+
BABY AD
+Identifying data
• Newborn male • Filipino• Born on Nov 19, 2013 via scheduled
repeat CS
+Birth History• Born full term • 45 year old G3P2 (3012) • 38 6/7 weeks age of gestation based on
LMP• 38 weeks by MT, AGA • AS 9, 9• BW 2860 grams• BL 46 cm• HC 34 cm• CC 30 cm• AC 30 cm
+Maternal history
• >7 prenatal check ups• UTI 1st trimester; treated with Cefalexin for 7 days• No fever, no rashes• Regular intake of ferrous sulfate and multivitamins• Maternal blood type: A+• HbsAg nonreactive• OGCT normal• CBC and urinalysis were not done
+Maternal Past Medical History
No Diabetes
No Hypertension
No asthma or allergy
+Family History
(+) Diabetes Mellitus- maternal
(-) Hypertension
(-) Congenital Anomalies
+Pedigree Chart
+OB-GYN History
G1- 2010 spontaneous abortion; s/p D&C
G2- 2011 live full term male PCS for fetal macrosomia and elderly primigravid, 9 lbs 2 ounces, TMC
G3 – Present pregnancy
+DeliveryClear amniotic Fluid
(+) Low set ears
(-) Cleft lip/Cleft palate
Good air entry
Good cardiac tone, HR 150
Grossly male genitalia
Extended scrotal skin over the penis
+Stay at the NICU
Subjective
• 13th hour of life
• Given milk formula (Tolerates 5- 10 ml)
• Active• (+) urine
output• (+) 2
meconium passage
Objective
• T – 36.7 C HR 120 bpm RR 50 cpm
• (+) Light jaundice to chest
• Low set ears• Good air entry• Good cardiac
tone, no murmurs
• Soft abdomen• Scrotal skin
over penis• Full pulses
Assessment
• Term Baby Boy
Plan
• For bilirubin levels
• Single phototherapy
• Referral to urologist
• Referral to geneticist
+Course in the NICU
Subjective
• 27th hour of life• Tolerates milk
formula (15- 20 ml every 2 hours)
• Active• 6 urine output• 4 meconium
passages
Objective
• T – 36.8 C HR 145 bpm RR 45 cpm
• Weight 2656 g• (+) jaundice to
abdomen• Low set ears• Good air entry• Good cardiac tone,
no murmurs• Soft abdomen• Scrotal skin over
penis• Full pulses
• TB 12.27 mg/ dl• IB 11.78 mg/ dl• DB 0.69 mg/ dl
Assessment
• Term baby boy• Hyperbilirubinemia,
unspecified• Webbed penis
Plan
• Continue single phototherapy
• For repeat bilirubin levels
• Continue observation
+Course in the NICU
Subjective
• 3rd day of life (AM)• Tolerates 25- 30
ml of milk feedings plus breastfeeding
• Active• 7 urine output• 5 meconium
passages
Objective
• Wt – 2675 g• T – 36.9 C HR 138
bpm RR 34 cpm • (+) light jaundice
to upper chest• Low set ears• Good air entry• Good cardiac tone,
no murmurs• Soft abdomen• Scrotal skin over
penis• Full pulses
• TB 13.4 mg/ dl• IB 2.82 mg/ dl• DB 0.80 mg/ dl
Assessment
• Term baby boy• Hyperbilirubinemia
, unspecified• Webbed penis• t/c Trisomy 21
Plan
• For 2D echo• Continue
observation• Discontinue
phototherapy
+Course in the NICU
Subjective
• 4th day of life (AM)• Tolerates 25- 40 ml
of milk feedings plus breastfeeding
• Active• 7 urine output• 4 meconium
passages
Objective
• Wt – 2695 g• T – 36.9 C HR 138
bpm RR 35 cpm • (+) light jaundice
to upper chest• Good air entry• Good cardiac tone,
no murmurs• Soft abdomen• Full pulses
Assessment
• Term baby boy• Hyperbilirubinemia
, unspecified• Webbed penis• t/c Trisomy 21
Plan
• Discontinue single phototherapy
• For chromosomal testing
• May go home
+Pertinent features
Mild upslanting of palpebral fissure
Median epicantic folds
Dysplastic right helix
Hypoplastic nipples
Mid phalanx hypoplasia, 5th digit with clinodactyly
+2D Echo
Normal echocardial structure
Normal function
Small PDA 1- 2 mm, continuous flow
Transitional Circulation
+Trisomy 21/ Down’s Syndrome Chromosomal condition associated with
intellectual disability, a characteristic facial appearance, and hypotonia
Each cell in the body has three copies of chromosome 21 instead of the usual two copies
+Epidemiology
From January 1, 2009 to January 1, 2013:
+Features Decreased muscle tone at birth
Excess skin at the nape of the neck
Flattened nose
Separated joints between the bones of the skull (sutures)
Single crease in the palm of the hand
Small ears
Small mouth
Upward slanting eyes
Wide, short hands with short fingers
+Genetics: Trisomy 21
• During reproduction and fertilization, the baby is a set of 46 chromosomes, 23 from the mother and 23 from the father (divided from the usual 46 chromosomes of each parent)
• An error occurs where the egg or sperm cell keeps both copies of the 21 chromosome hence the extra chromosome
+Complications
• Congenital heart defects
• Visual and hearing impairment (e.g. crossed- eyes, near- or
far- sightedness or cataracts)
• Thyroid problems
• Leukemia
• Recurrent respiratory infection
• Intestinal problems
• Skeletal problems
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