Odisha conjoined twins: Taken off ventilator support, one baby starts recognising mother

Kalia (left) and Jagga after the surgery

Less than a week after conjoined twins from Odisha were separated at the All India Institute of Medical Sciences, the institute Wednesday said that 28-month-old Jagga has been taken off ventilator support and will likely be moved out of intensive care unit (ICU) in the next 48 hours. AIIMS had, on November 26, successfully conducted India's first craniopagus surgery to separate Jagga and Kalia, who were joined at the head and are currently undergoing post-operative care in the ICU.

While Jagga has been taken off ventilator, doctors said Kalia's condition is stable but he continues to be on ventilator support. Doctors said that Kalia will be kept in the ICU "for a longer period".  AIIMS doctors said that Jagga's functioning of key organs - heart and kidneys - has "further improved", and that he has also shown "improved sensorium" - the ability of the brain to receive, process and interpret sensory stimuli.

On Monday, doctors had said that Jagga had started showing response to some commands, as well as to dialysis to support his compromised kidney function. On Wednesday, AIIMS doctors confirmed that Jagga has started recognising his mother and "responds to questions" - and that if he continues to remain stable, he will be shifted to a private ward in the next 48 hours.

The twins at AIIMS before the surgery

"Jagga was taken off ventilator support at 1:30 pm on Wednesday. His sensorium has improved and the control from the brain is improving. He has good respiratory effort and his lungs are also expanding. This is a positive development. He is also moving his hands and feet. But we have to wait and watch. The next 48 hours will be critical. Since he is not on ventilator, we should make sure he does not get tired out," Dr Shefali Gulati, chief of the child neurology division at AIIMS, told The Indian Express.

Doctors said Kalia had seizures till Tuesday evening and that his sensorium continues to be poor. "Kalia has had a lot of seizures. But he has not got seizures since Tuesday evening. We have new medicines to control it. His sensorium has not improved," Dr Gulati said.Earlier, they shared a common blood supply channel to the brain, and in the first stage, a new venous bypass was created to separate the veins shared by them. Doctors pointed out that since Kalia has a new venous bypass, there continues to be "manipulation" in his brain, resulting in seizures.

"Kalia did not have his own sinus and was using Jagga's. Since he now has an artificially created venous bypass for circulation, there is more manipulation in his case post-surgery. He had flurry of seizures after the first stage of surgery. It is logical that the manipulation in the brain is resulting in seizure. We have added new medicines for him," Dr Gulati said.

Doctors maintained that the "sudden change in physiology" of the twins - that is, maintaining circulation of blood on their own - is the biggest challenge for the critical care team during post-operative care. "The other factors for their recovery are ensuring they don't acquire infection, and maintaining stable functioning of key organs such as heart, brain and kidneys," the doctor said.