Welcome to clinical meeting

Dr. KANTA HALDER Resident (MD;Phase A)

BICH

Particulars of the patient

Name: Baby of Amena. Age: 5 days. Sex: Female. Address: Boubazar. Date of Admission: 02.09.2015. Date of Examination: 06.09.2015.

History of present illness According to the statement of mother, baby was

delivered by LUCS before the expected date of delivery and the size of the baby was small than that of a normal newborn. With these complaints, the baby was admitted in Dhaka Shishu Hospital for further evaluation and better management. The mother also complained that her baby developed yellow coloration of whole body from 3rd day of life.

Chief Complaints Born before date with small size of the baby. Yellow coloration of whole body from 3rd day of life.

Birth History Antenatal : Mother, Amena, a 30 years old lady,

gravida – 5th (1 spontaneous & 1 induced abortion), para – 3, was on irregular antenatal check up and was normotensive & nondiabetic. She had history of premature rupture of membrane for about 1 month which was watery, but not foul smelling. There was no history of fever with rash or taking any offending drug during her pregnancy period. She was immunized against tetanus and her blood group is A positive.

Birth History (cont..)

Postnatal : Baby cried immediately after birth, needed no resuscitation. Her birth weight was 1400 gm.

Natal : Baby was delivered by LUCS at 34 weeks of gestational age at 12.00 PM on 02.09.2015 at hospital due to maternal oligohydramnios.

Family History She is the 3rd issue of her non-consanguineous

parents.

Socio-economic History She came from a low socio-economic family.

Feeding HistoryBaby was given expressed breast milk from 3rd day of age through NG tube.

Physical Examination o Baby was lathergic, normothermic, icteric upto

abdomen.o Weight : 1400 gm ( below 3rd centile ).o Length : 42 cm ( just below 10th centile ).o OFC : 29 cm ( just below 10th centile ).o Temperature : 99° F.o CRT ˂ 3 seconds. o SaO₂ (Pulse oximeter) : 96% in room air. o Skin : Normal.

Cont.. o Frontanelle : Normal, not bulged.o Face : No dysmorphysm.o Eye : Pupil size was normal, light reflex was

present.o Nose : External and internal nares were present.o Ear : Soft pinna. o Oral cavity : Normal.o Neck : Normal.o Clavicle : Both were intact.

Cont.. o No chest deformity, chest movement was

symmetrical on both side.o Air entry was good and symmetrical in both

side, no added sound.o Respiratory rate : 40/min.o Apex beat was palpable in left 4th intercostal

space just medial to the mid clavicular line, 1st and 2nd heart sound was audible in all 4 areas, no murmur.

o Heart rate : 132/min.

Cont.. o Abdomen : Soft, not distended.o Umbillicus : Dry, healthy.o Liver : Not palpable.o Spleen : Not palpable.o Kidneys : Not ballotable.o Bowel sound : Present.o Genitalia : Normal.

Cont.. o Anal opening was patent.o Spine : Normal.o Hip joint (both) : Normal.o Movement of all joints : Normal.o Muscle tone : Hypotonic.o Primitive reflexes : Moderate.o No visible congenital anomaly.

Salient feature Baby of Amena, 5 days old female neonate, 3rd

issue of her parents, was delivered by LUCS at 34 weeks of gestational age due to maternal oligohydramnios with birth weight of 1400 gm and developed yellow coloration of whole body from 3rd day of age. Mother had history of premature rupture of membrane for about 1 month. Baby was lathergic, icteric, hypotonic with moderate reflex activities. Vitals were within normal limit. Her birth weight falls below 3rd centile.

Provisional Diagnosis Preterm (34 weeks) with Very Low Birth Weight

(1400 gm) with Small for Gestational Age with Neonatal jaundice with Neonatal Sepsis.

InvestigationsComplete Blood Count :

• Hb%: 16.5 gm/dl• WBC: Total count: 11,600/cumm Differential count:

o Neutrophil: 46%o Lymphocyte: 50%o Monocyte: 03%o Eosinophil: 01%o Basophil : 00%

Cont..

o RBC: Macrocytic RBC.o WBC: Shows as distribution.o Platelet: Normal.

• Platelet : 4,15,000/cumm• PBF:

Cont..Blood grouping and Rh typing : A (+ve).RBS : 1.2 mmol/L.S. Electrolyte : Na⁺ - 141.0 mmol/L K⁺ - 5.8 mmol/L Cl⁻ - 105.0 mmol/L.S. Calcium : 2.30 mmol/L.CRP : 6.1 mg/L.Blood C/S : No growth of any bacteria.

Cont..S. Billirubin : Total – 15.40 mg/dl. Direct – 0.40 mg/dl. Indirect - 15.00 mg/dl.

Final Diagnosis Preterm (34 weeks) with Very Low Birth Weight

(1400 gm) with Small for Gestational Age with Neonatal jaundice.

Management A.Counseling.B.Supportive: Maintenance of temperature (Incubator care). Airway clearance by O-P & N-P suction. Maintenance of breathing. Maintenance of circulation. Maintenance of hydration and nutrition : Inf.

10% dextrose in 0.225% NaCl along with EBM by NG tube feeding.

Cont..

Inj. Ceftazidime 100 mg/kg/day in 2 divided doses.

Inj. Amikacin 15 mg/kg/day in 2 divided doses.

Phototherapy.C.Follow up.

Thank You