INTERNATIONAL HOSPITAL
“ LOTUS TOWER ”
G.S.ROAD
GUWAHATI - 5
A TERM AGA , BABY WAS BORN TO A PRIMIGRAVIDA MOTHER BY EMERGENCY LSCS (INDICATION – MSL) PRESENTED ON 2ND DAY OF LIFE WITH A HISTORY OF
BIRTH ASPHYXIASEVERE RESPIRATORY DISTRESS - MAS
REFUSAL OF FEEDING
ANURIA
GENERALIZED SEIZURE
CLINICAL FINDINGSTACHYCARDIA
TACHYPNOEASEVERE RETRACTIONSLETHARGY
PERIPHERAL CYANOSIS
POOR REFLEXES
POOR AIR ENTRY BILATERALLY ON THE CHEST SPO2 WAS MAINTAINED IN 60 – 70 % WITH O2 @ 10 LTS / MIN
LARGE CEPHALHAEMATOMA LEFT SIDE
INVESTIGATION
POSITIVE SEPSIS SCREEN CHEST X-RAY – OVER INFLATED CHEST
- INFILTRATES ELECTROLYTE IMBALANCEHIGH SERUM CREATININE – 6.8 mg / dl
( Normal – 0.5 – 1.4 mg / dl )
DIAGNOSIS
HIE STAGE II
SEPTICEMIA
MAS
ARF
MANAGEMENT
STABILIZATION AND FLUID RESUSCITATIONMECHANICAL VENTILATION STARTED IN VIEW OF DESATURATION AND INCREASED WORK OF BREATHING
I.V. ANTIBIOTICS & SUPPORTIVESPERITONEAL DIALYSIS
PERITONEAL DIALYSIS
1ST PERITONEAL DIALYSIS ON 3RD DAY OF LIFE - EACH EXCHANGE 50 ml DIALYSATE - TOTAL 58 EXCHANGES2ND PERITONEAL DIALYSIS ON 7TH DAY OF LIFE - IN VIEW OF INCREASING SERUM CREATININE LEVEL (8.6 ml / dl )
- EACH EXCHANGE 50 ml DIALYSATE
- TOTAL 30 EXCHANGES
PROGRESS
EXTUBATION DONE ON 11TH DAY OF LIFE URINE OUTPUT – .7 - .8 ml / kg / hour
CREATININE LEVEL HAS GONE DOWN TO 1.6 mg / dl
TOLERATING NASO GASTRIC FEEDING
STARTED BREAST FEEDING
SHIFTED TO MOTHER
FOLLOW UP
WEIGHT GAIN - NORMAL
RENAL FUNCTION TEST - NORMAL
BORDERLINE DELAYED MILE STONES
DISCUSSION
ARF IN NEONATE IS DEFINED AS SERUM CREATININE LEVEL > 1.5 mg / dl DESPITE NORMAL MATERNAL RENAL FUNCTION CAUSES OF ARF IN NEONATE ARE
- SEPSIS
- METABOLIC DISEASE
- PERINATAL ASPHYXIA
- PREMATURITY Cont.
INCIDENCE OF ARF IN NICU IS 3 – 10 %
MORTALITY RATE IN ARF IS 20 – 24 %
ARF NEEDS FOR DIALYSIS ALONG WITH MECHANICAL VENTILATION ARE ASSOCIATED WITH HIGH MORTALITY .
DISCUSSION