a chance to 
fight against the deadly infection. Unfortunately, 
within 48 hours, he deteriorated further and needed 
a second operation. During this procedure, all 
except the first ten centimetres of the small intestine 
was found to be dead. It was a very hard decision 
for the surgeons to make, as well as for the parents, 
but since this was the only option to save his life, his 
entire dead small intestine was removed in the hope 
that once he was cured of the infection, he could be 
offered other alternatives. This left AH with only a 
very small percentage of the 250 cms of intestine 
of an average full-term newborn. “I remember, my 
wife was shocked after she had this news about 

1The British School, Muscat, Oman; 2Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.
*Corresponding Author email: kidsurg@squ.edu.om

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PATIENT'S VIEWPOINT

Hope Happens Here 
Battle with the consequences of severe neonatal gut infection

Theo Poulton1 and *Prakash Mandhan2



Theo Poulton and Prakash Mandhan

Patient's Viewpoint | 125

AH and so was I, but since we had no other option 
and we wanted him to survive, we made this hard 
decision. It helped to hear that there would be some 
options afterwards for AH to get an intestine” said 
AH’s father, an employee in a private company.

Despite this second operation, AH’s health 
was not good in the following few days. His father 
said, “We feared that we were very close to losing 
him, but we had great confidence in the doctors in 
SQUH and also hope from Almighty God that he 
would be alright”. He also said, “It was through our 
hope and the efforts of the surgeons, doctors and 
nurses that he survived and within a week he was a 
different boy.” 

During this difficult period, AH’s father said 
that they had great moral support from family and 
friends. AH’s mother agreed and added, “The most 
important thing was that my husband was there for 
me and that everyone in the Unit was trying his/her 
best for our son”. She continued, “When we looked 
at our twin sons in the neonatal unit, we always felt 
more protective of AH due to his condition. “I used 
to look at him, touch and cuddle him for hours to 
give him loads of support and love as he was my 
very tiny and cute baby,” said AH’s mother.

Due to the shortness of his small intestine, 
AH was now dependent on intravenous (IV) total 
parenteral nutrition for his supply of basic nutrients 
with the paediatric gastroenterologist taking over 
this special care. After a few weeks, it was time for 
the surgeon to restore AH’s intestine so that he could 
be started on oral feeds. “Based on our previous 
experience, this time we were more confident and 
less worried about the operation since we had great 
trust in AH’s surgeon, who had already operated on 
him twice”, AH’s father commented. “We had more 
hope now that AH would be able to have some feed 
and grow like his brother”. AH’s third operation 
successfully rejoined his 10 cm of small intestine to 
his large intestine and also made a temporary hole 
in his stomach for supplementary feeds.. “AH could 
be started on small feeds ten days after his third 
operation and we were very excited on that day” 
said his parents. “When I saw the nurse giving him 
his first feed, I was thrilled”, said AH’s mother. “I was 
imagining joyfully that soon I would be able to feed 
him myself ”. After a few days, his feed was increased 
slowly and he was also removed from the incubator 
as he was improving and looking well.

Time flew by. At eight months-old, AH now 

weighs 5.0 kg and receives nutrition from IV drips 
as well as from the tube into his stomach. “Although, 
he does have very minor problems with the tube 
in his stomach and with the central line for his IV 
feeding (which is very close to his heart), overall he 
is doing well”, said AH’s mother. By August 2010, 
AH had had four operations and his parents had 
more hope for his future health. 

AH has spent most of his life in SQU Hospital, his 
mother almost constantly with him. She is a teacher, 
but unable to fulfil her professional commitments 
due to AH’s condition. Her husband has been a 
great support and they share the care of AH and 
his twin brother at hospital and home. AH’s mother 
said that although the care in the ward was good, 
she sometimes felt frustrated at not being given all 
the details about her son’s condition, “I like to know 
everything about my baby and his condition. Maybe 
more junior staff are not used to being asked about 
every little thing. It’s not only the doctor’s decision. 
As his mother, I would like to be involved in his care 
plan”. She felt that the consultants did understand 
her feelings and did provide the information she 
wanted. Her husband agreed, saying, “For us, we 
would like to make the decisions. If they decide to 
operate on him and we are not convinced, then we 
will say no. I remember, when the surgeon said AH 
needed one more operation (to connect AH’s small 
and large intestines). He explained the risks and 
benefits. It took us some time to decide, but finally 
we agreed with him. I think it is better to make the 
decisions yourself rather than leaving it to others”. 

As for the overall care and support given to AH 
at SQUH, AH’s mother said, “I feel it is really very 
good especially from the consultants, such as the 
paediatric surgeon, the paediatric gastroenterologist, 
the neonatologist and the paediatrician”. It has been 
a great experience for us to see what a great team 
of doctors and nurses we have here. Everyone at 
different levels has been very helpful and supportive 
to us. The hospital administration has also been 
very cooperative for the supply of consumables, IV 
feeding and medicine for our son”. 

AH is now at home on IV nutrition, but 
regularly comes to SQUH for evaluation. The hope 
is that AH can have an intestine transplant, using 
part of the small intestine from his twin brother 
or a parent, so that he can have a chance to grow 
and survive without IV nutrition. One of the major 
disadvantages of IV nutrition is that it affects the 



Hope Happens Here  
Battle with the consequences of severe neonatal gut infection

126 | SQU Medical Journal, February 2011, Volume 11, Issue 1

liver functions and can eventually cause liver failure, 
and the need for a liver transplant. Up to now, there 
have been quite a few intestinal and liver transplants 
in children all over the world and the results are very 
encouraging. However, this treatment modality still 
needs more development before it becomes safe 
and easily available. 

“Since there is no facility for intestine and liver 
transplant in Oman, we have been in touch with 
transplant teams in Europe and America for our 
son”, said AH’s parents. “The doctors from Europe 
have asked us to send the medical reports and soon, 
inshallah, we will go and see a transplant team in 
order to get an opinion for AH. “I have done a lot of 
research and reading on the Internet about intestine 
and liver transplant”, said AH’s mother. “Although, I 
am not very comfortable with the final results, I have 

gradually become quite convinced about the need 
for it. Earlier, I was totally against the proposition 
when the consultants first suggested it. It is going 
to be a huge burden on both of us financially as well 
as socially as we are the only earning members in 
the family. Finally, we are a bit concerned about the 
care AH will need after the transplant. It is going 
to be very tough and hard on both of us to travel to 
Europe for post-transplant care hence we hope that 
transplant doctors in Europe will make a team with 
our surgeons and gastroenterologists in SQUH, so 
that we can get very similar care right here in SQUH. 
I have seen the hard work of our doctors and nurses 
in SQUH and we have a lot of confidence in all of 
them. We only wish this transplant could happen 
as soon as possible so that our son can have a more 
normal life”, concluded AH’s mother.