Welcome to clinical meeting

Dr. KANTA HALDER

Resident (MD;Phase A),

General paediartics,BICH.

Particulars of the patient

Name: Sourov Age: 6 days. Sex: Male. Address: Kuralia, Chadpur. Date of Admission: 06.11.2015. Date of Examination: 06.11.2015.

Chief Complaints Yellow colouration of skin & sclera from 4th day of life. Reluctant to feed for 1 day.

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

born by vaginal delivery at term at hospital with average birth weight and cried immediately after birth. The baby developed yellow colouration of skin & sclera from 4th day of life which was gradually increasing day by day. Baby also became reluctant to feed for 1 day. With these complaints, he was admitted in a local hospital and then referred to Dhaka Shishu Hospital for further evaluation and better management.

Birth History Antenatal : Mother, Rina, a 35 years old lady,

gravida – 5th, para – 5, was on irregular antenatal check up and was normotensive & nondiabetic. Her blood group was B (- ve), but she did not take Inj. Anti D during her previous pregnancies. There was no history of premature rupture of membrane, fever with rash or taking any offending drug during her pregnancy period and she was immunized against tetanus.

Birth History (cont..)

Postnatal : Baby cried immediately after birth, needed no resuscitation.

Natal : Baby was delivered normally at 39 weeks of gestation at hospital on 31.10.2015 at 05.30 PM with average birth weight.

Family History He is the 5th issue of his non-consanguineous

parents. Other sibs are in good health. There is no h/o jaundice or sidling death. Their blood group is not known.

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

Feeding HistoryBaby was on exclusive breast feeding.

Physical Examination o Baby was active, mildly pale, icteric up to palm

& sole.o Weight : 3200 gm( falls above 10th centile ).o Length : 48 cm ( falls above 10th centile ).o OFC : 34 cm ( falls above 10th centile ).o Temperature : 98° F.o CRT ˂ 3 seconds. o SPO₂ (Pulse oximeter) : 96% in room air.

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

present.o Ear : Formed pinna, firm and instant recoil.o Nose : Normal. o Oral cavity : Normal.o Neck : Normal.

Cont.. o Respiratory rate : 40/min. 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 Heart rate : 120/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.

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 : Both testes are in scrotum.

Cont..

o Spine : Normal.o Hip joint (both) : Normal.o Movement of all joints : Normal.o Muscle tone : Normal.o Primitive reflexes : Good.o No visible congenital anomaly.

Salient feature Sourov, 6 days old male neonate was

admitted with the complaints of jaundice from 4th day of age and reluctant to feed for 1 day. Baby was born by vaginal delivery at 39 weeks of gestational age with average birth weight and cried immediately after birth. Mother’s blood group is B (- ve), but she had no h/o taking Inj. Anti D. Baby was active, mildly pale, icteric up to palm & sole, normal primitive reflexes with good muscle tone. Vitals were within normal limit.

Provisional DiagnosisNeonatal jaundice due to Rh incompatibility in a Term (39 weeks) Appropriate for Gestational Age baby.

Differential DiagnosisNeonatal jaundice & neonatal sepsis in a Term (39 weeks) Appropriate for Gestational Age baby in a Rh (- ve) mother.

InvestigationsComplete Blood Count :

• Hb%: 16.6 gm/dl• WBC: Total count: 12,000/cumm Differential count:

o Neutrophil: 64%o Lymphocyte: 28%o Monocyte: 06%o Eosinophil: 02%o Basophil : 00%

Cont..

o RBC: Normocytic with normochromic.

o WBC: As distribution.o Platelet: Adequate.

• Platelet : 3,37,000/cumm.• PBF:

• Reticulocyte count: 01%.

Cont..Blood grouping and Rh typing : O (+ve).RBS : 3.4 mmol/L.S. Billirubin : Total – 37.40 mg/dl. Direct – 1.40 mg/dl. Indirect – 36.00 mg/dl.CRP : 1.2 mg/L.Coomb’s test : Negative.

Final Diagnosis Neonatal Jaundice in a Term (39 weeks)

Appropriate for Gestational Age baby of a Rh (- ve) mother.

Management A.Counseling.B.Supportive: Maintenance of temperature. Maintenance of airway, breathing & circulation. Maintenance of hydration and nutrition : Breast

feeding on demand along with Inf. 10% dextrose in 0.225% NaCl (100ml/kg).

Continuous phototherapy covering eyes and genitalia.

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

doses.C.Specific: Exchange transfusion was done with 0 (- ve)

blood on 07.11.2015.D.Follow up.

Pre-exchangeS. Billirubin : Total – 25.48 mg/dl. Direct – 1.00 mg/dl. Indirect – 24.48 mg/dl.

Post-exchangeS. Billirubin : Total – 8.4 mg/dl. Direct – 0.3 mg/dl. Indirect – 8.1 mg/dl.RBS : 13.5 mmol/L.S. Calcium : 2.36 mmol/L.S. Electrolyte : Na⁺ - 147.8 mmol/L K⁺ - 3.7 mmol/L Cl⁻ - 98.7 mmol/L.

Follow up On 08.11.2015S. Billirubin : Total – 14.6 mg/dl. Direct – 1.0 mg/dl. Indirect – 13.6 mg/dl. On 09.11.2015S. Billirubin : Total – 14.7 mg/dl. Direct – 0.4 mg/dl. Indirect – 14.3 mg/dl.

Thank you