APRIL 08 MARCH 09
MAS : 21
Jan 09
Name : B/o. MANGALAM Age / Sex: NB/M Dept : NeonatologyHos.No : 399420 Mrd.No :302313 Ward : I NB NICUD.O.A : 26.12.08 D.O.D : 03.01.09REF. BY. DR. MAHALINGAM PLACE: MADRUAI
DIAGNOSIS: MECONIUM ASPIRATION WITH RESPIRATORY DISTRESS CHD [MODERATE ASD WITH PPHN] THROMBOCYTOPENIACOURSE:
This Term / AGA / Male / born at private hospital by LSCS (Indication:
Meconium stained liquor) on 25.12.08. Baby cried soon after birth, H/o. Meconium
aspiration +, and developed respiratory distress since birth for that transferred to
MMHRC on 26.12.08 for further management. H/o. Cyanosis +. No Maternal H/o. PIH,
GDM & PROM. O/E. Baby activity & cry: Weak, Peripheral cyanosis +, CFT > 3 sec,
dyspnoeic +, tachypnoeic +, no birth injury, CVS: S1, S2 heard, murmur +. RS: RR:
>60/mt, Bilateral air entry equal, P/A: soft, CNS: NNR sluggish. External genitalia : Left
Undesended testis +. Baby was investigated – Peripheral smear showed
Thrombocytopenia (Platelet count – 20,000). Blood sugar & serum creatinine were
normal. Chest X ray showed Bilateral meconium infiltration. Echo showed moderate
sized ostium secundum type of ASD, L R shunt and Mild PHT. Baby was managed
with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate &
Syp. Digoxin. Baby had hypotension, perfusion was low Inj. Dopamine was started.
With the above measures baby respiratory distress reduced, so weaned form the ventilator
31.12.08 & started on tube feeds. Now baby is taking oral feeds and discharged today
with the advice to continue further follow up with the referral doctor.
INVESTIGATIONS:
Investigation Result Unit Date
HAEMOGLOBIN 15.2 gm/dl 26/12/2008
TOTAL COUNT 9100 cells/cumm 26/12/2008
PCV 43 % 26/12/2008
MCV 113 FL 26/12/2008
MCH 39 PG 26/12/2008
MCHC 34 % 26/12/2008
RDW 13 % 26/12/2008
RBC 3.8 MILL/Cumm 26/12/2008
MPV 7.9 FL 26/12/2008
NEUTROPHILS 60 % 26/12/2008
LYMPHOCYTE 38 % 26/12/2008
EOSINOPHIL 02 % 26/12/2008
PLATELET COUNT 20,000 CELLS Lakhs/Cumm 26/12/2008
CREATININE 0.7 mg /dl 27/12/2008
PERIPHERAL SMEAR SHOWED (26.12.08): RBCs show normochromic
normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No
atypical or immature cells. DC: Neutrophils: 54%, Eosinophils: 01%, Monocytes: 05%,
Lymphocytes: 40%. Platelets normal in number and morphology. IMPRESSION:
THROMBOCYTOPENIA.
ECHO REPORT SHOWED (27.12.08) : SITUS SOLITUS. LEVOCARDIA. AV, VA
CONCORDANCE. NORMAL RELATED GREAT VESSELS. MODERATE SIZED
OSTIUM SECUNDUM OF ASD. LEFT TO RIGHT SHUNT > 2:1. TR PEAK
GRADIENT = 30mm of hg. NO PDA / COARCTATION. MILD PHT. IMPRESSION : MODERATE SIZED OSTIUM SECUNDUM TYPE OF ASD, L R SHUNT AND MILD PHT.
ADVICE ON DISCHARGE :
Tab. Edigra 1/8th TID x 1 weekSyp. Digoxin 0.75ml OD x Till further advice
PLAN : REPEAT ECHO AFTER 1 WEEK
Admission weight : 3.690 KgDischarge Weight : 3.680 Kg
Name : B/o. Amarshanthi Age/Sex : NB/ M Dept : NeonatologyHos.No: 399328 Mrd.No : 302215 Ward : IL.NB. NICUD.O.A : 24/12/08 D.O.D : 25/12/08 ************************************************************************DIAGNOSIS: NEONATAL JAUNDICE / RH INCOMPATIBILITY WITH NEONATAL CONVULSION AND ? MECONIUM ASPIRATION
COURSE:
This 1 days old Term / Female / AGA born at private hospital by normal vaginal
delivery on 23.12.08 to RH negative mother. No H/o Birth asphyxia. H/o. respiratory
distress since birth, H/o. ? meconium aspiration +, H/o. refusal of feeds +, H/o convulsion
– 1 episode. No maternal H/o PIG, GDM & PROM, O/E. Baby’s activity & cry were
weak, Tachypnoeic +, dyspnoeic +, grunting +, cyanosis +, no birth injury, no obvious
external anomaly. CVS: S1, S2 heard, RS: RR > 60/min, sub costal indrawing +, P/A:
distension +, CNS: NNR sluggish. Baby was investigated peripheral smear showed
leukoerythroblastic blood picture (HB : 13.3m%, TC – 2 lakhs, Platelet count : 70000)
DCT : positive, Serum bilirubin : 18.8mg%, Serum Creatinine : 1.1 mg%, Reticulocyte
count : 3.6%. Baby was managed with mechanical ventilator support, Iv fluids, Iv
antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inj. Gardenol, Baby had severe
jaundice, treated with triple sided phototherapy & exchange blood transfusion. Post
exchange serum bilirubin was 16.1mg%. On 25.12.08 ABG showed respiratory acidosis
& hyperkalemia, Asthalin nebulization & Inj. Insulin infusion started. Baby’s blood
sugar hourly monitored. Baby developed Hypotension, ionotropes started. Baby had
desaturation, persistent cyanosis & bradycardia, CPR carried out, Inj. Adrenaline, Inj.
Atropine given. Even with above measures baby could not be revived, DECLARED
DEAD on 25.12.08 at 9.30pm
INVESTIGATION :
Investigation Result Unit Date
CREATININE 1.1 mg /dl 25/12/2008 BILIRUBIN TOTAL 18.8 mg/dl 25/12/2008 BILIRUBIN DIRECT 3.4 mg/dl 25/12/2008 DIRECT ANTI HUMAN GLOBULIN TEST (COOMBS)
POSITIVE 25/12/2008
HAEMOGLOBIN 13.3 gm/dl 25/12/2008 TOTAL COUNT 2.0 LAKHS cells/cumm 25/12/2008 HAEMOGLOBIN 13.3 gm/dl 25/12/2008 TOTAL COUNT 2.0 LAKSH {TWICE RPT} cells/cumm 25/12/2008 PCV 44 % 25/12/2008 PCV 44 % 25/12/2008 MCV 158 FL 25/12/2008 MCV 158 FL 25/12/2008 MCH 47 PG 25/12/2008 MCH 47 PG 25/12/2008 MCHC 30 % 25/12/2008 MCHC 30 % 25/12/2008 RDW 31 % 25/12/2008 RDW 31.0 % 25/12/2008 RBC 2.8 MILL/Cumm 25/12/2008 RBC 2.8 MILL/Cumm 25/12/2008 MPV 8.8 FL 25/12/2008 MPV 8.8 FL 25/12/2008 NEUTROPHILS 30 % 25/12/2008 LYMPHOCYTE 68 % 25/12/2008 EOSINOPHIL 02 % 25/12/2008 NEUTROPHILS 30 % 25/12/2008 LYMPHOCYTE 68 % 25/12/2008 EOSINOPHIL 02 % 25/12/2008 PLATELET COUNT 70,000 CELLS Lakhs/Cumm 25/12/2008 PLATELET COUNT 70,000 CELLS Lakhs/Cumm 25/12/2008 RETICULOCYTE COUNT (Children)
3.6 % 25/12/2008
BILIRUBIN TOTAL 16.1 mg/dl 25/12/2008 BILIRUBIN DIRECT 3.8{TWICE RPT} mg/dl 25/12/2008
PERIPHERAL SMEAR (25.12.08): RBCs show normocytes and macrocytes. Nucleated RBCs 120 /100 WBCs. WBC count shows leukocytosis with shift to left. No atypical or immature cells. DC: Neutrophils: 25%, Eosinophils: 00%, Monocytes: 02%,
Lymphocytes: 73%. Platelets count diminished. IMPRESSION: LEUKOERYTHROBLASTIC BLOOD PICTURE
FEB 09
Name : B/o. SOORATH EMINA Age/Sex : NB/ F Dept : NeonatologyHos.No: 403566 Mrd.No : 305105 Ward : IL.NB. NICUD.O.A : 02/02/09 D.O.D : 05/02/09 ************************************************************************REF.BY.DR.KYRDUDYN PLACE : RAMNAD
DIAGNOSIS: PNEUMONITIS (EARLY ONSET OF SEPSIS)
COURSE:
This 5 days old Term / AGA/ female born at private hospital by LSCS
(Indication : Previous LSCS with PROM) on 28.01.09. H/o. Baby cried immediately
after birth and developed respiratory distress since birth, for that referred to MMHRC on
02.02.09 for further management. Maternal H/o. PROM – 8 hours +, H/o. Meconium
aspiration +, H/o. vomiting – 2 episodes +, H/o PIH & GDM. O/E. activity & cry were
weak, dyspnoeic +, tachypnoeic +, colour : icteric, CFT < 3 sec, no birth injury, no
obvious external anomaly. CVS: S1, S2 heard, RS: Bilateral crepitation +, P/A:
distended +, CNS : NNR sluggish. Baby was investigated – Peripheral smear, Blood
sugar & Serum creatinine were normal. Serum bilirubin T : 14.9mg%, D : 0.5mg%.
Chest X-ray suggestive of Pneumonitis. Echo was normal. Baby was managed with
oxygen, Iv fluids, Iv antibiotics, Inj. calcium gluconate, Inj. Rantac & Phototherapy.
With the above measures baby’s respiration became normal, activity improved and
started on small tube feeds. Now baby is taking oral feeds and discharged today with the
advice to continue the further follow-up with the referral doctor.
INVESTIGATION :
Investigation Result Unit DateCREATININE 0.3 mg /dl 02/02/2009 BILIRUBIN TOTAL
14.9 mg/dl 02/02/2009
BILIRUBIN DIRECT
0.5 mg/dl 02/02/2009
HAEMOGLOBIN gm/dl 02/02/2009 TOTAL COUNT cells/cumm 02/02/2009 HAEMOGLOBIN 17.1 gm/dl 02/02/2009 TOTAL COUNT 7200 cells/cumm 02/02/2009 PCV % 02/02/2009 PCV 51 % 02/02/2009 MCV FL 02/02/2009 MCV 101 FL 02/02/2009 MCH PG 02/02/2009 MCH 34 PG 02/02/2009 MCHC % 02/02/2009 MCHC 33 % 02/02/2009 RDW % 02/02/2009 RDW 18 % 02/02/2009 RBC MILL/Cumm 02/02/2009 RBC 4.9 MILL/Cumm 02/02/2009 MPV FL 02/02/2009 MPV 6.7 FL 02/02/2009 LYMPHOCYTE % 02/02/2009 EOSINOPHIL % 02/02/2009 MONOCYTES % 02/02/2009 NEUTROPHILS 58 % 02/02/2009 LYMPHOCYTE 40 % 02/02/2009 EOSINOPHIL 02 % 02/02/2009 PLATELET COUNT
Lakhs/Cumm 02/02/2009
PLATELET COUNT
2.4 Lakhs/Cumm 02/02/2009
PERIPHERAL SMEAR (02.02.09): RBCs shows normochromic normocytes and
macrocytes . Nucleated RBCs 2/100 WBCs. WBC count normal. No atypical or
immature cells. DC: Neutrophils: 42%, Eosinophils: 02%, Monocytes: 05%,
Lymphocytes: 51%. Platelets count normal in number and morphology. IMPRESSION:
NORMAL SMEAR STUDY
ECHO REPORT SHOWED (02.02.09) : SITUS SOLITUS. LEVOCARDIA.
NORMAL VALVES, IAS, IVS INTACT, GREAT VESSELS NORML, NO PDA /
COARCTATION, NO PHT, NORMAL LV AND RV FUNCTION.
IMPRESSION : NORMAL STUDY.
ADVICE ON DISCHARGE :
Inj. Magnex 125mg IV BD x 5 daysInj.Amikacin. 40mg IVOD x 5 days
Admission weight : 2.715 KgDischarge weight : 2.975 Kg
Name : B/o. KALAIARASI Age / Sex: NB/ M Dept : NeonatologyHos.No : 403698 Mrd.No : 305199 Ward : I NB NICU
D.O.A :02.02.09 D.O.D : 20.02.09************************************************************************REF. BY. DR. SABARI RAJA., PLACE : SIVAGANGAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME COURSE:
This Term / AGA / Male / born at private hospital by LSCS (Indication : Fetal
Bradycardia with thick meconium stained liquor) on 02.02.09. H/o. Baby cried
immediately after birth and developed respiratory distress and convulsion since birth for
that referred to MMHRC on 02.02.09 for further management. Maternal H/o. PROM 6
hours +, UTI +. No Maternal H/o PIH & GDM. O/E. Baby activity : Sluggish & cry:
Irritable, peripheral cyanosis +, convulsion +, dyspnoeic +, tachypnoeic +, Pallor +, no
birth injury, no obvious external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower
chest indrawing+, P/A: soft, CNS: Irritable, Convulsion +. Baby was investigated –
Peripheral smear showed neutrophilic leukocytosis. Blood sugar & Serum creatinine
were normal. Echo within normal limits. Chest X ray showed meconium aspiration
syndrome. Baby was managed with Mechanical ventilator support, Iv fluids, Iv
antibiotics, Inj. Dopamine infusion, Inj. Gardenol, Inj. Calcium gluconate, Inj. Surfactant
& Domstal drops. With the above measures baby’s respiratory distress reduced so
weaned from the ventilator on 12.02.09 & started on small tube feeds. On 12.02.09 as
baby had lower chest indrawing, suspected as CLD hence started on Tab. Aldactone and
mucolite drops. Now baby’s respiration became normal and is taking breast-feeds and
discharged today with advice to continue further fellow up with the referral doctor.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "AB" POSITIVE 03/02/2009
HAEMOGLOBIN 18.2 [ TWICE RPT ] gm/dl 03/02/2009 TOTAL COUNT 33900 cells/cumm 03/02/2009 PCV 54 % 03/02/2009 MCV 114 FL 03/02/2009 MCH 38 PG 03/02/2009 MCHC 33 % 03/02/2009 RDW 19 % 03/02/2009 RBC 4.7 MILL/Cumm 03/02/2009 MPV 7.3 FL 03/02/2009 NEUTROPHILS 80 % 03/02/2009 LYMPHOCYTE 19 % 03/02/2009 EOSINOPHIL 01 % 03/02/2009 PLATELET COUNT 1.9 Lakhs/Cumm 03/02/2009 CREATININE 0.8 mg /dl 05/02/2009
PERIPHERAL SMEAR SHOWED (03.02.09): RBCs shows normochromic
normocytes and macrocytes . Nucleated RBCs 6/100 WBCs. WBC count shows
neutrophilic leukocytosis. No atypical or immature cells. DC: Neutrophils: 82%,
Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 12%. Platelets count normal in
number and morphology.
IMPRESSION: NEUTROPHILIC LEUKOCYTOSIS.
ECHO CARDIOGRAPHY REPORT (07.02.09) : SITUS SOLITUS. LEVOCARDIA.
NORMAL VALVES. GREAT VESSELS NORMAL. IAS, IVS INTACT. NO PDA/
COARCTATION. NO PULMONARY HYPERTENSION. NORMAL LV AND RV
FUNCITON. IMPRESSION : NORMAL STUDY.
Admission Weight : 3.250 KgDischarge Weight : 3.320 Kg
Name : B/o. PUSHPALATHA Age / Sex: NB/ M Dept : NeonatologyHos.No : 404046 Mrd.No : 305407 Ward : I NB NICUD.O.A :05.02.09 D.O.D : 20.02.09************************************************************************REF. BY. DR. SABARI RAJA., PLACE : SIVAGANGAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH THROMBOCYTOPENIA
COURSE:
This Term / AGA / Male baby born at private hospital by LSCS : (Indication :
Previous LSCS) on 05.02.09. H/o. Baby cried immediately after birth and developed
respiratory distress and convulsion since birth, for that referred to MMHRC on 05.02.09
for further management. Maternal H/o. Pervious LSCS, H/o. Consanguinous marriage.
No Maternal H/o PIH, GDM & PROM. O/E. Baby activity & cry: Weak, peripheral
cyanosis +, convulsion +, dyspnoeic +, tachypnoeic +, no birth injury, no obvious
external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest indrawing+, P/A:
soft, CNS: NNR sluggish, Convulsion +. Baby was investigated – Peripheral smear
showed Thrombocytopenia. Blood sugar was normal. Serum creatinine : 1.1 (07.02.09),
1.2 (10.02.09), 0.8 (13.02.09). Platelet counts : 20,000 (05.02.09), 60,000 (10.02.09).
Chest X ray showed meconium aspiration syndrome. Baby was managed with
Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Dopamine infusion, Inj. Nor –
adrenalin, Inj. Pavlon, Inj. Calcium gluconate, Inj. Gardenol, Inj. Rantac & Domstal
drops. With the above measures baby’s respiratory distress reduced so weaned from the
ventilator on 16.02.09 & started on small tube feeds. On 16.02.09 as baby had features
suggestive of CLD started on Tab. Aldactone. Now baby’s respiration became normal
and is taking oral feeds hence discharged today with advice to continue further fellow up
with the referral doctor.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING
" AB " POSITIVE 05/02/2009
BLOOD GROUP RH TYPING
" AB " POSITIVE 06/02/2009
HAEMOGLOBIN 15.5 gm/dl 05/02/2009 TOTAL COUNT 18700 cells/cumm 05/02/2009
HAEMOGLOBIN 15.5 gm/dl 06/02/2009 TOTAL COUNT 18700 cells/cumm 06/02/2009 PCV 44 % 05/02/2009 PCV 44 % 06/02/2009 MCV 107 FL 05/02/2009 MCV 109 FL 06/02/2009 MCH 37 PG 05/02/2009 MCH 37 PG 06/02/2009 MCHC 34 % 05/02/2009 MCHC 34 % 06/02/2009 RDW 17 % 05/02/2009 RDW 17.0 % 06/02/2009 RBC 4.0 MILL/Cumm 05/02/2009 RBC 4.0 MILL/Cumm 06/02/2009 MPV 10.4 FL 05/02/2009 MPV 10.4 FL 06/02/2009
P/S
RBCs: NORMOCHROMIC NORMOCYTIC. NO HAEMOPARASITES ARE SEEN. WBCs: COUNT IS NORMAL. NO IMMATURE CELLS ARE SEEN. PLATELET COUNT IS DECREASED.
06/02/2009
NEUTROPHILS 80 % 05/02/2009 LYMPHOCYTE 19 % 05/02/2009 EOSINOPHIL 01 % 05/02/2009 NEUTROPHILS 80 % 06/02/2009 LYMPHOCYTE 19 % 06/02/2009 EOSINOPHIL 01 % 06/02/2009 PLATELET COUNT
20,000 CELLS Lakhs/Cumm 05/02/2009
PLATELET COUNT
20,000 CELLS Lakhs/Cumm 06/02/2009
IMPRESSION THROMBOCYTOPENIA 06/02/2009 CREATININE 1.1 mg /dl 07/02/2009 CREATININE 1.2 mg /dl 10/02/2009 PLATELET COUNT
60,000 CELLS Lakhs/Cumm 10/02/2009
CREATININE 0.8 mg /dl 13/02/2009
PERIPHERAL SMEAR SHOWED (03.02.09): RBCs shows normochromic
normocytes and macrocytes . Nucleated RBCs 6/100 WBCs. WBC count shows
neutrophilic leukocytosis. No atypical or immature cells. DC: Neutrophils: 82%,
Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 12%. Platelets count normal in
number and morphology.
IMPRESSION: NEUTROPHILIC LEUKOCYTOSIS.
Admission Weight : 3.420 KgDischarge Weight : 3.265 Kg
Name : B/o. Ushnara {Twin – I} Age/Sex : NB/ M Dept : Neonatology
Hos.No: 406170 Mrd.No : 306825 Ward : IL.NB. NICUD.O.A : 25.02.09 D.O.D : 26.02.09 ************************************************************************DIAGNOSIS: PRE TERM (26 WEEKS) / ELBW
RESPIRATORY DISTRES SYNDROME
COURSE:
This Pre Term (26 weeks) / ELBW / male / Twin – I born at MMHRC by Normal
vaginal delivery (Breech presentation) on 25.02.09. H/o. Baby had weak cry after birth
and developed grunting and respiratory distress for that baby shifted to NICU for further
management. No Maternal H/o PIH, GDM & PROM. O/E. Activity & cry were weak,
grunting +, Peripheral cyanosis +, dyspnoeic +, tachypnoeic +, CFT > 3 sec, no birth
injury, no obvious external anomaly. CVS: S1, S2 heard, hypotension +, RS: RR :
>60/mt, Lower chest indrawing +, P/A: soft, CNS : NNR sluggish. Baby was
investigated – HB : 16.1 gm%, TC – 18,400 cells, Platelet count 2.7 lakhs. Blood sugar
was normal. Baby was managed in incubator with Mechanical ventilator support,
Surfactant [2 doses], Iv fluids, Iv antibiotics, Inj. calcium gluconate, Inj. Vitamin K, Inj.
Aminophylline & Ionotropes. With the above measures now baby is maintaining oxygen
saturation of 97% with mechanical ventilator support of FIO2 – 30%. Since parents were
not willing for further management, Baby is discharged Against Medical Advice on
26.02.09
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "O" POSITIVE 25/02/2009
HAEMOGLOBIN 16.1 gm/dl 26/02/2009 TOTAL COUNT 18,400 cells/cumm 26/02/2009 PCV 49 % 26/02/2009 MCV 106 FL 26/02/2009 MCH 35 PG 26/02/2009 MCHC 32 % 26/02/2009 RDW 17.1 % 26/02/2009 RBC 4.6 MILL/Cumm 26/02/2009
MPV 7.8 FL 26/02/2009 NEUTROPHILS 61 % 26/02/2009LYMPHOCYTE 38 % 26/02/2009 EOSINOPHIL 01 % 26/02/2009 PLATELET COUNT 2.7 Lakhs/Cumm 26/02/2009
Name : B/o. Ushnara {Twin – II} Age/Sex : NB/ M Dept : Neonatology
Hos.No: 406171 Mrd.No : 306826 Ward : IL.NB. NICUD.O.A : 25.02.09 D.O.D : 26.02.09 ************************************************************************DIAGNOSIS: PRE TERM (26 WEEKS) / ELBW
RESPIRATORY DISTRES SYNDROME
COURSE:
This Pre Term (26 weeks) / ELBW / male / Twin – II born at MMHRC by Normal
vaginal delivery (Breech presentation) on 25.02.09. H/o. Baby had weak cry after birth
and developed grunting and respiratory distress for that baby shifted to NICU for further
management. No Maternal H/o PIH, GDM & PROM. O/E. Activity & cry were weak,
grunting +, Peripheral cyanosis +, dyspnoeic +, tachypnoeic +, CFT > 3 sec, no birth
injury, no obvious external anomaly. CVS: S1, S2 heard, hypotension +, RS: RR :
>60/mt, Lower chest indrawing +, P/A: soft, CNS : NNR sluggish. Baby was
investigated – HB : 19.7 gm%, TC – 11,200 cells, Platelet count 2 lakhs. Blood sugar
was normal. Baby was managed with Mechanical ventilator support, Surfactant [3
doses], Iv fluids, Iv antibiotics, Inj. calcium gluconate, Inj. Vitamin K, Inj.
Aminophylline & Ionotropes. With the above measures now baby is maintaining oxygen
saturation of 92% with mechanical ventilator support of FIO2 – 85%. Since parents were
not willing for further management, Baby is discharged Against Medical Advice on
26.02.09
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "A" NEGATIVE 25/02/2009
HAEMOGLOBIN 19.7 gm/dl 26/02/2009 TOTAL COUNT 11,200 cells/cumm 26/02/2009 PCV 60 % 26/02/2009 MCV 103 FL 26/02/2009 MCH 33 PG 26/02/2009 MCHC 32 % 26/02/2009 RDW 17.5 % 26/02/2009 RBC 5.8 MILL/Cumm 26/02/2009
MPV 8.2 FL 26/02/2009 NEUTROPHILS 24 % 26/02/2009 LYMPHOCYTE 75 % 26/02/2009 EOSINOPHIL 01 % 26/02/2009 PLATELET COUNT 2.0 Lakhs/Cumm 26/02/2009
Name : B/o. ANITHA BEGAM Age/Sex : NB/ M Dept : NeonatologyHos.No: 404311 Mrd.No : 305573 Ward : IL.NB. NICUD.O.A : 09/02/09 D.O.D : 28/02/09 ************************************************************************
REF. BY: DR.PREMA PRABHAKAR., PLACE: MELUR
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME CHD (SMALL MID MUSCULAR VSD, SMALL ASD, TINY
PDA)COURSE:
This new born Term / AGA/ male baby born at private hospital by LSCS
(Indication : PROM with failure to induction ) on 08.02.09, H/o. Baby cried immediately
after birth, then developed respiratory distress, H/o. Meconium aspiration +, H/o. cord
around the neck +, for that referred to MMHRC on 09.02.09. Maternal H/o. PROM +
with failure to induction. No Maternal H/o PIH & GDM. O/E. Baby activity & cry were
weak, dyspnoeic +, Tachypnoeic +, no cyanosis, CVS: S1, S2 heard, RS: RR > 60/mt.
lower chest indrawing +, Bilateral crepitation +, P/A: soft, CNS : NNR sluggish. Baby
was investigated – Peripheral smear showed neutrophilic leukocytosis, Blood sugar &
Serum creatinine were normal. Serum magnesium : 6.6. Chest X-ray suggestive of
meconium aspiration syndrome. ECHO showed small mid, muscular VSD, Small ASD,
Tiny PDA. Baby was managed with mechanical ventilator, Iv fluids, Iv antibiotics, Inj.
Nor – adrenaline infusion, Inj. Dopamine infusion, Inj. calcium gluconate, Inj. Rantac,
Tab. Edigra & Syp. Digoxin. With the above measures baby’s respiratory distress
reduced and weaned from mechanical ventilator on 18.02.09 and started on small tube
feeds. On 18.02.09 Tab. Aldactone was started since respiratory features were suggestive
of CLD. Now baby is on breast feeds and discharged today with the advice to continue
further follow up with the referral doctor.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "A" POSITIVE 09/02/2009
HAEMOGLOBIN 13.8 gm/dl 09/02/2009 TOTAL COUNT 17200 cells/cumm 09/02/2009 PCV 42 % 09/02/2009 MCV 94 FL 09/02/2009 MCH 30 PG 09/02/2009 MCHC 32 % 09/02/2009 RDW 16 % 09/02/2009 RBC 4.4 MILL/Cumm 09/02/2009 MPV 6.6 FL 09/02/2009 NEUTROPHILS 80 % 09/02/2009 LYMPHOCYTE 19 % 09/02/2009 EOSINOPHIL 01 % 09/02/2009 PLATELET COUNT 3.0 Lakhs/Cumm 09/02/2009 CREATININE 0.9 mg /dl 11/02/2009 MAGNESIUM 6.6 mg/dl 14/02/2009
PERIPHERAL SMEAR SHOWED (09.02.09): RBCs show normochromic normocytes
and few macrocytes. No nucleated RBCs or hemoparasites. WBC count shows
neutrophilic leukocytosis. No atypical or immature cells.
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS.
ECHO REPORT SHOWED (09.02.09) : SITUS SOLITUS. LEVOCARDIA. SMALL
MID MUSCULAR VSD, TINY PDA, SMALL OSTIUM SECUNDUM TYPE OF ASD,
L -> R SHUNT, NO PAH, GOOD LV AND RV FUNCTION.
IMPRESSION : CHD. SMALL MID MUSCULAR VSD, TINY PDA, SMALL ASD.
NO PAH.
APRIL 09Hos.No : 409759 Mrd.No : 309279 Ward : I NB NICUD.O.A : 28.03.09 D.O.D : 08.04.09************************************************************************REF. BY. DR. VIGNESHRAJ PLACE: DINDIGUL
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH THROMBOCYTOPENIA ? EARLY ONSET SEPSISCOURSE:
This pre term 36 weeks / AGA / Male / born at private hospital by LSCS (Indication:
Oligohydraminios) on 28.03.08. H/o. Baby cried soon after birth, H/o. Meconium aspiration
+, resuscitated at referral doctor clinic and developed respiratory distress since birth for that
referred to MMHRC on 28.03.09 for further management. Maternal H/o. PROM – 6hours +.
No Maternal H/o. PIH & GDM. O/E. Baby activity & cry: Weak, colour : Pink, CFT < 3
sec, dysphonic +, tachypnoeic +, no birth injury, CVS: S1, S2 heard, RS: RR: >60/mt, low
chest indrowing, Bilateral air entry equal, P/A: soft, CNS: NNR sluggish. Baby was
investigated – Peripheral smear showed leukocytosis & Thrombocytopenia (HB :
20.6%mg/dl, TC : 22,800, Platelet count – 20,000). Blood sugar was normal. serum
creatinine 1.1mg/dl (30.03.09), 0.7mg/dl (31.03.09). Chest X ray showed Bilateral
meconium infiltration. Baby was managed with C-PAP, Iv fluids, Iv antibiotics, Inj. Calcium
gluconate & Ionodrops. Baby had persistent respiratory distress, Inj. Midazolam infusion
started on 30.03.09. With the above measures baby respiratory distress reduced, so weaned
form the C-PAP on 03.04.09 & started on tube feeds. Now baby is taking oral feeds and
discharged today with the advice to continue further follow up with the referral doctor.
INVESTIGATION :
Investigation Result Unit DateHAEMOGLOBIN 20.6 [ TWICE RPT ] gm/dl 29/03/2009 TOTAL COUNT 22800 cells/cumm 29/03/2009 PCV 57 % 29/03/2009 MCV 109 FL 29/03/2009 MCH 38 PG 29/03/2009 MCHC 35 % 29/03/2009 RDW 12.7 % 29/03/2009 RBC 5.3 MILL/Cumm 29/03/2009 MPV 7.8 FL 29/03/2009 NEUTROPHILS 59 % 29/03/2009 LYMPHOCYTE 40 % 29/03/2009 EOSINOPHIL 01 % 29/03/2009 PLATELET COUNT 20,000 CELLS Lakhs/Cumm 29/03/2009 CREATININE 1.1 mg /dl 31/03/2009 CREATININE 0.7 mg /dl 31/03/2009
PERIPHERAL SMEAR SHOWED (30.03.09) : RBCs show normochromic
normocytes and macrocytes. Nucleated RBCs 5/100 WBCs. WBC count shows
leukocytosis. No atypical or immature cells. DC: Neutrophils: 49%, Eosinophils: 01%,
Monocytes: 05%, Lymphocytes: 45%. Platelet count diminished. IMPRESSION:
LEUKOCYTOSIS. THROMBOCYTOPENIA.
Name : B/o. Poomari Age / Sex: NB/F Dept : NeonatologyHos.No : 408068 Mrd.No : 308130 Ward : I NB NICUD.O.A : 13.03.09 D.O.D : 08.04.09************************************************************************REF. BY. DR. MUTHUPANDIAN PLACE: MANAMADURAI DIAGNOSIS: MECONIUM ASPIRATION SYNDROME CHD [SMALL ASD WITH MILD PAH] ACUTE RENAL FAILURE (RECOVERED)
COURSE:
This Term / AGA / Female / born at private hospital by LSCS (Indication: Failure
to Progress) on 13.03.09. Baby cried soon after birth, H/o. Meconium aspiration +, and
developed respiratory distress since birth for that referred to MMHRC on 13.03.09 for
further management. No Maternal H/o. PIH, GDM & PROM. O/E. Baby activity :
Weak, cry: Irritable, Colour : Pink, CFT > 3 sec, dyspnoeic +, tachypnoeic +, no birth
injury, CVS: S1, S2 heard, murmur +, RS: RR: >60/mt, lower chest indrowing +,
P/A: soft, CNS: NNR sluggish. Baby was investigated – Peripheral smear & Blood sugar
were normal. Serum creatinine : 1.2mg/dl (14.03.09), 1.4mg/dl (17.03.09), 0.9mg/dl
(19.03.09). Chest X ray showed bilateral meconium infiltration. Echo showed
congenital heart disease, Small sized ostium secundum type of ASD (4 – 5mm), L R
shunt and Mild PAH. Baby was managed with Mechanical ventilator support, Iv fluids,
Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Inj. Midazolam Infusion &
Ionotropes. Child had ET bleed, FFB transfusion given. On 14.03.09 baby’s oxygen
saturation not maintained & surfactant 1dose given, on 23.03.09 baby was pale, packed
cell transfusion given. With the above measures baby respiratory distress reduced, so
weaned form the ventilator 03.04.09 & started on tube feeds. Now baby is taking breast
feeds and discharged today with the advice to continue further follow up with the referral
doctor.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "B" POSITIVE 14/03/2009
HAEMOGLOBIN 12.9 gm/dl 13/03/2009 TOTAL COUNT 13900 cells/cumm 13/03/2009 PCV 37 % 13/03/2009 MCV 103 FL 13/03/2009 MCH 35 PG 13/03/2009 MCHC 34 % 13/03/2009 RDW 17.1 % 13/03/2009 RBC 3.6 MILL/Cumm 13/03/2009 MPV 6.6 FL 13/03/2009 NEUTROPHILS 85 % 13/03/2009 LYMPHOCYTE 14 % 13/03/2009 EOSINOPHIL 01 % 13/03/2009 PLATELET COUNT 2.5 Lakhs/Cumm 13/03/2009 CREATININE 1.2 mg /dl 15/03/2009 CREATININE 1.4 mg /dl 17/03/2009 CREATININE 0.9 mg /dl 19/03/2009
PERIPHERAL SMEAR SHOWED (14.03.09) : RBCs show normochromic
normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No
atypical or immature cells. DC: Neutrophils: 88%, Eosinophils: 01%, Monocytes: 05%,
Lymphocytes: 06%. Platelet count normal in number and morphology.
IMPRESSION: NORMAL SMEAR STUDY.
ECHO REPORT (16.03.09) : SITUS SOLITUS, LEVOCARDIA, SMALL OSTIUM
SECUNDUM TYPE OF ASD SEEN ( 4 – 5mm) L -> R SHUNT, IVS INTACT, RVSP ~
35mm of HG, MV,AV,PV NORMAL, GREAT VESSELS NORMALLY ARISING, NO
PERICARDIAL EFFUSION, NO PDA / COARCTATION, NORMAL LV AND RV
FUNCTION. IMPRESSION : CONGENITAL HEART DISEASE. SMALL PDA.
MILD PAH
ADVICE ON DISCHAGRE :
Syp. Deriphyllin 8 drops TID x 2 weeks
Domstal drops 5 drops TID x 2 weeks
Zincovit drops 10 drops OD x Till further advice
Evion drops 5 drops OD x Till further advice
Name : B/o. Thanga radhika Age / Sex: NB/ F Dept : NeonatologyHos.No : 410141 Mrd.No : 309586 Ward : I NB NICUD.O.A :02.04.09 D.O.D : 16.04.09************************************************************************REF. BY. DR.ANBURAJAN., PLACE : THENI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME COURSE:
This Term / AGA / female / born at private hospital by LSCS (Indication : Primi
with CPD) on 01.04.09. H/o. Baby did not cry immediately after birth, resuscitation was
done at referral doctor clinic. Baby developed respiratory distress since birth, for that
referred to MMHRC on 02.04.09, for further management. H/o. Meconium stained
liquor +. No Maternal H/o PIH, PROM & GDM. O/E. Baby activity & cry were weak,
Peripheral cyanosis +, poor perfusion +, grunting +, dyspnoeic +, tachypnoeic +, no birth
injury, no obvious external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest
indrawing+, Bilateral crepitations +, P/A: soft, CNS:NNR sluggish. Baby was
investigated – Peripheral smear showed neutrophilic leukocytosis. Blood sugar was :
34mg/dl (Corrected with dextrose). Serum creatinine was normal. Chest X-ray showed
bilateral infiltration. Baby was managed with Mechanical ventilator support, Ionotropes,
Iv fluids, Iv antibiotics, Inj. Gardenol, Inj. Calcium gluconate and Inj. Vitamin K. With
the above measures baby’s respiratory distress reduced so weaned from the ventilator on
08.04.09 & started on small tube feeds. Now baby’s respiration became normal and is
taking Oral feeds and discharged today with advice to continue further fellow up with the
referral doctor.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "B" POSITIVE 02/04/2009
HAEMOGLOBIN 17.8 gm/dl 02/04/2009 TOTAL COUNT 26,800 cells/cumm 02/04/2009 PCV 53 % 02/04/2009 MCV 105 FL 02/04/2009 MCH 35 PG 02/04/2009 MCHC 33 % 02/04/2009 RDW 11.9 % 02/04/2009 RBC 5.0 MILL/Cumm 02/04/2009 MPV 8.2 FL 02/04/2009 NEUTROPHILS 58 % 02/04/2009 LYMPHOCYTE 40 % 02/04/2009 EOSINOPHIL 02 % 02/04/2009 PLATELET COUNT 2.0 Lakhs/Cumm 02/04/2009 CREATININE 0.7 mg /dl 03/04/2009
PERIPHERAL SMEAR SHOWED (02.04.09): RBCs shows normochromic normocytes
and macrocytes . Nucleated RBCs 2/100 WBCs. WBC count shows neutrophilic
leukocytosis. No atypical or immature cells. DC: Neutrophils: 56%, Eosinophils: 01%,
Monocytes: 05%, Lymphocytes: 38%. Platelets count normal in number and morphology.
IMPRESSION: NEUTROPHILIC LEUKOCYTOSIS.
Admission Weight : 2.825 KgDischarge Weight : 2.72
MAY 09
Name : B/o. Kavitha Age/Sex : NB/ F Dept : NeonatologyHos.No: 414605 Mrd.No : 312433 Ward : IL.NB. NICUD.O.A : 09.05.09 D.O.D : 09.05.09 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA MECONIUM ASPIRATION BILATERAL PNEUMOTHORAX COURSE:
This Term / AGA/ Female born at private hospital by Normal vaginal delivery on
09.05.09. H/o. Baby had weak cry immediately after birth resuscitated at referral doctor
clinic, H/o. Thick meconium stained liquor +, H/o. Respiratory distress since birth for
that referred to MMHRC on 09.05.09 for further management. No Maternal H/o PIH,
GDM & PROM. O/E. On admission baby had no spontaneous respiration, HR : 60/mt,
cyanosis +, CFT > 3 sec, BP not recordable, intubated and connected to Mechanical
ventilator support. CVS: S1, S2 heard, BP not recordable, RS: Bilateral air entry
diminished, P/A: soft, CNS : NNR not elicitable. Baby was investigated – Peripheral
smear showed neutrophilic leukocytosis. Chest X-ray showed Bilateral Pneumothorax.
ICD done bilaterally. Baby was managed with Mechanical ventilator support,
Ionotropes, Iv fluids, Iv antibiotics, Inj. NaHco3, Inj. calcium gluconate & Inj. Vitamin K.
Even with the above measures baby’s O2 Saturation not maintained, had persistent
bradycardia followed by cardiac arrest. CPR was carried out, Inj. Adrenaline & Atropin
were given. Baby could not be revived, “Declared Dead” on 09.05.09 at 9.10 PM.
INVESTIGATION :
Investigation Result Unit DateHAEMOGLOBIN 12.7 gm/dl 10/05/2009 TOTAL COUNT 38,700 [TWICE RPT] cells/cumm 10/05/2009 PCV 39 % 10/05/2009 MCV 111 FL 10/05/2009 MCH 35 PG 10/05/2009 MCHC 32 % 10/05/2009 RDW 19.7 % 10/05/2009 RBC 3.5 MILL/Cumm 10/05/2009 MPV 7.2 FL 10/05/2009 NEUTROPHILS 74 % 10/05/2009 LYMPHOCYTE 25 % 10/05/2009 EOSINOPHIL 01 % 10/05/2009 PLATELET COUNT
3.7 Lakhs/Cumm 10/05/2009
PERIPHERAL SMEAR (21.01.09): RBCs shows normochromic normocytes and
macrocytes. Nucleated RBCs 5/100 WBCs. WBC count shows neutrophilic
leukocytosis. No atypical or immature cells. DC: Neutrophils: 64%, Eosinophils: 01%,
Monocytes: 05%, Lymphocytes: 30%. Platelets count normal in number and morphology.
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS
Name : B/o. Regina Age / Sex: NB/F Dept : NeonatologyHos.No : 415649 Mrd.No :313091 Ward : I NB NICUD.O.A :18.05.09 D.O.D : 29.05.09************************************************************************
DIAGNOSIS: PRETERM (32 WEEKS) / LBW RESPIRATORY DISTRESS SYNDROME SURFACTANT THREAPY GIVEN
COURSE:
This Preterm (32 weeks) / LBW / male born at MMHRC by LSCS (Indication :
premature labour with transverse lie) on 18.05.09. H/o. Baby cried immediately after
birth, then developed respiratory distress and grunting since birth, for that admitted in
NICU, for further management. Maternal H/o. PCOD +, conception after PCOD
puncturing. No Maternal H/o. PIH, GDM & PROM. O/E. Activity & cry were weak,
Peripheral cyanosis +, grunting +, CFT prolonged, dyspnoeic +, tachypnoeic +, no birth
injury, no obvious external anomaly. CVS : S1 & S2 heard, RS : RR > 60/mt, subcostal
retraction +, Bilateral air entry equal. P/A : Soft, CNS : NNR sluggish. Baby was
investigated : Peripheral smear, Blood sugar were normal. Serum creatinine : 1.0 mg/dl.
Chest x-ray showed respiratory distress syndrome. Baby was managed with mechanical
ventilator support, Ionotropes, surfactant (2doses), Iv fluids, Iv antibiotics, Inj.
Aminophylline, Inj. calcium gluconate, Inj. Vitamin K, FFP transfusion & Single side
Phototherapy. With the above measures baby’s activity improved, respiration became
normal & started on small tube feeds. Now baby is taking oral feeding and discharged
today with the advice to continue the following.
INVESTIGATION :Investigation Result Unit Date
BLOOD GROUP RH TYPING
"A" POSITIVE 19/05/2009
HAEMOGLOBIN 17.0 (TWICE RPT) gm/dl 19/05/2009
TOTAL COUNT 6700 cells/cumm 19/05/2009
PCV 51 % 19/05/2009
MCV 109 FL 19/05/2009
MCH 36 PG 19/05/2009
MCHC 33 % 19/05/2009
RDW 17.2 % 19/05/2009
RBC 4.6 MILL/Cumm 19/05/2009
MPV 7.9 FL 19/05/2009
NEUTROPHILS 50 % 19/05/2009
LYMPHOCYTE 49 % 19/05/2009
EOSINOPHIL 01 % 19/05/2009
PLATELET COUNT 2.5 Lakhs/Cumm 19/05/2009
CREATININE 1.0 mg /dl 20/05/2009
PERIPHERAL SMEAR SHOWED (19.05.09) : RBCs show normochromic
normocytes, macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No atypical
or immature cells. DC: Neutrophils: 49%, Eosinophils: 01%, Monocytes: 01%,
Lymphocytes: 49%. Platelet count normal in number and morphology.
IMPRESSION: NORMAL SMEAR STUDY.
Name : B/o. Bobby Age / Sex: NB/F Dept : NeonatologyHos.No : 415669 Mrd.No :313127 Ward : I NB NICUD.O.A :18.05.09 D.O.D : 29.05.09************************************************************************REF.BY.DR. RAJA GOPAL – BOOMA NURSING HOME PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION PNEUMOTHORAX (RIGHT SIDE) ACUTE RENAL FAILURE (RECOVERED) ASD WITH PDA
COURSE:
This 2 days old Term / AGA / female / born at private hospital by LSCS
(Indication : Meconium stained liquor) on 17.05.09. H/o. Baby cried immediately after
birth and developed respiratory distress since birth. H/o. Meconium aspiration +, for that
referred to MMHRC on 18.05.09 for further management. No Maternal H/o PIH, PROM
& GDM. O/E. Baby’s activity & cry were weak, dyspnoeic +, tachypnoeic +, no birth
injury, no obvious external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest
indrawing+, P/A: soft, CNS: NNR sluggish, Baby was investigated – HB:18gm%, TC :
4,700, Platelet count 80,000 (19.5.09) 70,000 (21.05.09), Blood sugar was normal.
Serum creatinine : 1.5mg/dl(19.05.09), 1.7mg/dl(21.05.09). 1.2mg/dl( 22.05.09),
0.9mg/dl(23.05.09), Blood urea : 60mg/dl(21.05.09). 53mg/dl ( 22.05.09),
56mg/dl(23.05.09). Serum LDH was elevated. Urine routine showed albumin 2+, Urine
PCR : Protein - 45, Creatinine : 13, ratio - 3.6 : 1.0. Echo showed congenital heart
disease- Moderate sized ASD with PDA, Mild PAH. USG abdomen showed bilateral
medical renal disease. Chest X ray showed right side pneumothorax (18.05.09). Repeat
X-ray was normal (19.05.09). Nephrologist opinion was obtained. Baby was managed
with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Midazolam infusion, Inj.
Lasix, Inj. Calcium gluconate & Inj. Vitamin K. With the above measures baby’s
respiratory distress reduced, weaned from the ventilator on 24.05.09 & started on small
tube feeds. Now baby’s respiration became normal, activity improved, serum creatinine
became 0.9mg/dl(23.05.09) and taking breast-feeds. Baby is discharged today with
advice to continue further follow up with the referral doctor.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "B" POSITIVE 19/05/2009
CREATININE 1.5 mg /dl 19/05/2009 HAEMOGLOBIN 18.0 (TWICE RPT) gm/dl 19/05/2009 TOTAL COUNT 4700 cells/cumm 19/05/2009 PCV 54 % 19/05/2009 MCV 119 FL 19/05/2009 MCH 39 PG 19/05/2009 MCHC 32 % 19/05/2009 RDW 21 % 19/05/2009 RBC 4.5 MILL/Cumm 19/05/2009 MPV 7.2 FL 19/05/2009 NEUTROPHILS 67 % 19/05/2009 LYMPHOCYTE 32 % 19/05/2009 EOSINOPHIL 01 % 19/05/2009 PLATELET COUNT 80,000 CELLS Lakhs/Cumm 19/05/2009 CREATININE 1.7 mg /dl 21/05/2009 UREA 60 mg/dl 21/05/2009 CREATININE 1.2 mg /dl 22/05/2009 PLATELET COUNT 70,000 CELLS Lakhs/Cumm 21/05/2009 POTASSIUM 2.0 mEq / L 21/05/2009 SODIUM 128 mEq / L 21/05/2009 UREA 53 mg/dl 22/05/2009 LDH 730 Iu/l 21/05/2009
COLOUR YELLOW 22/05/2009
TRANSPARENCY CLEAR 22/05/2009
REACTION ACIDIC 22/05/2009
ALBUMIN [++] 22/05/2009
SUGAR NIL 22/05/2009
EPI CELLS 2-3 / HPF 22/05/2009 PUS CELLS 2-3 / HPF 22/05/2009 URINE SPOT PROTEIN 45 mg/dl 22/05/2009 URINE SPOT CREATININE 13 mg/dl 22/05/2009 URINE FOR PROTEIN CREATININE RATIO
3.6 : 1.0 22/05/2009
CREATININE 0.9 mg /dl 23/05/2009 POTASSIUM 2.1 mEq / L 23/05/2009 SODIUM 135 mEq / L 23/05/2009 UREA 56 mg/dl 23/05/2009
PERIPHERAL SMEAR SHOWED (19.05.09) : RBCs show normochromic
normocytes, macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No
atypical or immature cells. DC: Neutrophils: 67%, Eosinophils: 00%, Monocytes: 01%,
Lymphocytes: 32%. Platelet count adequate.
ECHO SHOWED ON 21.05.09 : SITUS SOLITUS, LEVOCARDIA, 3MM OSTIUM
SECUNDUM TYPE OF ASD SEEN, L -> R SHUNT, IVS INTACT, 1mm PDA SEEN,
L -> R SHUNT, MV, AV, PV NORMAL, RVSP – 30mm of hg, CHAMBERS
NORMAL SIZE, NORMAL LV FUNCTION, GREAT VESSELS NORMALLY
ARISING, NO COARCTATION. IMPRESSION : CONGENITAL HEART
DISEASE, MODERATE SIZED ASD WITH PDA, MILD PAH.
USG ABDOMEN PELVIS REPORT ON 21.05.09 : Bilateral medical renal disease.
ADVICE ON DISCHARGE :
Syp. Domstal drops 8 drops TID x 2 weeks
Admission weight : 2.290kgDischarge weight : 2.195kg
JUNE 09
Name : B/o. Jothi Lakshmi Age / Sex: NB/ F Dept : NeonatologyHos.No : 415923 Mrd.No : 313278 Ward : I NB NICUD.O.A : 20.05.09 D.O.D : 01.06.09******************************************************************REF. BY. DR.ARAVIND BABU., PLACE : VIRUDHUNAGAR
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERINATAL ASPHYXIA PERSISTENT PULMONARY HYPERTENSION
COURSE:
This Term / AGA / female born at private hospital by forceps delivery on 20.05.09 to
RH negative mother. H/o. Baby cried immediately after birth and developed respiratory
distress since 2 hours of life, for that referred to MMHRC on 20.05.09, for further
management. H/o. Meconium Aspiration +. No H/o. Cord around the neck, convulsion. No
Maternal H/o PIH, GDM & PROM. O/E. Baby activity & cry were weak, Peripheral
cyanosis +, dyspnoeic +, tachypnoeic +, left club foot +, cephalhematoma +, no obvious
external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest indrawing+, Grunting
+, Bilateral air entry equal, P/A: soft, CNS:NNR Absent. Baby was investigated –
Peripheral smear showed neutrophilic leukocytosis. Blood sugar & Serum creatinine were
normal. Serum Bilirubin : T – 3.2, D – 0.6. DCT was negative. Echo showed Congenital
Heart disease, Tiny PDA with PFO, mild PAH (? Newborn PAH). Baby was managed with
Mechanical ventilator support, Ionotropes, 1 dose of surfactant, Iv fluids, Iv antibiotics,
Inj. Calcium gluconate, Inj. Rantac, Inj. Vitamin K, Tab. Edigra, Mucolite drops, Domstal
Drops, & FFB transfusion. With the above measures baby’s Respiratory distress came
down, hence weaned from ventilator on 27.05.09, then started on small tube feeds. Baby
tolerated feed well and increased slowly. Now baby is on sufficient oral feeds and
discharged today with advice to continue the following.
INVESTIGATION :Investigation Result Unit Date
BLOOD GROUP RH TYPING "B" POSITIVE 21/05/2009
BILIRUBIN TOTAL 3.2 mg/dl 20/05/2009 BILIRUBIN DIRECT 0.6 mg/dl 20/05/2009 DIRECT ANTI HUMAN GLOBULIN TEST (COOMBS)
"NEGATIVE" 21/05/2009
HAEMOGLOBIN 20.5 gm/dl 20/05/2009 TOTAL COUNT 15,500 cells/cumm 20/05/2009 PCV 63 % 20/05/2009 MCV 105 FL 20/05/2009 MCH 34 PG 20/05/2009 MCHC 32 % 20/05/2009 RDW 19.9 % 20/05/2009 RBC 6.0 MILL/Cumm 20/05/2009 MPV 7.4 FL 20/05/2009 NEUTROPHILS 69 % 20/05/2009 LYMPHOCYTE 30 % 20/05/2009 EOSINOPHIL 01 % 20/05/2009 PLATELET COUNT 2.1 Lakhs/Cumm 20/05/2009 CREATININE 0.9 mg /dl 21/05/2009
CREATININE 0.6 mg /dl 29/05/2009
PERIPHERAL SMEAR SHOWED (02.04.09): RBCs shows normochromic
normocytes and macrocytes . Nucleated RBCs 2/100 WBCs. WBC count shows
neutrophilic leukocytosis. No atypical or immature cells. DC: Neutrophils: 62%,
Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 32%. Platelets count normal in
number and morphology.
IMPRESSION: NEUTROPHILIC LEUKOCYTOSIS.
ECHO CARDIOGRAPHY REPORT (21.05.09) : SITUS SOLITUS. LEVOCARDIA.
SMALL PFO +. L R SHUNT. TINY PDA + (<1mm). L R SHUNT. ALL CHAMBERS
NORMAL SIZE. NORMAL LV AND RV FUNCTIN. IVS INTACT. GREAT VESSELS
NORMALLY ARISING. MV, RV, PV NORMAL. RVSP 35 mm of hg. NO
COARCTATION.
IMPRESSION. CONGENITAL HEART DISEASE. TINY PDA WITH PFO MILD PAH
(? NEWBORN PAH)
ADVICE ON DISCHARGE :
Tab. Edigra 50mg 1/10th BD x 2 weeks
Name : B/o. Seema Age / Sex: NB/ M Dept : NeonatologyHos.No : 418760 Mrd.No : 315274 Ward : I NB NICUD.O.A : 13.06.09 D.O.D : 17.06.09******************************************************************REF. BY. DR.SARAVANAN., PLACE: PARAMAKUDI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME THROMBOCYTOPENIA
COURSE:
This Term / AGA / male born at private hospital by LSCS (Indication : Meconium
Stained Liquor and Failure to thrive) on 12.06.09, with H/o. Respiratory difficulty after 3
hours of life, hence referred to MMHRC on 13.06.9. No Maternal H/o PIH, GDM &
PROM. O/E. Baby activity & cry : Moderate, Colour : Pink, CFT < 2sec, no birth injury,
no obvious external anomaly, CVS: S1, S2 heard, RS: Bilateral air entry equal, P/A: soft,
CNS:NNR +. Baby was investigated – Peripheral smear showed neutrophilic leukocytosis
with thrombocytopenia. Blood sugar & Serum creatinine were normal. Baby was
managed with CPAP, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K.
With the above measures baby’s activity & cry : Fair, respiration became normal. Now
baby is on sufficient oral, hence discharged today with advice to continue further follow up
with the referral doctor.
INVESTIGATION :Investigation Result Unit Date
BLOOD GROUP RH TYPING "A" POSITIVE 13/06/2009
HAEMOGLOBIN 14.9 gm/dl 13/06/2009 TOTAL COUNT 18700 cells/cumm 13/06/2009 PCV 44 % 13/06/2009 MCV 103 FL 13/06/2009 MCH 34 PG 13/06/2009 MCHC 33 % 13/06/2009 RDW 19.2 % 13/06/2009 RBC 4.2 MILL/Cumm 13/06/2009 MPV 9.9 FL 13/06/2009 NEUTROPHILS 85 % 13/06/2009 LYMPHOCYTE 14 % 13/06/2009 EOSINOPHIL 01 % 13/06/2009 PLATELET COUNT 30,000 CELLS Lakhs/Cumm 13/06/2009 PLATELET COUNT 1.1 Lakhs/Cumm 13/06/2009 CREATININE 0.7 mg /dl 14/06/2009
PERIPHERAL SMEAR SHOWED (15.06.09): RBCs shows normochromic
normocytes and macrocytes . Nucleated RBCs 2/100 WBCs. WBC count shows
neutrophilic leukocytosis. No atypical or immature cells. DC: Neutrophils: 81%,
Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 13%. Platelets count diminished.
IMPRESSION: NEUTROPHILIC LEUKOCYTOSIS.
ECHO CARDIOGRAPHY REPORT (15.06.09) : SITUS SOLITUS. LEVOCARDIA.
NORMAL VALVES. IAS, IVS INTACT. GREAT CESSELS NORMAL. NO PDA /
COARCTATION. NO PULMONARY HYPERTENSTION. GOOD LV AND RV
FUNCTION. IMPRESSION : NORMAL STUDY
ADVICE ON DISCHARGE :
Inj. Ceftocin 150mg IV BD x 4 days
Name : B/o. Rupavathy Age / Sex: NB/ M Dept : NeonatologyHos.No : 418894 Mrd.No : 315337 Ward : I NB NICUD.O.A : 14.06.09 D.O.D : 18.06.09******************************************************************REF. BY. DR. LAKSHMI GANESH., PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROMEPERSISTENT PULMONARY HYPERTENSION (RECOVERED)
COURSE:
This Term / AGA / male born by LSCS at private hospital on 14.06.09 with H/o.
Baby cried immediately after birth. H/o Respiratory distress since birth, hence referred to
MMHRC for further management. No H/o. Convulsion & Cord around the neck.
Maternal H/o. LSCS (Indication : Failure the progress and meconium stained liquor). No
Maternal H/o PIH, GDM, UTI, Fever, skin raches and hypothyroidism. O/E. Baby
activity & cry were weak, Colour : Pink, Peripheral cyanosis +, no birth injury and no
obvious external anomaly, CVS: S1, S2 heard, RS: Bilateral crepitatin +, P/A: soft,
CNS:NNR Absent. Local exmination left side undescended tests +. Baby was
investigated – Peripheral smear showed normal smear study. Blood sugar – 177mg/dl,
serum creatinine – 1.2. chest x-ray suggestive of meconium aspiration syndrome. Baby
was managed with Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Dopamine
infusion, Inj. Gardenol surfaced – 2 dose given, mechanical ventilator support and Inj.
Rantac 12th hourly. ABG was done. With above measures baby’s activity improved but
had persistent fall in oxygen saturation. 12th hourly ABG was done, PO2 & PCO2 showed
improvement but baby’s parents want to continue the further management in government
hospital, hence discharged AT REQUEST on 12.06.09.
INVESITGATION
Investigation Result Unit DateHAEMOGLOBIN 18.0{TWICE RPT} gm/dl 14/06/2009 TOTAL COUNT 8600 cells/cumm 14/06/2009 PCV 53 % 14/06/2009 MCV 111 FL 14/06/2009 MCH 37 PG 14/06/2009 MCHC 33 % 14/06/2009 RDW 16.5 % 14/06/2009 RBC 4.8 MILL/Cumm 14/06/2009 MPV 6.6 FL 14/06/2009 NEUTROPHILS 84 % 14/06/2009 LYMPHOCYTE 15 % 14/06/2009 EOSINOPHIL 01 % 14/06/2009 PLATELET COUNT 1.8 Lakhs/Cumm 14/06/2009 CREATININE 1.0 mg /dl 16/06/2009
PERIPHERAL SMEAR SHOWED (15.06.09): RBCs show normochromic normocytes
and microcytes. No nucleated RBCs or hemoparasites. WBC count normal. No atypical
or immature cells. DC: Neutrophils: 86%, Eosinophils: 01%, Monocytes: 01%,
Lymphocytes: 12%. Platelets count normal in number and morphology.
Name : B/o. Rathina Age / Sex: NB/ M Dept : NeonatologyHos.No : 418921 Mrd.No : 315361 Ward : I NB NICUD.O.A : 14.06.09 D.O.D : 22.06.09******************************************************************REF. BY : DR. ANBUCHELIYAN., PLACE : BODINAYAKANURREF. BY : DR. MAHALINGAM., PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH NEONATAL SEIZURE
CLINICAL SEPSIS
COURSE:
This Term / AGA / male born at private hospital by LSCS (Indication : meconium
stained liquor, Fetal distress, Failure to Progress, PIH) on 14.06.09. H/o. Baby cried
immediately after birth and developed respiratory distress since birth, H/o. Meconium
Aspiration +, for that referred to MMHRC on 14.06.09 for further management. Baby
received with only spo2 - 40% O2 saturation, hence baby was intubated and put on
mechanical ventilator support at NICU. No H/o. Cyanosis & cord around the neck.
Maternal H/o. PIH, Fever, and Bleeding PV at 3rd month of gestation. No Maternal H/o
GDM, PROM & Hypothyroidism. O/E. Baby activity & cry were weak, Colour :
Peripheral cyanosis +, CFT – Prolonged, dyspnoeic +, tachypnoeic +, no birth injury, no
obvious external anomaly, CVS: S1, S2 heard, RS: Bilateral air entry + RR: >70/mt, sub
costal retraction +, P/A: soft, CNS:NNR sluggish. Baby was investigated – Peripheral
smear showed normal smear study. TC : 3,200, Blood sugar was normal. Serum creatinine
1.2mg/dl (15.06.09), 1.0mg/dl (18.06.09), 0.6mg/dl (20.06.09) CRP was positive. Blood
culture no growth. Chest x-ray suggestive of meconium aspiration syndrome. Baby was
managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium
gluconate, Inj. Dopamine infusion, Inj. Gardenol, Inj. Rantac, Mucolite drops & oxygen
therapy. With the above measures baby’s Respiration became normal, hence weaned from
ventilator on 16.06.09, and started on small tube feeds. Now baby is on sufficient oral feeds
and discharged today with advice to continue the following.
INVESTIGATION :
Investigation Result Unit DateHAEMOGLOBIN 12.3 gm/dl 15/06/2009 TOTAL COUNT 3200 (TWICE RPT) cells/cumm 15/06/2009 PCV 35 % 15/06/2009 MCV 111 FL 15/06/2009 MCH 38 PG 15/06/2009 MCHC 34 % 15/06/2009 RDW 18.4 % 15/06/2009 RBC 3.2 MILL/Cumm 15/06/2009 MPV 8.7 FL 15/06/2009 NEUTROPHILS 70 % 15/06/2009 LYMPHOCYTE 29 % 15/06/2009 EOSINOPHIL 01 % 15/06/2009 PLATELET COUNT 1.5 Lakhs/Cumm 15/06/2009 CREATININE 1.2 mg /dl 15/06/2009 CREATININE 1.0 mg /dl 18/06/2009 CREATININE 0.6 mg /dl 20/06/2009
Name : B/o. Santha kumari Age / Sex: NB/ M Dept : NeonatologyHos.No : 420108 Mrd.No : 316129 Ward : I NB NICUD.O.A : 23.06.09 D.O.D : 24.06.09******************************************************************REF. BY. DR.MAHALINGAM., PLACE: MADURAI
DIAGNOSIS: MECONIUM ASPIRATION WITH RAISED RENAL PARAMETERS COURSE:
This 1 day old post dated / AGA / male born at private hospital by LSCS (Indication
: post dated pregnancy) on 22.06.09. H/o. Baby cried immediately after birth and developed
respiratory distress since birth. H/o. Meconium aspiration +, for that referred to MMHRC
on 23.06.09 for further management. No Maternal H/o PIH, GDM & PROM. O/E. Baby’s
activity & cry were weak. Colour : peripheral cyanosis +, CFT > 3sec, dyspnoeic +,
tachypnoeic +, no birth injury, no obvious external anomaly, CVS: S1, S2 heard, RS :
RR:60/mt, Bilateral air entry equal, P/A: soft, CNS:NNR sluggish. Baby was investigated –
HB : 14.6gm%, TC : 21,600, Platelet count : 3.3lakhs, serum Creatinine : 1.9mg/dl. Chest
x-ray showed Bilateral minimal meconium infiltration. CRP was negative. Baby was
managed with CPAP, Iv fluids, Inotropes, Iv antibiotics, Inj. Gardenol, Inj. Lasix, Inj.
Calcium gluconate & Inj. Vitamin K. Now baby is maintaining SPO2 100% with CPAP -
Fio2 of 30%, since parents want to continue further management at Government Hospital,
discharged AT REQUEST on 24.06.09.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "A" POSITIVE 24/06/2009
C-REACTIVE PROTEIN(CRP) LATEX NEGATIVE 24/06/2009
CREATININE 1.9 mg /dl 24/06/2009 HAEMOGLOBIN 14.6 gm/dl 24/06/2009 TOTAL COUNT 21,600 cells/cumm 24/06/2009 PCV 42 % 24/06/2009 MCV 106 FL 24/06/2009 MCH 36 PG 24/06/2009 MCHC 34 % 24/06/2009 RDW 17.1 % 24/06/2009 RBC 4.0 MILL/Cumm 24/06/2009 MPV 6.6 FL 24/06/2009 NEUTROPHILS 84 % 24/06/2009 LYMPHOCYTE 15 % 24/06/2009 EOSINOPHIL 01 % 24/06/2009 PLATELET COUNT 3.3 Lakhs/Cumm 24/06/2009
JULY 09
Name : B/o. Sankareswari Age / Sex: NB/ F Dept : NeonatologyHos.No : 420515 Mrd.No : 316382 Ward : I NB NICUD.O.A :26.06.09 D.O.D :03.07.09************************************************************************REF. BY: DR. DEEPAN., PLACE: VIRUDHUNAGAR
DIAGNOSIS: NEONATAL ENCEPHALOPATHY,
MECONIUM ASPIRATION SYNDROME
COURSE:
This term / AGA / female / born at private hospital by LSCS (Indication : CPD &
Cord around the neck) on 26.06.09, H/o. Baby did not cry immediately after birth, H/o.
Thick meconium stained liquor, H/o. Baby had weak cry after ambu bag & mask
ventilation for 40 sec. H/o. Baby had respiratory distress with grunting since birth, hence
referred to MMHRC on 26.06.09, for further management. H/o cord around the neck +.
No Maternal H/o. PIH, GDM, PROM, fever and hypothyroidism. O/E. Baby’s activity &
cry were weak, Colour : Pink, CFT : > 3sec, dyspnoeic +, no birth injury and no obvious
external anamolies, CVS: S1, S2 heard, RS: Bilateral air entry +, Sub costal retraction
and lower chest indrawing +, P/A: soft, CNS: NNR sluggish, Encephalopathy +. Baby
was investigated peripheral smear showed neutrophilic leukocytosis. Blood sugar and
serum Creatinine were normal. Chest x-ray showed meconium aspiration syndrome.
Baby was managed with oxygen therapy, Iv fluids, Iv. Antibiotics, Inj. calcium
gluconate, Inj. Dopamine infusion, Inj. Eptoin and Inj. Rantac. With above measures
baby’s activity & cry : fair, respiration became normal and baby is now on breast feed,
hence discharged today.
INVESTIGATION
Investigation Result Unit Date
BLOOD GROUP RH TYPING "O" NEGATIVE 27/06/2009
HAEMOGLOBIN 15.4 gm/dl 26/06/2009 TOTAL COUNT 34,900 cells/cumm 26/06/2009 PCV 47 % 26/06/2009 MCV 98 FL 26/06/2009 MCH 31 PG 26/06/2009 MCHC 32 % 26/06/2009 RDW 11.2 % 26/06/2009 RBC 4.8 MILL/Cumm 26/06/2009 MPV 7.4 FL 26/06/2009 LYMPHOCYTE 01 % 26/06/2009 PLATELET COUNT 2.4 Lakhs/Cumm 26/06/2009 CREATININE 1.0 mg /dl 28/06/2009
PERIPHERAL SMEAR SHOWED ON (27.06.09): RBCs shows normochromic normocytes
and macrocytes. Nucleated RBCs 25/100 WBCs. WBC count shows neutrophilic leukocytosis.
No atypical or immature cells. DC: Neutrophils: 70%, Eosinophils: 01%, Monocytes: 05%,
Lymphocytes: 24%. Platelets count normal in number and morphology. IMPRESSION :
NEUTROPHILIC LEUKOCYTOSIS
Name : B/o. Vimala devi Age / Sex: NB/ F Dept : NeonatologyHos.No : 420145 Mrd.No : 316144 Ward : I NB NICUD.O.A :24.06.09 D.O.D :03.07.09************************************************************************REF. BY: DR. CAPT. AUGUSTUS SAMVEL DODD., PLACE: MADURAI
REF. BY : DR. THUTHESAN PAVA PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME NEONATAL SEIZURE COURSE:
This Term / AGA / female / born at private hospital by normal vaginal delivery on
23.06.09 with H/o. Baby cried immediately after birth, H/o. respiratory distress since
birth, H/o. Thick meconium stained liquor and aspiration +, hence referred to MMHRC
on 24.06.09 for further management. H/o. convulsion + after admission. No H/o. Cord
around the neck and cyanosis. Maternal H/o : No Maternal H/o. PIH, GDM, PROM,
Fever, UTI and hypothyroidism. O/E. Baby’s activity & cry were weak, dyspnoeic +,
tachypnoeic +, no birth injury and no obvious external anamolies, CVS: S1, S2 heard,
RS: Bilateral air entry +, lower chest indrawing & respiratory distress +, P/A: distended,
CNS: NNR sluggish. Baby was investigated peripheral smear showed neutrophilic
leukocytosis. Blood sugar and serum Creatinine were normal. CRP – Negative, Blood
culture – no growth, Chest x-ray suggestive of meconium aspiration syndrome. Baby
was managed with mechanical ventilator support, Iv fluids, Iv. Antibiotics, Inj. calcium
gluconate, Inj. Gardenol, Inj. Dopamine infusion, Mucolite drops & Domstal drops. With
above measures baby’s respiration became normal, hence weaned from ventilator support
on 27.06.09 and started on small tube feeds. Now baby is on direct breast feeds and no
further convulsion seen, hence discharged today with advice to continue the follow-up
with referral doctor.
INVESTIGATION
Investigation Result Unit Date
BLOOD GROUP RH TYPING "B" POSITIVE 24/06/2009
C-REACTIVE PROTEIN(CRP) LATEX
NEGATIVE 24/06/2009
CREATININE 0.9 mg /dl 24/06/2009 HAEMOGLOBIN 20.3{TWICE RPT} gm/dl 24/06/2009 TOTAL COUNT 17000 cells/cumm 24/06/2009 PCV 60 % 24/06/2009 MCV 108 FL 24/06/2009 MCH 36 PG 24/06/2009 MCHC 33 % 24/06/2009 RDW 19.4 % 24/06/2009 RBC 5.5 MILL/Cumm 24/06/2009 MPV 7.3 FL 24/06/2009 NEUTROPHILS 89 % 24/06/2009 LYMPHOCYTE 10 % 24/06/2009 EOSINOPHIL 01 % 24/06/2009 PLATELET COUNT 2.0 Lakhs/Cumm 24/06/2009
Name : B/o. Geetha Age / Sex: NB/M Dept : NeonatologyHos.No : 421462 Mrd.No : 316971 Ward : I NB NICUD.O.A :04.07.09 D.O.D :17.07.09************************************************************************REF. BY: DR. PARATHASARATHY., PLACE: PARAMAKUDI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME SEPTICEMIA COURSE:
This term / AGA / male / born at private hospital by LSCS (Indication : Post
dated with oligohydramnios / meconium stained liquor ) on 04.07.09. H/o. Baby cried
soon after birth and developed respiratory distress since birth for that referred to
MMHRC on 04.07.09 for further management. Maternal H/o. Oligohydrmnios +. No
Maternal H/o. PIH, GDM & PROM. O/E. Baby’s activity & cry were weak, Peripheral
cyanosis +, CFT : > 3sec, dyspnoeic+, tachypnoeic +, not anemic, not icteric, no birth
injury and no obvious external anomaly, CVS: S1, S2 heard, RS: RR > 60/mt, lower
chest indrawing +, P/A: soft, CNS: NNR sluggish. Baby was investigated peripheral
smear showed neutrophilic leukocytosis. Blood sugar and serum Creatinine were normal.
Chest x-ray showed left upper lobe infiltration. Baby was managed with CPAP, Iv fluids,
Iv. Antibiotics, Inj. calcium gluconate, Inj. Aminophylline & Inj. Dopamine. On
08.07.09 baby had brown coloured vomitus, Inj. Rantac was added. On 10.07.09, baby
had abdominal distension, ryles tube feeding was with held. On 16.07.09. Baby had
convulsion Inj. Gardenol was added. On 17.07.09 baby had desaturation with the C-PAP,
so intubated and connected to mechanical ventilator support. As baby had low perfusion
with hypotension, Ionotrophes were restarted. Now baby is on mechanical ventilator
support and maintaining O2 saturation 98% with Fio2 of 100%. Since parents were not
willing for further management, baby is discharged AGAINST MEDICAL ADVICE on
17.07.09.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "O" POSITIVE 04/07/2009
HAEMOGLOBIN 17.6 gm/dl 04/07/2009 TOTAL COUNT 23,000 [ TWICE RPT ] cells/cumm 04/07/2009 PCV 53 % 04/07/2009 MCV 105 FL 04/07/2009 MCH 34 PG 04/07/2009 MCHC 32 % 04/07/2009 RDW 13.5 % 04/07/2009 RBC 5.1 MILL/Cumm 04/07/2009 MPV 8.1 FL 04/07/2009 NEUTROPHILS 67 % 04/07/2009 LYMPHOCYTE 31 % 04/07/2009 EOSINOPHIL 02 % 04/07/2009 PLATELET COUNT 2.5 Lakhs/Cumm 04/07/2009 CREATININE 1.0 mg /dl 05/07/2009 CREATININE 0.7 mg /dl 09/07/2009
PERIPHERAL SMEAR SHOWED (06.07.09) : RBCs shows normochromic
normocytes and macrocytes. No nucleated RBCs 2/100 WBCs. WBC count shows
neutrophillic leukocytosis. No atypical or immature cells. DC: Neutrophils: 60%,
Eosinophils: 02%, Monocytes: 05%, Lymphocytes: 33%. Platelet count normal in
number and morphology. IMPRESSION: NETROPHILIC LEUKOCYTOSIS.
Name : B/o. Aruna Rani Age / Sex: NB/ M Dept : Neonatology
Hos.No : 422643 Mrd.No : 317756 Ward : I NB NICUD.O.A : 15.07.09 D.O.D : 20.07.09************************************************************************REF. BY: DR.K.K RAVISANKAR., PLACE: MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION OF NEWBORN ACUTE RENAL FAILURE
COURSE:
This Term / LBW / male baby born at private hospital by LSCS (Indication :
severe oligohydramnios with fetal distress) on 14.07.09 with baby cried immediately
after birth, H/o. Baby had respiratory distress since birth. Hence referred to MMHRC on
15.07.09, for further management. No H/o. cyanosis and convulsion. H/o. meconium
aspiration +. Maternal H/o. white discharge +, H/o. maternal fever +, H/o. sever
oligohydramnios and cord around the neck shown in the antenatal USG abdomen. O/E.
Baby’s activity & cry were weak, respiratory distress +, colour : pink, CFT > 3 sec,
CVS : S1 S2 heard, RS : sub costal and intercostal retraction +, bilateral air entry +, P/A:
soft, CNS: NNR sluggish. Baby was investigated peripheral smear showed mild
leukocytosis. Blood sugar – 104mg/dl, serum Creatinine – 1.1(15.07.09), 1.8(20.07.09)
CRP was negative. Blood culture – no growth. Chest x-ray suggestive of meconium
aspiration syndrome. Baby was managed with mechanical ventilator support, Iv fluids,
Iv. Antibiotics, Inj. Dopamine infusion, Inj. Nor aderenaline infusion, Inj.calcium
gluconate, Inj. Rantac and Inj. Aminophylline. With above management baby’s oxygen
saturation was maintained activity & cry were weak. Since baby’s parents were not
willing for further management, baby was discharged today “AGAINST MEDICAL
ADVICE” on 20.07.09
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "O" POSITIVE 15/07/2009
C-REACTIVE PROTEIN(CRP) LATEX NEGATIVE 15/07/2009
HAEMOGLOBIN 19.9 (TWUCE RPT) gm/dl 15/07/2009 TOTAL COUNT 15800 cells/cumm 15/07/2009 PCV 59 % 15/07/2009 MCV 107 FL 15/07/2009 MCH 35 PG 15/07/2009 MCHC 33 % 15/07/2009 RDW 12.9 % 15/07/2009 RBC 5.5 MILL/Cumm 15/07/2009 MPV 8.4 FL 15/07/2009 NEUTROPHILS 59 % 15/07/2009 LYMPHOCYTE 40 % 15/07/2009 EOSINOPHIL 01 % 15/07/2009 PLATELET COUNT 2.0 Lakhs/Cumm 15/07/2009 CREATININE 1.1 mg /dl 15/07/2009 CREATININE 0.8 mg /dl 18/07/2009 CREATININE 1.8 mg /dl 20/07/2009
Name : B/o. Haria Devi Age/Sex : NB/ F Dept : NeonatologyHos.No: 423288 Mrd.No : 318219 Ward : IL.NB. NICUD.O.A : 20.07.09 D.O.D : 21.07.09
************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA THICK MECONIUM ASPIRATION
COURSE:
This Pre term (35 weeks) / AGA / female born at MMHRC by normal vaginal
delivery on 20.07.09 with H/o. Baby did not cry immediately after birth, H/o. Thick
meconium stained liquor, hence immediately intubated with 3 size ET tube and
resuscitated with ambu bag ventilator, then baby’s activity & cry regained and shifted to
NICU for further management. No H/o. convulsion and cord around the neck. Maternal
H/o. draining PV – 3 days, H/o. Hepatitis E Positive, Maternal H/o. Jaundice with
elevated LFT. O/E. Baby activity & cry – weak. Colour : Pink, CFT < 3 sec, Mild
respiratory distress +, no birth injury, no obvious external anomaly. Baby was
extubated on the same day of birth and was on oxygen therapy. CVS : S1 S2 heard, RS :
Bilateral air entry equal, mild lower chest indrawing +, P/A soft, CNS : NNR sluggish.
Baby was investigated : Peripheral smear showed Neutrophilic leukocytosis. Blood sugar
– normal. CRP – Negative, Blood culture report awaited. Baby was managed with
oxygen therapy, Iv fluids, Inj. Calcium gluconate and Inj. Vitamin K. With above
measures baby’s activity & cry - fair, no respiratory distress and baby is on sufficient
oral feeds hence discharged today with advice to continue.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "B" POSITIVE 20/07/2009
HAEMOGLOBIN 12.5 gm/dl 20/07/2009 TOTAL COUNT 23600 cells/cumm 20/07/2009 PCV 37 % 20/07/2009 MCV 111 FL 20/07/2009 MCH 37 PG 20/07/2009 MCHC 33 % 20/07/2009 RDW 13.5 % 20/07/2009 RBC 3.3 MILL/Cumm 20/07/2009 MPV 9.0 FL 20/07/2009 NEUTROPHILS 65 % 20/07/2009 LYMPHOCYTE 32 % 20/07/2009 EOSINOPHIL 03 % 20/07/2009 PLATELET COUNT 3.3 Lakhs/Cumm 20/07/2009
PERIPHERAL SMEAR (20.07.09): RBCs show normochromic normocytes and
macrocytes. Nucleated RBCs 2/100 WBCs. WBC count shows neutrophilic
leukocytosis. No atypical or immature cells. DC: Neutrophils: 63%, Eosinophils: 03%,
Monocytes: 03%, Lymphocytes: 31%. Platelets count normal in number and morphology.
IMPRESSION : NEUTROPHILIC LEUKOCYTOSISName : B/o. Saritha Rani Age / Sex: NB/M Dept : NeonatologyHos.No : 423715 Mrd.No : 318497 Ward : I NB NICUD.O.A : 23.07.09 D.O.D : 27.07.09************************************************************************REF. BY: DR.S.N SURESH KUMAR., PLACE: MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PULMONARY HYPERTENSION ACUTE SEPTAL DEFECT
COURSE:
This Term / AGA / male baby born at private hospital by LSCS (Indication : Non
progression of labour) on 21.07.09 with H/o. baby cried immediately after birth and had
respiratory distress since birth, hence child was referred to MMHRC on 23.07.09 for
further management. H/o. Meconium stained liquor +, H/o. Aspiration +. No H/o.
cyanosis and cord around the neck. No Maternal H/o. PIH, GDM, UTI, fever and
hypothyroidism. O/E. Baby’s activity & cry were weak, respiratory distress +, colour :
Icteric, CFT < 3 sec, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external
anomaly, CVS : S1 S2 heard, RS : Bilateral air entry equal, P/A: soft, CNS: NNR
sluggish. Baby was investigated peripheral smear, Blood sugar & serum Creatinine were
normal. DCT was negative. Reticulocyte count – 2.6%. Serum Bilirubin : T – 13.3
mg/dl, D- 0.4mg/dl (23.07.09), T - 12.9mg/dl, D – 0.5 mg/dl (27.07.09). Echo showed
congenital heart disease, moderate sized ASD, mild PAH. Baby was managed with
Oxygen, Iv fluids, Iv. Antibiotics, Inj.calcium gluconate, Inj. Vitamin K and Double side
phototheraphy. With these above measures baby’s activity & cry – moderate, ictures and
respiratory distress reduced, hence started on oral feeds. Since baby’s parents were not
willing for further management, was discharged “AGAINST MEDICAL ADVICE” on
27.07.09
INVESTIGATION :
Investigation Result Unit DateCREATININE 0.9 mg /dl 24/07/2009 BILIRUBIN TOTAL
13.3 mg/dl 24/07/2009
BILIRUBIN DIRECT
0.4 mg/dl 24/07/2009
DIRECT ANTI HUMAN GLOBULIN TEST (COOMBS)
"NEGATIVE" 25/07/2009
HAEMOGLOBIN 18.0 gm/dl 24/07/2009 TOTAL COUNT 7100 cells/cumm 24/07/2009 HAEMOGLOBIN 18.0 gm/dl 24/07/2009 TOTAL COUNT 7100 cells/cumm 24/07/2009 HAEMOGLOBIN 18.0 gm/dl 24/07/2009 TOTAL COUNT 7100 cells/cumm 24/07/2009 PCV 55 % 24/07/2009 PCV 55 % 24/07/2009 PCV 55 % 24/07/2009 MCV 94 FL 24/07/2009 MCV 94 FL 24/07/2009 MCV 94 FL 24/07/2009 MCH 30 PG 24/07/2009 MCH 30 PG 24/07/2009 MCH 30 PG 24/07/2009 MCHC 32 % 24/07/2009 RDW 14.1 % 24/07/2009 RBC 5.8 MILL/Cumm 24/07/2009 MPV 8.2 FL 24/07/2009 P/S RBC'S: ARE NORMOCHROMIC
NORMOCYTIC. NO HAEMOPARASITES ARE 24/07/2009
SEEN. WBC'S: COUNTS ARE NORMAL. NO IMMATURE CELLS ARE SEEN. PLATELETS ARE NORMAL IN COUNT AND MORPHOLOGY.
NEUTROPHILS 61 % 24/07/2009 LYMPHOCYTE 38 % 24/07/2009 EOSINOPHIL 01 % 24/07/2009 PLATELET COUNT
2.9 Lakhs/Cumm 24/07/2009
IMPRESSION NORMAL STUDY. 24/07/2009 RETICULOCYTE COUNT (Children)
2.6 % 24/07/2009
BILIRUBIN TOTAL
12.8 mg/dl 27/07/2009
BILIRUBIN DIRECT
0.5 mg/dl 27/07/2009
CREATININE 0.4 mg /dl 27/07/2009
ECHO CARDIOGRAPHY REPORT (27.07.09) : SITUS SOLITUS. LEVOCARDIA.
SMALL OSTIUM SECUNDUM TYPE OF ASD SEEN (5mm). LR SHUNT. IVS
INTACT. RVSP 40mm of hg. OTHER VALVES NORMAL. GREAT VESSELS
NORMALLY ARISING. NO PDA / COARCTATION. NORMAL LV FUNCTION.
IMPRESSION : CONGENITAL HEART DISEASE. MODERATE SIZED ASD.
MILD PAH.
Name : B/o. Kamala Age / Sex: NB/M Dept : NeonatologyHos.No : 423815 Mrd.No :318543 Ward : I NB NICUD.O.A : 24.07.09 D.O.D : 28.07.09************************************************************************
REF. BY : DR. KARTHIKEYINI., PLACE : DEVAKOTTAI
DIAGNOSIS: PRETERM (32 – 34 WEEKS)
RESPIRATORY DISTRESS SYNDROME
PERIPHERAL CIRCULATORY FAILURE
HIGH RISK FOR SEPSIS [PROM > 7 DAYS]
SURFACTANT THERAPY GIVEN ON 25.07.09
COURSE :
This Pre term (32 - 34 weeks) / AGA / male born at Private hospital by Normal
vaginal delivery on 24.07.09. H/o. Baby cried immediately after birth and developed
respiratory distress since birth for that referred to MMHRC on 24.07.09 for further
management. Maternal H/o. PROM – 7 days, UTI +. No Maternal H/o. GDM and PIH.
O/E. Activity & cry : weak, Peripheral cyanosis +, CFT > 3 sec, dyspnoeic +,
tachypnoeic +, no obvious external anomaly. CVS : S1 & S2 heard, Hypertension +,
RS : RR > 60/mt, Lower chest indrawing +. P/A : Soft, CNS : NNR sluggish. Baby was
investigated : Peripheral smear was normal smear study. CRP was negative. Chest x-ray
suggestive of respiratory distress syndrome. Echo showed IAS aneurysm. Baby was
managed with Mechanical ventilator support, Ionotropes, Iv fluids, Iv antibiotics, Inj.
calcium gluconate, Inj. Vitamin K and 2 doses of surfactant given. On 27.07.09 baby had
persistent cyanosis with hypotension, Inj. Nor adrenaline infusion was started. Baby had
decreased urine output and raised renal parameters of Blood urea – 81mg/dl and Serum
creatinine was - 1.3mg/dl, Inj. Lasix infusion was added on 28.07.09. Now baby is in
mechanical ventilator support, maintaining oxygen saturation 94% with the FIO2 of
100%. Since parents were not willing for further management, baby is discharged
“Against Medical Advice” on 28.07.09 at 12.00 no
INVESTIGATION :
Investigation Result Unit DateBLOOD GROUP RH TYPING
"A" POSITIVE 24/07/2009
C-REACTIVE PROTEIN(CRP) LATEX
NEGATIVE 24/07/2009
C-REACTIVE PROTEIN(CRP) LATEX
NEGATIVE 25/07/2009
HAEMOGLOBIN 14.5 gm/dl 24/07/2009 TOTAL COUNT 8500 cells/cumm 24/07/2009 HAEMOGLOBIN 14.5 gm/dl 25/07/2009 TOTAL COUNT 8500 cells/cumm 25/07/2009 PCV 41 % 24/07/2009 PCV 41 % 25/07/2009 MCV 104 FL 24/07/2009 MCV 104 FL 25/07/2009 MCH 36 PG 24/07/2009 MCH 36 PG 25/07/2009 MCHC 34 % 24/07/2009 MCHC 34 % 25/07/2009 RDW 17.3 % 24/07/2009 RDW 17.3 % 25/07/2009 RBC 4.0 MILL/Cumm 24/07/2009 RBC 4.0 MILL/Cumm 25/07/2009 MPV 7.6 FL 24/07/2009 MPV 7.6 FL 25/07/2009 P/S RBC'S: NORMOCHROMIC NORMOCYTIC. 25/07/2009
NO HAEMOPARASITES ARE SEEN. WBC'S: COUNTS ARE NORMAL. NO IMMATURE CELLS ARE SEEN. PLATELETS ARE NORMAL IN COUNT AND MORPHOLGY.
NEUTROPHILS 65 % 24/07/2009 LYMPHOCYTE 34 % 24/07/2009 EOSINOPHIL 01 % 24/07/2009 NEUTROPHILS 65 % 25/07/2009 LYMPHOCYTE 34 % 25/07/2009 EOSINOPHIL 01 % 25/07/2009 PLATELET COUNT
2.8 Lakhs/Cumm 24/07/2009
PLATELET COUNT
2.8 Lakhs/Cumm 25/07/2009
IMPRESSION NORMAL STUDY. 25/07/2009 CREATININE 1.0 mg /dl 27/07/2009
ECHO CARDIOGRAPHY REPORT (25.07.09) : SITUS SOLITUS. LEVOCARDIA.
AV, VA CONCORDANCE. NORMAL RELATED GREAT VESSELS. NORMAL
VALVES. CHAMBERS NORMAL. IAS, IVS INTACT. IAS ANEURYSM +. NO
SHUNT. NO PDA / COARCTATION. NO PULMONARY HYPERTENSION.
IMPRESSION : IAS ANEURYSM. NO SHUNT.
AUG 09
Name : B/o. Jothi Age / Sex: NB/M Dept : NeonatologyHos.No : 425280 Mrd.No : 319549 Ward : I NB NICU
D.O.A : 07.08.09 D.O.D :09.08.09************************************************************************REF. BY: DR.J.AMBA BHAVANI., PLACE: MADURAI
DIAGNOSIS: PRE TERM (33 WEEKS) / AGA / MALE
RESPIRATORY DISTRESS SYNDROME
TO R/O EARLY ONSET OF SEPSIS
PDA WITH MODERATE PAH
SURFACTANT THERAPY GIVEN
COURSE:
This Pre term ( 33 weeks) / AGA / male / born at private hospital by LSCS
(Indication : previous LSCS ) on 07.08.09 with H/o. Baby cried soon after birth
developed cyanosis and respiratory distress since birth, for that referred to MMHRC on
07.08.09 for further management, Maternal H/o. G5 P3 A2 L2, H/o. recurrent UTI at 7
months, treated. No Maternal H/o. PIH, GDM & PROM. O/E. Baby’s activity & cry
were weak, colour : Peripheral cyanosis +, CFT : > 3sec, grunting respiration +,
tachypnoeic +, Spo2 – 60-70% with the oxygen hood immediately intubated and
connected to ventilator support. no birth injury, CVS: S1, S2 heard, RS: RR > 60/mt,
chest indrawing +, Bilateral air entry equal, P/A: soft, CNS: NNR sluggish, External
genitalia – left undescended testis. Baby was investigated : Peripheral smear showed HB
– 16.5gm%, TC – 13,000 cells & platelet count – 2.1 lakhs, Blood sugar : 48mg/dl.
Chest x-ray showed bilateral reticular pattern with air bronchogram. Echo showed small
PDA 3mm with L R shunt, PFO +, moderate pulmonary hypertension, TR moderate.
Baby was managed with Mechanical ventilator support, Iv fluids, Iv. Antibiotics, Inj.
calcium gluconate, Inj. Vitamin K & surfactant (3 doses). Now baby is maintaining
oxygen saturation (Spo2 – 100%) with mechanical ventilator support of Fio2 – 70%.
Since parents want to continue further management at some other hospital discharged AT
REQUEST on 08.08.09
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "B" POSITIVE 07/08/2009
HAEMOGLOBIN 16.5 gm/dl 08/08/2009 TOTAL COUNT 13,000 cells/cumm 08/08/2009 PCV 48 % 08/08/2009 MCV 102 FL 08/08/2009 MCH 34 PG 08/08/2009 MCHC 33 % 08/08/2009 RDW 17.5 % 08/08/2009 RBC 4.7 MILL/Cumm 08/08/2009 MPV 7.2 FL 08/08/2009 NEUTROPHILS 40 % 08/08/2009 LYMPHOCYTE 58 % 08/08/2009 EOSINOPHIL 02 % 08/08/2009 PLATELET COUNT 2.1 Lakhs/Cumm 08/08/2009
GLUCOMETER SUGAR 9PM:48mg/dl 08/08/2009
ECHO SHOWED ON 08.08.09 : SITUS SOLITUS, LEVOCARDIA, SMALL PDA
SEEN (3 MM), L R SHUNT, NORMAL RELATED GREAT VESSELS, PFO +, NO
COARCTATION, MODERATE PULMONARY HYPERTENSION, IMPRESSION : CONGENITAL HEART DISEASE, SMALL PDA, PFO, MODERATE TR, MODERATE PULMONARY HYPERTENSION.
Name : B/o. Suba Age/Sex : NB/ F Dept : Neonatology
Hos.No: 426283 Mrd.No : 320146 Ward: IL.NB. NICUD.O.A : 14.08.09 D.O.D : 20.08.09 ************************************************************************
DIAGNOSIS: TERM / IUGR MECONIUM ASPIRATION WITH RESPIRATORY DISTRESS
COURSE:
This Term / IUGR / female baby born at MMHRC on 14.08.09 by LSCS
(Indication : Primi with Oligohydramnios) with H/o. baby cried immediately after birth
and had poor activity and feeding, hence admitted at NICU for further management, H/o.
Thick meconium stained liquor +. No maternal H/o. PIH, GDM, PROM, Fever, UTI &
Hypothyroidism. O/E. Baby’s activity & cry were weak. Colour : Pink, CFT < 3 sec,
dyspnoeic, tachypnoeic, no birth injury, no obvious external anomaly. CVS: S1 & S2
heard, RS: RR 66 / min Bilateral air entry equal. P/A: soft, CNS : NNR sluggish. Baby
was investigated : HB – 19.8mg/dl, TC : 22,600, platelet count – 3.1 lakhs, Blood sugar
& serum creatinine were normal. Baby was managed with oxygen, Iv fluids, Iv
antibiotics, Inj. Calcium gluconate & single sided phototherapy. With above measures
baby became active and had no respiratory distress. Now baby is on breast feeds, hence
discharged today.
INVESTIGATION :
Investigation Result Unit DateHAEMOGLOBIN 19.8 [TWICE RPT] gm/dl 15/08/2009 TOTAL COUNT 22,600 cells/cumm 15/08/2009 PCV 58 % 15/08/2009 MCV 102 FL 15/08/2009 MCH 34 PG 15/08/2009 MCHC 33 % 15/08/2009
RDW 17 % 15/08/2009 RBC 5.7 MILL/Cumm 15/08/2009 MPV 7.4 FL 15/08/2009 NEUTROPHILS 78 % 15/08/2009 LYMPHOCYTE 20 % 15/08/2009 EOSINOPHIL 02 % 15/08/2009 PLATELET COUNT 3.1 Lakhs/Cumm 15/08/2009 CREATININE 0.4 mg /dl 15/08/2009
Name : B/o. Kasiammal Age / Sex: NB/M Dept : NeonatologyHos.No : 427217 Mrd.No : 320747 Ward : I NB NICU
Name : B/o. Kasiammal Age / Sex: NB/M Dept : NeonatologyHos.No : 427217 Mrd.No : 320747 Ward : I NB NICUD.O.A :23.08.09 D.O.D :26.08.09************************************************************************
DIAGNOSIS: THICK MECONIUM ASPIRATION
RESPIRATORY DISTRESS
COURSE:
This Term / AGA / female / born at MMHRC by LSCS (Indication : Fetal distress
with thick meconium stained liquor ) on 23.08.09. H/o. Baby cried soon after birth &
developed respiratory distress since birth for that admitted at NICU for further
management. H/o. Thick meconium stained liquor +. No maternal H/o. PIH/GDM/PROM
& Hypothyroidism. O/E. Baby’s activity & cry were weak, Colour : pink, CFT : < 3sec,
Tachypnoeic +, no birth injury, no obvious external anamoly. CVS: S1, S2 heard, RS:
RR : 60/mt, Mild lower chest indrawing +, P/A: soft, CNS: NNR sluggish. Baby was
investigated peripheral smear showed Neutrophilic leukocytosis. Blood sugar was
normal. Baby was managed with oxygen, Iv. Fluids, Iv. Antibiotics, Inj. Calcium
gluconate & Inj. Vitamin K. With these above measures baby’s respiration became
normal and started on small tube feeds. Now baby is taking breast feeds & discharged
today with advice to continue following.
INVESTIGATION :
Investigation Result Unit DateHAEMOGLOBIN 17.0 [TWICE RPT] gm/dl 23/08/2009 TOTAL COUNT 21,100 cells/cumm 23/08/2009 PCV 50 % 23/08/2009 MCV 106 FL 23/08/2009 MCH 35 PG 23/08/2009 MCHC 33 % 23/08/2009 RDW 16.7 % 23/08/2009
RBC 4.7 MILL/Cumm 23/08/2009 MPV 8.1 FL 23/08/2009 NEUTROPHILS 83 % 23/08/2009 LYMPHOCYTE 15 % 23/08/2009 EOSINOPHIL 02 % 23/08/2009 PLATELET COUNT 2.9 Lakhs/Cumm 23/08/2009
PERIPHERAL SMEAR SHOWED ON (24.08.09): RBCs show normochromic
normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count shows
neutrophilic leukocytosis. No atypical or immature cells. DC: Neutrophils: 76%,
Eosinophils: 02%, Monocytes: 05%, Lymphocytes: 17%. Platelets count normal in
number and morphology.
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS
Admission weight : 3.145kg
Discharge weight : 3.050kg
Name : B/o. Eluvakkal Age/Sex : NB/ F Dept : NeonatologyHos.No: 426224 Mrd.No : 320132 Ward: IL.NB. NICUD.O.A : 14.08.09 D.O.D : 29.08.09 ************************************************************************
DIAGNOSIS: TERM / IUGR / BIRTH ASPHYXIA THIN MECONIUM ASPIRATION
COURSE:
This Term / IUGR / female baby born at MMHRC by normal vaginal delivery on
14.08.09. H/o. baby had weak cry at birth, resuscitated with one cycle of ambu mask
ventilation & had respiratory distress since birth. H/o. Cord around the neck +, H/o.
Thick meconium stained liquor +. For that admitted at NICU for further management.
Antenatally USG abdomen showed cadiomegaly, hepatomegaly & ascites. Maternal H/o.
severe Oligohydraminios +, G4 P1 L1 A2, 1st child had CHD. No maternal H/o. PIH,
GDM & PROM. O/E. Baby’s activity & cry were weak. Colour : cyanosis, CFT < 3 sec,
dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anomaly. CVS: S1 &
S2 +, RS: RR 60/mint, inter costal retraction +, P/A: soft, CNS : NNR sluggish. Baby
was investigated peripheral smear showed leukocytosis. Blood sugar was normal. Serum
creatinine – 1.7mg/dl, 0.8mg/dl (17.08.09), karyotyping sent, report awaited. Baby was
managed with mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium
gluconate, Inj. Vitamin K and Ionotrophic support. ET tip culture showed coagulase
negative staphycococus, antibiotics were changed according to culture sensitivity. With
these above measures, baby’s respiration became normal, activity improved so weaned
from the ventilator on 24.08.09 & tapering of Ionotropes done. Baby was started on small
tube feeds & tolerating feeds well. Now baby is taking breast feeds & discharged today
with the advice to continue the following.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "B" POSITIVE 14/08/2009
HAEMOGLOBIN 14.1 gm/dl 14/08/2009 TOTAL COUNT 21,400 cells/cumm 14/08/2009 PCV 42 % 14/08/2009 MCV 99 FL 14/08/2009 MCH 33 PG 14/08/2009 MCHC 33 % 14/08/2009 RDW 15.4 % 14/08/2009 RBC 4.2 MILL/Cumm 14/08/2009 MPV 8.7 FL 14/08/2009 NEUTROPHILS 62 % 14/08/2009 LYMPHOCYTE 37 % 14/08/2009 EOSINOPHIL 01 % 14/08/2009 PLATELET COUNT 1.8 Lakhs/Cumm 14/08/2009 CREATININE 1.7 mg /dl 15/08/2009 CREATININE 0.8 mg /dl 17/08/2009
PERIPHERAL SMEAR SHOWED ON (14.08.09): RBCs shows normochromic
normocytes and macrocytes. Nucleated RBCs 4/100 WBCs. WBC count shows
leukocytosis. No atypical or immature cells. DC: Neutrophils: 59%, Eosinophils: 01%,
Monocytes: 03%, Lymphocytes: 37%. Platelets count normal in number and morphology.
IMPRESSION : LEUKOCYTOSISName : B/o. Sorna Gowri Age/Sex : NB/ F Dept : NeonatologyHos.No: 427884 Mrd.No : 321209 Ward: IL.NB. NICUD.O.A : 28.08.09 D.O.D : 30.08.09 ************************************************************************
DIAGNOSIS: MECONIUM ASPIRATION NEONATAL SEIZURE BILATERAL PNEUMOTHORAX
COURSE:
This Boderline Term / IUGR / female born at private hospital by normal vaginal
delivery on 28.08.09. H/o. Birth asphyxia +, Thick meconium stained, Liquor +,
Resuscitated, intubated, ambu bag, ventilation given, then & referred to MMHRC on
28.08.09 for further management. Maternal H/o. Polyhydramnios +. Maternal H/o. Fetal
distress +. Antenatal USG abdomen showed ? Reversal of diastolic flow. No maternal
H/o. PIH, GDM. O/E. Baby’s activity & cry : weak. Colour : Pink, peripheral cyanosis
+, CFT < 3 sec, tachypnoeic +, lower chest indrawing +, low set of ears +, cleft palate +,
no birth injury, CVS: S1 & S2 heard, RS: RR >60/mt, LCI +, P/A : Soft, CNS : NNR
sluggish. Baby was investigated peripheral smear showed HB : 17.9gm%, TC : 19,300
cells & Platelet count : 1.1 lakhs, Blood sugar & serum creatinine were normal. Baby was
managed with mechanical ventilator support, Iv. Fluids, Iv antibiotics, Inj. Calcium
gluconate & Inj. Vitamin K. As baby had hypotension, Inj. Dopamine infusion was
started. On 29.08.09. baby had convulsion, Inj. Gardenol was added. Baby had recurrent
seizures, not controlled with Inj. Gardenol, so Inj. Eptoin was added. On 30.08.09. Baby
had desaturation. Chest X-ray was taken, which showed Bilateral pneumothorax - ICD
was done, on both sides. Even with these above measures, baby had desaturation
followed by bradycardia, Inj. Atropine and Inj. Adrenaline were given. CPR was carried
out. But baby could not be revived & DECLARED DEAD on 30.08.09.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "B" POSITIVE 29/08/2009
HAEMOGLOBIN 17.9 gm/dl 29/08/2009 TOTAL COUNT 19300 cells/cumm 29/08/2009 PCV 54 % 29/08/2009 MCV 109 FL 29/08/2009 MCH 36 PG 29/08/2009 MCHC 33 % 29/08/2009 RDW 21.6 % 29/08/2009 RBC 4.9 MILL/Cumm 29/08/2009 MPV 8.2 FL 29/08/2009 NEUTROPHILS 80 % 29/08/2009 LYMPHOCYTE 19 % 29/08/2009 EOSINOPHIL 01 % 29/08/2009 PLATELET COUNT 1.1 Lakhs/Cumm 29/08/2009 CREATININE 0.5 mg /dl 29/08/2009
PERIPHERAL SMEAR SHOWED ON (28.08.09): RBCs show normocytes and
macrocytes. Nucleated RBCs 5/100 WBCs. WBC count shows neutrophilic leukocytosis.
No atypical or immature cells. DC: Neutrophils: 86%, Eosinophils: 01%, Monocytes:
03%, Lymphocytes: 10%. Platelets count just adequate. IMPRESSION :
NEUTROPHILIC LEUKOCYTOSIS
SEP 09Hos.No : 426693 Mrd.No : 320442 Ward : I NB NICUD.O.A :19.08.09 D.O.D :01.09.09************************************************************************REF.BY.DR. SABITHA SRIDHARAN PLACE : MADURAI
DIAGNOSIS: PRETERM (30 - 32 WEEKS) / LBW / FEMALE / TWIN - I RESPIRATORY DISTRESS SYNDROME SURFACTANT THERAPY GIVEN ON 19.08.09
CONGENITAL HEART DISEASE, (SMALL PDA(1 mm) / SMALL ASD (3 mm) & SEVERE PAH)
COURSE:
This pre term (30 - 32 weeks) / LBW / female / Twin I born at private hospital by
normal vaginal delivery on 19.08.09. H/o. Baby cried immediately after birth for that
referred to MMHRC on 19.08.09 for further management. No H/o. PIH / GDM / PROM.
O/E. Baby’s activity & cry were weak. Colour : Pink, peripheral cyanosis +, CFT > 3sec,
dyspnoeic+, tachypnoeic +, no birth injury, no obvious external anamoly, CVS: S1, S2
heard, RS: RR > 60/mt. Bilateral air entry equal, P/A: soft, CNS: NNR sluggish. Baby
was investigated peripheral smear, blood sugar & serum creatinine were normal. ECHO
showed CHD, Small ASD (3 mm), small PDA (1mm) & severe PAH. Chest x-ray
suggestive of RDS. Baby was managed with mechanical ventilator support, Iv fluids, Inj.
Calcium gluconate, Inj. Vitamin K, Ionotrophic support and 1 dose of Inj. Surfactant.
Three dose of Syp. Brufen was given for PDA closure. With these above measures,
baby’s respiration became normal. So weaned from the ventilator on 26.08.09 and started
on small tube feeds. Baby was slowly weaned from oxygen theraphy. ET – Tip culture
showed Enterobactor growth. Antibiotics were changed according to culture sensitivity.
Now baby’s activity improved & taking breast feeds well & discharged today with the
advice to continue further follow-up with the referral doctor.
INVESTIGATIONInvestigation Result Unit Date
BLOOD GROUP RH TYPING "B" POSITIVE 19/08/2009
HAEMOGLOBIN 18.4 [TWICE RPT] gm/dl 19/08/2009 TOTAL COUNT 6900 cells/cumm 19/08/2009 PCV 53 % 19/08/2009 MCV 107 FL 19/08/2009 MCH 37 PG 19/08/2009 MCHC 34 % 19/08/2009 RDW 15.6 % 19/08/2009 RBC 4.9 MILL/Cumm 19/08/2009 MPV 6.8 FL 19/08/2009 NEUTROPHILS 48 % 19/08/2009 LYMPHOCYTE 50 % 19/08/2009 EOSINOPHIL 02 % 19/08/2009 PLATELET COUNT 2.9 Lakhs/Cumm 19/08/2009 CREATININE 0.4 mg /dl 22/08/2009
PERIPHERAL SMEAR SHOWED ON (19.08.09): RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No atypical or immature cells. DC: Neutrophils: 40%, Eosinophils: 02%, Monocytes: 05%, Lymphocytes: 53%. Platelets count normal in number and morphology. ECHO SHOWED ON 21.08.09 : SITUS SOLITUS, LEVOCARDIA, 3 mm OSTIUM SECUNDUM TYPE OF ASD SEEN, L R SHUNT, IVS INTACT, MV, AV, PV NORMAL, GREAT VESSELS NORMALLY ARISING, SMALL 1mm PDA SEEN, L R SHUNT ONLY DURING SYSTOLE, NO COARCTATION, NO PERICARDIAL EFFUSION, NORMAL LV AND RV FUNCTION. IMPRESSION : CONGENTIAL HEART DISEASE, SMALL ASD, SMALL PDA, SEVERE PAH.
Name : B/o. Vanitha Rex Age/Sex : NB/ F Dept : NeonatologyHos.No: 427202 Mrd.No : 320734 Ward: IL.NB. NICUD.O.A : 22.08.09 D.O.D : 08.09.09 ************************************************************************
REF.BY.DR.NANDHINI PANDIYAN., PLACE : MADURAI
DIAGNOSIS: PRETERM ( 32 – 34 WEEKS) WITH RESPIRATORY DISTRESS SURFACTANT THERAPHY GIVEN ON 24.08.09 CHD [SMALL ASD (2mm)]
COURSE:
This Pre term (34 – 35 weeks) / AGA / female born at private hospital by LSCS
( Ind : previous LSCS with Oligohydramnios) on 22.08.09. H/o. Baby cried immediately
after birth. baby had respiratory distress since birth, for that referred to MMHRC on
22.08.09 for further management. Maternal H/o. Decreased fetal movements +,
Oligohydramnios +. No maternal H/o. PIH & PROM. O/E. Baby’s activity & cry –
weak, peripheral cyanosis +, CFT < 3 sec, grunting +, tachypnoeic, no birth injury, no
obvious external anamoly, CVS: S1 & S2 heard, RS: RR > 60/mt, lower chest indrawing
+, P/A: soft, CNS : NNR sluggish. Baby was investigated : Peripheral smear showed
neutrophilic leukocytosis. Blood sugar was normal. Serum creatinine – 1.3mg/dl
(23.08.09) & 0.7mg/dl (27.08.09). ECHO showed CHD, Small ASD (2mm) with left to
right shunt. Baby was managed with mechanical ventilator support, Iv fluids, Iv
antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inj. Dopamine infusion. With these
above measures baby’s respiratory distress reduced & weaned from the ventilator on
01.09.09. Baby was started on small tube feeds. Baby was slowly weaned from the
oxygen therapy. ET Tip culture showed non – fermenting gram Negative Bacilli,
antibiotics were changed according to culture sensitivity. Now baby’s activity improved,
respiration became normal and taking breast feeds well. Baby is discharged today with
the advice to continue further follow-up with the referral doctor.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "O" POSITIVE 23/08/2009
HAEMOGLOBIN 15.5 gm/dl 23/08/2009
TOTAL COUNT 19,000 [TWICE RPT] cells/cumm 23/08/2009
PCV 46 % 23/08/2009
MCV 97 FL 23/08/2009
MCH 32 PG 23/08/2009
MCHC 33 % 23/08/2009
RDW 15.6 % 23/08/2009
RBC 4.8 MILL/Cumm 23/08/2009
MPV 7.7 FL 23/08/2009
NEUTROPHILS 77 % 23/08/2009
LYMPHOCYTE 20 % 23/08/2009
EOSINOPHIL 03 % 23/08/2009
PLATELET COUNT 3.1 Lakhs/Cumm 23/08/2009
CREATININE 1.3 mg /dl 24/08/2009
CREATININE 0.7 mg /dl 27/08/2009
PERIPHERAL SMEAR SHOWED ON 240.08.09 : RBCs show normochromic
normocytes and macrocytes, Nucleated RBCs 2/100 WBCs. WBC count shows
neutrophilic leukocytosis. No atypical or immature cells. Neutrophilic : 60%, Eosinophils
: 03%, Monocytes : 05%, Lymphocytes : 32%. Platelets count normal in number and
morphology.
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS
ECHO SHOWED ON 28.08.09 : SITUS SOLITUS, LEVOCARDIA, SMALL
OSTIUM SECUNDUM TYPE OF ASD SEEN (2mm), L R, IVS INTACT, MV, AV,
PV NORMAL, NO PDA / COARCTATION, NORMAL LV FUNCTION, NO PAH.
IMPRESSION : CONGENITAL HEART DISEASE, SMALL ASD, L R SHUNT,
NO PAH
Name : B/o. Rajeswari Age/Sex : NB/ M Dept : NeonatologyHos.No: 426692 Mrd.No : 320441 Ward: IL.NB. NICUD.O.A : 19.09.09 D.O.D : 24.09.09 ************************************************************************
REF. BY : DR. SABITHA SRIDHARAN., PLACE : MADURAI
DIAGNOSIS: PRETERM (30-32 WEEKS) / LBW / MALE / TWIN II RESPIRATORY DISTRESS SYNDROME SURFACTANT THERAPY GIVEN ON 19.08.09 & 20.08.09 CONGENITAL HEART DISEASE SMALL PDA (2mm) / MODERATE ASD (3mm) / ? COARCATION
COURSE:
This Pre term (30-32 weeks) / LBW / Male / Twin II born at Private Hospital by
normal vaginal delivery on 19.08.09. H/o. Baby did not cry immediately after birth for
that referred to MMHRC on 19.08.09 for further management. No Maternal H/o PIH,
GDM & PROM. O/E. Baby’s activity & cry : weak, colour : pink, peripheral cyanosis +,
CFT > 3 sec, tachypnoeic +, dyspnoeic +, no birth injury, no obvious external anomaly.
CVS: S1 & S2 heard, RS: RR > 70/mt, Bilateral decreased air entry, P/A: soft, CNS :
NNR sluggish. Baby was investigated : Peripheral smear and Blood sugar were normal.
ECHO showed CHD, moderate sized ASD and small PDA, ? Coarctation. Chest x-ray
suggestive of RDS. Baby was managed with Mechanical ventilator support, Iv fluids, Iv
antibiotics, Inj. Calcium gluconate, Ionotrophic support & 2 doses of Surfactant . on
19.08.09 and 20.08.09. 3 doses of Syp. Brufan was given for PDA closure. Baby icteric
on day of life and was managed with single side phototherapy. Serum creatinine 1.2mg%
(22.08.09) and repeat serum creatinine – 0.9mg% (24.08.09). Baby developed rashes over
genitalia. Dermatologist’s opinion was obtained. With these above measures baby’s
respiration became normal, so weaning from ventilator was attempted on 29.05.09 and
was put on T-piece O2 on flow. Baby had apnoeic spells, hence was put on ventilator
again on 08.09.09. Repeat HB done showed 11.9mg/dl (02.09.09) and 10.6mg/dl
(08.09.09) respectively. 30ml of whole fresh blood was transfused on 08.09.09, intra and
post – transfusion period are uneventful. ET tip culture showed enterobactor growth.
Antibiotics were changed according to culture sensitivity. With these above measures
respiration improved, so weaned from ventilator on 11.09.09 and started on small tube
feeds. Baby was slowly weaned from oxygen therapy, now baby’s activity improved and
taking breast feeds well, hence discharged today with advice to continue the following.
INVESTIGATION :
Investigation Result Unit Date
BLOOD GROUP RH TYPING "B" POSITIVE 19/08/2009
HAEMOGLOBIN 15.9 gm/dl 19/08/2009 TOTAL COUNT 11,300 cells/cumm 19/08/2009 PCV 46 % 19/08/2009 MCV 110 FL 19/08/2009 MCH 37 PG 19/08/2009 MCHC 34 % 19/08/2009 RDW 14.6 % 19/08/2009 RBC 4.2 MILL/Cumm 19/08/2009 MPV 6.8 FL 19/08/2009 NEUTROPHILS 64 % 19/08/2009 LYMPHOCYTE 35 % 19/08/2009
EOSINOPHIL 01 % 19/08/2009 PLATELET COUNT 3.7 Lakhs/Cumm 19/08/2009 CREATININE 1.2 mg /dl 22/08/2009 CREATININE 0.9 mg /dl 24/08/2009
PERIPHERAL SMEAR SHOWED ON (19.08.09): RBCs show normochromic
normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count high normal.
No atypical or immature cells. DC: Neutrophils: 47%, Eosinophils: 01%, Monocytes:
05%, Lymphocytes: 47%. Platelets count normal in number and morphology.
ECHO SHOWED ON 28.08.09 : SITUS SOLITUS, LEVOCARDIA, 3mm OSTIUM
SECUNDUM TYPE OF ASD SEEN, L R SHUNT, IVS INTACT, 2mm PDA SEEN,
L R SHUNT, MV,, AV, PV NORMAL, RVSP = 25 mm of hg, NRMAL LV AND RV
FUNCTION, ? COARCTATION (POST DUCTAL), GRADIENT = 25mm of hg,
IMPRESSION : CONGENITAL HEART DISEASE, MODERATE SIZED ASD
AND SMALL PDA, ? COARCTATION
ADVICE ON DISCHARGE :
Domstal drops 8 drops TID x 2 weeks
Syp. Deriphylline 6 drops TID x 2 weeks
Tab. Aldactone 1/6 th OD x 2 weeks
Axbex drops 5 drops OD x Till further advice
Evion drops 5 OD x Till further advice
Name : B/o. Selva Rajeswari Age/Sex : NB/ M Dept : NeonatologyHos.No: 432985 Mrd.No : 324667 Ward: IL.NB. NICUD.O.A : 12.10.09 D.O.D : 17.10.09 ************************************************************************
REF.BY.DR. NITHIYA DEVI PLACE : BODINAYAKKANUR
DIAGNOSIS: SEPTICEMIA WITH MECONIUM ASPIRATION SYNDROME CHD WITH PULMONARY HYPERTENSION
COURSE:
This term male baby was referred to MMHRC on 12/10/2009 H/o.
Respiratory Distress since birth. Maternal History: G4 P1 L1 A2mother with 39
weeks gestation, LSCS done on 12/10/09 at 2.45 p.m., (Ind: Thick Meconium
stained liquor / non progression of labour) Baby cried after resuscitation and had
respiratory distress since birth. No maternal H/o. PIH, GDM & PROM. O/E.
Baby’s activity & cry – weak, peripheral cyanosis+, CRT > 3 sec, Spo2 – 83%
with O2, CVS: S1 & S2 heard, RS: RR > 70/mt, lower chest indrawing +,
subcostal retraction+, tachypnoea +, dyspnea+. P/A: soft, no organomegaly, CNS :
NNR sluggish. Child was immediately intubated and connected to mechanical
ventilator support. Baby was investigated HB – 17.7gm%, TC : 14800, platelets –
50,000, CRP – +ve. Chest X – ray, showed Bilateral infiltrates. Echo showed:
ASD with pul Hypertension. Baby was treated with Iv fluids, Iv antibiotics, Inj.
Calcium gluconate, Inj. Vitamin K, Dopamine infusion and pulmonary
vasodilators. ABG 12th hourly monitored. As baby continued to have respiratory
distress and high Pco2, surfactant therapy given on 15/10/09. As the baby parents
were not willing for further management, baby is discharged AGAINST
MEDICAL ADVICE on 17.10.09.
INVESTIGATION :
PERIPHERAL BLOOD SMEAR STUDY
RBC 4.7 Cells/cumm 13-10-2009
HAEMOGLOBIN 17.7 13.6 to 19.6 g/dL 13-10-2009
TOTAL WBC COUNT 14800 10000 to 25000 Cells/cumm 13-10-2009
DIFFERENTIAL COUNT
Polymorphs 48 40 - 70 % 13-10-2009
Lymphocytes 49 25 - 50 % 13-10-2009
Monocytes 01 01 - 06 % 13-10-2009
Eosinophils 02 01 - 10 % 13-10-2009
Basophils 00 00 - 01 % 13-10-2009
PLATELET COUNT 50000 150000 to 450000 Cells/cumm 13-10-2009
PCV (HEMATOCRIT) 51 44 to 62 % 13-10-2009
MCV 109 76 to 96 Fl 13-10-2009
MCH 37 27 to 32 pg/cell 13-10-2009
MCHC 34 32 to 36 % 13-10-2009
RDW 12.4 20 to 42 % 13-10-2009
MPV 7.0 6 to 10.2 Fl 13-10-2009
BIO CHEMISTRY
CREATININE (Jaffe
Kinetic) 0.8 0.4 to 1.4 mg/dL 14-10-2009
MICROBIOLOGY
CRP-C REACTIVE
PROTEIN
POSITIVE 24 MICROGRAM /ML 13-10-2009
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes and macrocytes.
Nucleated RBCs 2/100WBCs.
WBC count shows neutrophilic leukocytosis.
No atypical or immature cells.
13-10-2009
DIFFERENTIAL COUNT : NeutroPhils :38%
Eosinophils :01%
Monocytes :05%
Lymphocytes :56%
13-10-2009
Platelets Count diminished 13-10-2009
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS.
THROMBOCYTOPENIA.
13-10-2009
ECHO SHOWED ON 14.10.09 : SITUS SOLITUS, LEVOCARDIA, 6 mm OSTIUM
SECUNDUM TYPE OF ASD SEEN,(MODERATE SIZED) L R SHUNT, NO
COARCTATION, PULMONARY HYPERTENSION IMPRESSION :
CONGENTIAL HEART DISEASE, OS ASD (MODERATE SIZED) L R
SHUNT, WITH PULMONARY HYPERTENSION.
OCT 09Name : B/o. Priya Age/Sex : NB/ F Dept : NeonatologyHos.No: 430666 Mrd.No : 323082 Ward: IL.NB. NICUD.O.A : 23.09.09 D.O.D : 02.10.09 ************************************************************************
REF. BY : DR. GOMATHI., PLACE : THIRUMANGALAM
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION
COURSE:
This term female baby delivered by LSCS (Ind : Fetal distress with thick
meconium stained liquor) said to have cried immediately after birth but soon
developed respiratory distress and referred to MMHRC for further management.
H/o. grunting +. No maternal H/o. PIH, GDM, Fever with rash or hypothyroidism.
O/E. Baby cry and activity poor with severe respiratory distress. Peripheries –
cyanosis, CFT > 3 sec, no birth injury, no obvious external anomaly. CVS: S1 &
S2 +, RS: Grunting +, SCR +, ICR +, Bilateral air entry, Bilateral occasional
crepitations, P/A: soft, CNS : NNR weak. Baby was investigated : Hb : 17.0, TC :
23,200, platelet count – 2.8 lakhs, CRP – Positive, Blood sugar – 30mg/dl, serum
creatinine – 0.9. Baby was managed with Mechanical ventilator support, Iv fluids,
Iv antibiotics, Inj. Gardenol & Domstal drops. With above measures baby cry and
activity poor. Since parents were not willing for further management, baby is
discharged AGAINST MEDICAL ADVICE on 02.10.09.
PERIPHERAL SMEAR (23.09.09): RBCs – Normal
WBCs – Normal
DC: Neutrophils: 61%, Eosinophils: 01%, Myleocytes : 01%, Lymphocytes: 37%.
Platelets count normal in number and morphology.
IMPRESSION : NORMAL SMEAR STUDY
Name : B/o. Dorkas Suganya Age/Sex : NB/ F Dept : Neonatology
Hos.No: 431128 Mrd.No : 323377 Ward: IL.NB. NICUD.O.A : 27.09.09 D.O.D : 03.10.09 ************************************************************************
DIAGNOSIS: PRETERM (30-32 WEEKS)/ LBW / FEMALE RESPIRATORY DISTRESS WITH BIRTH ASPHYXIA (SURFACTANT THERAPY ON 27.09.09)
COURSE:
This preterm IUGR female baby delivered by LSCS (Ind: Severe PIH with
reversal of diastolic flow in fetus) at MMHRC on 27.09.09. Baby cried after
stimulation admitted for respiratory distress. Maternal H/o. PIH+ on
antihypertensives. No H/o. GDM / UTI / hypothyroidism / fever with rash. USG
done showed IUGR and Reversal of diastolic flow. O/E. Baby cry and activity:
weak, peripheral cyanosis+, no icterus, respiratory distress+ SpO2 – 94% with O2,
no obvious external congenital anomaly. CVS: HR – 148 / min, S1, S2+, no
murmur, RS : RR – 74/min, SCR+, ICR+, BAE, no added sounds, P/A: soft, CNS:
Tone decreased, NNR sluggish. Baby was investigated, HB: 17.5g%, TC: 12,400
cells/cu.mm, platelets count – 1.6 lakhs, Blood Sugar : 54 mg%, serum creatinine :
1.4mg% repeat 0.9 (02.10.09) Chest x-ray suggestive of Hyaline Membrane
Disease. Baby was managed with nasal C-PAP ventilation, surfacant therapy, Iv
fluids, Iv antibiotics, Iv Aminophylline, Iv Calcium gluconate and Inj. Vitamin K.
Baby continued to have mild distress and had icterus on 3rd day, started on
phototherapy. FFP transfusion given on 01/10/09. On 03/10/09 baby developed
severe respiratory distress and had desaturation. Baby was intubated and connected
to mechanical ventilator support. Dopamine infusion was started. Baby had ET
tube bleeding hence WFB transfusion given. Inspite of all the above measures,
baby’s condition deteriorated and went into apnea, cardiac arrest and could not be
revived. Hence DECLARED DEAD on 03/10/09 at 5.00 am.
Name : B/o. Mahalakshmi Age/Sex : NB/ M Dept : NeonatologyHos.No: 428869 Mrd.No : 321846 Ward: IL.NB. NICUD.O.A : 06.09.09 D.O.D : 22.10.09 ************************************************************************
DIAGNOSIS: PRETERM (29 WEEKS) / VLBW / RESPIRATORY DISTRESS SYNDROME
SURFACTANT THERAPHY GIVEN ON 06.09.09
NEONATAL SEIZURE
COURSE:
This Pre term (29-30 weeks) / VLBW / male born at MMHRC by
LSCS ( Ind : HELLP Syndrome / Hypothyroidism / ISCI conception) to RH
negative mother on 06.09.09 at 7.50pm. H/o. Baby cried soon after birth and had
respiratory distress since birth. H/o. Baby had recurrent apnoea, intubated and
connected to mechanical ventilator support. Baby was admitted at NICU for
further management. Maternal H/o. Elderly primi, Maternal H/o. PIH + on anti
hypertensives. Maternal H/o. hypothyroid + an Tab. Eltroxin 50gm 1OD. No
maternal H/o. GDM. O/E. Baby’s activity & cry – weak, colour : pink, peripheral
cyanosis +, abnormal cyclic movement of four limbs+, CFT < 3 sec, lower chest
indrawing +, tachypnoeic +, no birth injury, no obvious external anamoly, CVS: S1
& S2 heard, RS: Bilateral air entry equal, LCI +, P/A: soft, CNS : NNR sluggish.
Mother blood group : B –ve. Baby’s Blood group : O +ve. Baby was investigated
peripheral smear, blood sugar, serum creatinine & seurm bilirubin were normal.
DCT – Negative. TSH : 5.31 uIU/ml. ECHO was normal. ET tip culture on
12.09.09 showed no growth. Chest x-ray suggestive of respiratory distress
syndrome. Baby was managed with mechanical ventilator support, Iv fluids, Iv
antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Inj. Gardenol, Inj.
Aminophylline, Inj. Dopamine and 1 dose of Inj. Surfactant. Series of ABG’s were
done & ventilator settings were adjusted according to that. Baby was stated on
small ryles tube feeds on 10.09.09. As baby had vomiting, Domstal drops was
added. Baby had GI bleed, Inj. Rantac was added and FFP transfusion was given
on 11.09.09. Baby had ET bleed with GI bleed -> FFP transfusion was given on
16.09.09 & 17.09.09. As baby had abdominal distension. USG abdomen was done
which showed distended stomach with no organomegaly. Baby’s ryles tube feed
was slowly raised. On 25.09.09 baby was pale, HB : 10.2mg%, packed cell
transfusion was given. As baby had difficultly in weaning from the ventilator for
more than 30 days, suspected Bronchopulmonary, dysplasia & started on diuretics
& steroids. With these above management baby was slowly weaned from the
ventilator. Baby was extubated on 09.10.09 and kept in oxygen hood. Et culture
showed Enterobactor growth on 13.10.09. antibiotics were added according to
culture sensitivity.
Name : B/o. Thilagavathy Age/Sex : NB/ M Dept : NeonatologyHos.No: 434949 Mrd.No : 325905 Ward: IL.NB. NICUD.O.A : 28.10.09 D.O.D : 29.10.09 ************************************************************************
DIAGNOSIS: PERINATAL ASPHYXIA THICK MECONIUM STAINED LIQUOR
MECONIUM ASPIRATION SYNDROME
COURSE:
This term male / AGA / baby referred to MMHRC as a case of meconium
stained liquor with respiratory distress. H/o. baby delivered by labour naturale on
28.10.09 at 6am. Birth weight : 3.2kg. H/o. Baby cried soon after birth but baby
then developed respiratory distress and cyanosis +. No Maternal H/o. PIH, GDM,
Hypothyroidism, UTI, drug intake. H/o. Cord around the neck once +. O/E. Baby
cry and activity : nil, severe respiratory distress +, no birth injury, no obvious
external congenital anomaly, cyanosis +, peripheral cold, CFT > 3sec, Spo2 : 42%
with oxygen. CVS: HR – 146/min, S1, S2 +, no murmur, RS : RR : 88/min, ICR
+, SCR +, Bilateral air entry +, Bilateral crepitation +, P/A : Soft, no
organomegaly, CNS : Drowsy, NNR absent. Baby was investigated showed Hb :
14.7g%, Tc : 17,400cells, platelets : 2.47 lakhs, CRP : Positive. Chest x-ray
showed Bilateral infiltrate. ABG showed metabolic acidosis ( HCO3 : 8.8mm) for
which bicarb correction given. Baby was immediately intubated and connected to
mechanical ventilator. Baby was managed with Iv. fluids, Iv. antibiotics, Iv.
Inotropes, Inj. Vitamin K and Inj. Calcium gluconate. Inspite of above measures
baby had desaturation condition of the baby continuously detoriated and went into
cardiac arrest. Baby was resuscitated with CPR and adrenaline, atropine. Inspite of
that baby could not be revived and DECLARED DEAD on 29.10.09 at 1.45am.
INVESTIGATION :
BLOOD BANK
BLOOD GROUPING & Rh TYPING
B POSITIVE 29-10-2009 / 10:54
RBC
4.13 29-10-2009 / 02:08
HAEMOGLOBIN 14.7 13.6 to 19.6 g/dL 29-10-2009 / 02:08
TOTAL WBC COUNT 17400 10000 to 25000 Cells/cumm 29-10-2009 / 02:08
DIFFERENTIAL COUNT
Polymorphs 85.0 40 - 70 % 29-10-2009 / 02:08
Lymphocytes 10 25 - 50 % 29-10-2009 / 02:08
Monocytes 04 01 - 06 % 29-10-2009 / 02:08
Eosinophils 01 01 - 10 % 29-10-2009 / 02:08
Basophils 00 00 - 01 % 29-10-2009 / 02:08
PLATELET COUNT 247000 150000 to 450000 Cells/cumm 29-10-2009 / 02:08
PCV (HEMATOCRIT) 43 44 to 62 % 29-10-2009 / 02:08
MCV 106 76 to 96 Fl 29-10-2009 / 02:08
MCH 35 27 to 32 pg/cell 29-10-2009 / 02:08
MCHC 33 32 to 36 % 29-10-2009 / 02:08
RDW 17.6 20 to 42 % 29-10-2009 / 02:08
MPV 6.2 6 to 10.2 Fl 29-10-2009 / 02:08
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 89 Mg/l 29-10-2009 / 00:13
Name : B/o. Revathy Age/Sex : NB/ F Dept : NeonatologyHos.No: 435212 Mrd.No : 326113 Ward: IL.NB. NICUD.O.A : 30.10.09 D.O.D : 02.11.09 ************************************************************************
REF. BY : DR. SABARIRAJA., PLACE : SIVAGANGAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION OF NEWBORN
COURSE:
This term / IUGR / female baby was born at private hospital by LSCS
(Ind : Previous LSCS with scar tenderness) on 30.10.09 at 7.45pm. H/o. Thick
meconium stained liquor +. Baby did not cry immediately after birth had weak cry
after resuscitation. Baby had respiratory distress with cyanosis. Since birth for that
referred to MMHRC on 30.10.09 for further management. No Maternal H/o. PIH,
GDM & PROM. O/E. Baby activity’s & cry – weak. Peripheral cyanosis +, CFT >
3 sec, dyspnoeic +, tachypnoeic +, grunting +, no birth injury, no obvious external
anomaly. CVS: S1 & S2 +, RS: RS : RR @70/mt, lower chest indrawing +,
supraclavicuar indrawing +, Bilateral crepitations +. P/A: soft, CNS : NNR
sluggish. Baby was investigated peripheral smear showed : Hb : 18.3gms%, TC :
18,000cells/mm3, platelet count – 1.1 lakhs. Blood sugar was normal. chest x-ray
suggestive of Bilateral meconium infiltration. serum creatinine : 1.2mg/dl. Baby
was managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj.
Calcium gluconate & Inj. Vitamin K & Ionotrophic support. series of ABG’s were
done and ventilator settings were adjusted according to that. On 01.11.09, baby had
desaturation with the ventilator support, ABG taken which showed (PCO2 : 86, Po2 :
63.5 & Hco3 : 30) Ventilator settings were raised. With these above measures
baby’s saturation maintained. Now baby is maintaining oxygen saturation (Spo2 :
98%) with Fio2 of 100%. Since parents were not willing for further management.
Baby is discharged AGAINST MEDICAL ADVICE on 02.11.09 at 2.30pm.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
B POSITIVE 31-10-2009 / 10:07
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC
5.0 Cells/cumm 31-10-2009 / 17:42
HAEMOGLOBIN 18.3 13.6 to 19.6 g/dL 31-10-2009 / 17:42
TOTAL WBC COUNT 18000 10000 to 25000 Cells/cumm 31-10-2009 / 17:42
DIFFERENTIAL COUNT
Polymorphs 44 40 - 70 % 31-10-2009 / 17:42
Lymphocytes 47 25 - 50 % 31-10-2009 / 17:42
Monocytes 08 01 - 06 % 31-10-2009 / 17:42
Eosinophils 01 01 - 10 % 31-10-2009 / 17:42
Basophils 00 00 - 01 % 31-10-2009 / 17:42
PLATELET COUNT 110000 150000 to 450000 Cells/cumm 31-10-2009 / 17:42
PCV (HEMATOCRIT) 56 44 to 62 % 31-10-2009 / 17:42
MCV 112 76 to 96 Fl 31-10-2009 / 17:42
MCH 36 27 to 32 pg/cell 31-10-2009 / 17:42
MCHC 32 32 to 36 % 31-10-2009 / 17:42
RDW 12.4 20 to 42 % 31-10-2009 / 17:42
MPV 7.8 6 to 10.2 Fl 31-10-2009 / 17:42
BIO CHEMISTRY
CREATININE (Jaffe Kinetic) 1.2 0.4 to 1.4 mg/dL 01-11-2009 / 18:54
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 35 MG/L 01-11-2009 / 08:42
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes and macrocytes.
Nucleated RBCs 5/100WBCs.
WBC count shows leukocytosis.
No atypical or immature cells.
31-10-2009 / 17:42
DIFFERENTIAL COUNT : NeutroPhils :35%
Eosinophils :01%
Monocytes :05%
Lymphocytes :59%
31-10-2009 / 17:42
Platelets Count slightly diminished 31-10-2009 / 17:42
IMPRESSION : -- 31-10-2009 / 17:42
NOV 09Name : B/o. Nalini Age/Sex : NB/ M Dept : NeonatologyHos.No: 435995 Mrd.No : 326588 Ward: IL.NB. NICUD.O.A : 05.11.09 D.O.D : 06.11.09 ************************************************************************
REF. BY : DR. ANBURAJAN., PLACE : THENI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION
OF NEWBORN
COURSE:
This term / AGA / male baby was born at private hospital by LSCS ( Ind :
Multipara with fibroid / maternal fever ) on 05.11.09. H/o. Meconium stained
liquor +. Baby had weak cry after birth & baby had respiratory distress since birth
and had apnoea for that referred to MMHRC on 05.11.09 for further management.
Maternal H/o. fever with rigor – 1 day. No H/o. PIH, GDM & PROM. O/E.
Baby’s activity & cry : nil, cyanosed, CFT : prolonged, peripheral pulses : weak.
Hypotension +, tachypnoeic +, Spo2 : 40% with O2 hood, immediately intubated
and with tube & bag ventilation Spo2 : 58%, no birth injury, no obvious external
anamoly, CVS : S1 S2 heard, RS : RR : 78/mt, Bilateral crepitations +, lower chest
indrawing +, P/A : soft, CNS : NNR not elicitable. Hypotonia +. Baby was
investigated, ABG initially showed acidosis. (High Pco2 : 92.8 with Hco3 : 11.3)
corrected with Hco3. baby’s peripheral smear showed HB : 13.4gms%, TC :
17,400cells and platelet count : 1.9 lakhs. Blood sugar were normal. Chest x-ray
showed Bilateral meconium infiltration. CRP was negative. Blood culture was
sent, report awaited. Baby was managed with Mechanical Ventilator support, Iv
fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Inj. Dopamine & Inj.
Surfactant. As baby had persistent cyanosis with hypotension, Inj. Nor – adrenaline
infusion was started. As ABG’s showed high Pco2 ventilator mode changed as
HFV ventilator settings were raised. Even with these above measures, baby had
desaturaion with the ventilator support. Grave prognosis was explained to the
parents. Since parents were not willing for further management, baby is discharged
AGAINST MEDICAL ADVICE on 06.11.09 at 11.30am.
INVESTIGATION :
BLOOD BANK
BLOOD GROUPING & Rh TYPING
B NEGATIVE 06-11-2009 / 12:11
PERIPHERAL BLOOD SMEAR STUDY
RBC
3.88 06-11-2009 / 03:04
HAEMOGLOBIN 13.4 13.6 to 19.6 g/dL 06-11-2009 / 03:04
TOTAL WBC COUNT 17400 10000 to 25000 Cells/cumm 06-11-2009 / 03:04
DIFFERENTIAL COUNT
Polymorphs 75 40 - 70 % 06-11-2009 / 03:04
Lymphocytes 20 25 - 50 % 06-11-2009 / 03:04
Monocytes 04 01 - 06 % 06-11-2009 / 03:04
Eosinophils 01 01 - 10 % 06-11-2009 / 03:04
Basophils 00 00 - 01 % 06-11-2009 / 03:04
PLATELET COUNT 192000 150000 to 450000 Cells/cumm 06-11-2009 / 03:04
PCV (HEMATOCRIT) 41 44 to 62 % 06-11-2009 / 03:04
MCV 105 76 to 96 Fl 06-11-2009 / 03:04
MCH 34 27 to 32 pg/cell 06-11-2009 / 03:04
MCHC 32 32 to 36 % 06-11-2009 / 03:04
RDW 18.2 20 to 42 % 06-11-2009 / 03:04
MPV 7.1 6 to 10.2 Fl 06-11-2009 / 03:04
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 05-11-2009 / 23:24
Name : B/o. Thilleswari Age/Sex : NB/ M Dept : NeonatologyHos.No: 435817 Mrd.No : 326483 Ward: IL.NB. NICUD.O.A : 04.11.09 D.O.D : 08.11.09
************************************************************************
DIAGNOSIS: PRETERM ( 32– 34 WEEKS) / VLBW WITH RESPIRATORY DISTRESS SURFACANT THERAPHY GIVEN ON 04/11/2009 ? IVH
COURSE:
This pre–term (32 – 34 weeks) VLBW (B.W – 1.195kg) / Male baby was
born at MMHRC on 04/11/2009 by Normal vaginal delivery. H/o. Baby had weak
cry after birth with Apgar score – 7/10 at 1 min and 8/10 at 5 min. Baby had
Respiratory distress since birth for that admitted at NICU for further management.
Maternal H/o. GDM & PROM. O/E: Baby’s activity & cry – weak, colour: pink,
CFT < 3 sec, dyspnoeic+, tachypnoeic+, no birth injury, no obvious external
anamoly. CVS: S1, S2 heard, RS – RR > 60/mt, lower Chest Indrawing+, SCR+,
P/A: soft, CNS: NNR sluggish. Baby was investigated peripheral smear, Blood
sugar & serum creatinine were normal. Chest X-ray suggestive of RDS. Baby was
managed with C–PAP, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj.
Vitamin K & one dose of Inj. Surfactant on 07/11/2009. Baby had peripheral
cyanosis followed by desaturation, Soda – bi carbonate given – had Apnoea
connected to mechanical Ventilator support and started on Ionotropes. Even with
these above measures baby’s had desaturation followed by Bradycardia.
Resuscitated with 3 doses Inj. Atropine & Inj. Adenaline. CPR was carried out. But
could not be revived & DECLARED DEAD ON 08/11/2009 at 2.45 P.M.
Name : B/o. Bhavani Twin II Age/Sex : NB/ F Dept : NeonatologyHos.No: 436129 Mrd.No : 326678 Ward: IL.NB. NICUD.O.A : 06.11.09
D.O.D : 13.11.09 ************************************************************************
DIAGNOSIS: PRETERM (30 – 32 WEEKS) / LBW / PERINATAL ASPHYXIA/ RESPIRATORY DISTRESS / RECURRENT APNEA
SURFACTANT THERAPY GIVEN ON 06.11.09
Name : B/o. Indumathi Age/Sex : NB/ F Dept : NeonatologyHos.No: 435109 Mrd.No : 326045 Ward: IL.NB. NICUD.O.A : 29.10.09 D.O.D : 12.11.09 ************************************************************************
REF. BY : DR. LATHA MURUGAN., PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERINATAL ASPHYXIA MILD PPHN
COURSE:
This term / AGA / female baby was referred to MMHRC on 29.10.09 as a
case of Meconium aspiration syndrome. Baby born at private hospital on 29.10.09
at 9.15pm by normal vaginal delivery. H/o. thick meconium stained liquor. Baby
did not cry immediately, had weak cry after stimulation. H/o. resuscitation with
bag and mask ventilation. Maternal H/o. Fever – 1 week, 15 days before delivery.
O/E. Baby’s activity and cry weak, peripheral cyanosis +, CRT > 3sec, RS : RR :
70/min, tachypnoeic +, lower chest indrawing +, P/A : Soft, CVS: S1 & S2 +,
murmur +, CNS : NNR, not elicitable. Baby had Spo2 of 60% with O2 hood. Baby
was intubated and connected to mechanical ventilator. Baby was investigated with
HB : 19gm%, TC : 12,800, platelet – 2 lakhs, Blood sugar : 384mg/dl, CRP :
Positive, serum creatinine : 0.9. ET culture and blood culture showed no growth.
Chest x-ray showed Meconium aspiration syndrome. Baby was managed with
Mechanical ventilator, Iv fluids, Inj. Ronem, Inj. Aztreonem, Syp. Osteocalcium,
Domstal drops. Inj. Gardenol, Inj. Pavlon, Inj. Dopamine and mucolite drops. With
these above measures baby respiration improved, activity improved and tolerating
RTF. Baby was weaned form ventilator on 09.11.09 and was maintaining on C-
PAP. Since baby attenders not willing to continue treatment baby was discharged
AGAINST MEDICAL ADVICE on 12.11.09.
INVESTIGATION :
HAEMATOLOGY & CLINICAL PATHOLOGY
TOTAL WBC COUNT 8900 6000 to 18000 Cells/cumm 12-11-2009 / 15:09
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 30-10-2009 / 11:28
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC
3.38 31-10-2009 / 16:05
HAEMOGLOBIN 12.1 13.6 to 19.6 g/dL 31-10-2009 / 16:05
TOTAL WBC COUNT 19800 10000 to 25000 Cells/cumm 31-10-2009 / 16:05
DIFFERENTIAL COUNT
Polymorphs 70.0 40 - 70 % 31-10-2009 / 16:05
Lymphocytes 20.0 25 - 50 % 31-10-2009 / 16:05
Monocytes 6.0 01 - 06 % 31-10-2009 / 16:05
Eosinophils 2.0 01 - 10 % 31-10-2009 / 16:05
Basophils 1.0 00 - 01 % 31-10-2009 / 16:05
PLATELET COUNT 242000 150000 to 450000 Cells/cumm 31-10-2009 / 16:05
PCV (HEMATOCRIT) 36 44 to 62 % 31-10-2009 / 16:05
MCV 107 76 to 96 Fl 31-10-2009 / 16:05
MCH 35 27 to 32 pg/cell 31-10-2009 / 16:05
MCHC 33 32 to 36 % 31-10-2009 / 16:05
RDW 17.3 20 to 42 % 31-10-2009 / 16:05
MPV 7.7 6 to 10.2 Fl 31-10-2009 / 16:05
BIO CHEMISTRY
CREATININE (Jaffe Kinetic) 0.9 0.4 to 1.4 mg/dL 31-10-2009 / 22:40
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 48 MICROGRAM/ML 31-10-2009 / 07:38
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes and macrocytes. 31-10-2009 / 16:05
Nucleated RBCs 6/100WBCs.
WBC count shows neutrophilic leukocytosis.
No atypical or immature cells.
DIFFERENTIAL COUNT : NeutroPhils :70%
Eosinophils :02%
Monocytes :05%
Lymphocytes :23%
31-10-2009 / 16:05
Platelets Count normal in Number and morphology 31-10-2009 / 16:05
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 31-10-2009 / 16:05
ECHO SHOWED ON 05.11.09 : SITUS SOLITUS, LEVOCARIDA, SMALL
MUSCULAR VSD, L R SHUNT, IAS ANEURYSM +, NO SHUNT, NO PDA /
COARCTATION. IMPROESSION : CONGENITAL HEART DISEASE, SMALL
MUSCULAR VSD, L SHUNT, IAS ANEURYSM, MILD PAH
DR. A. KANNAN., MD., DCH., SR. CONSULTANT.
Name : B/o. Abirami Age/Sex : NB/ F Dept : NeonatologyHos.No: 436179 Mrd.No : 326727 Ward: IL.NB. NICUD.O.A : 07.11.09 D.O.D : 14.11.09 ************************************************************************
REF. BY : DR. JEYA CHITRA, PLACE : MADURAI
DIAGNOSIS: THICK MECONIUM ASPIRATION PERINATAL ASPHYXIA
COURSE:
This term / AGA / female baby was born at private hospital by LSCS ( IND :
Postdated with maternal fever ) on 07.11.09 at 6.28am. H/o. Thick meconium
stained liquor +, resuscitated with ET tube suctioning & after with ambu bag
ventilation, baby’s respiration was established, baby had respiratory distress since
birth, for that referred to MMHRC on 07.11.09 for further management. Maternal
H/o. High grade fever with thrombocytopenia + at the time of delivery. No
Maternal H/o. PIH, GDM & PROM. O/E. Baby’s activity – sluggish, cry : irritable,
colour : pink, CFT < 3sec, tachypnoeic +, no birth injury, no obvious external
anamoly, CVS: S1 & S2 +, RS: RR @ 60/mt, lower chest indrawing +, P/A : soft,
CNS : Irritable. Baby was investigated : peripheral smear showed Neutrophilic
leukocytosis. Blood sugar & serum creatinine were normal. CRP was Negative.
Blood culture showed no growth. Chest x-ray showed Bilateral meconium
infiltration. Baby was managed with C-PAP, Iv. Fluids, Iv. antibiotics, Inj.
Calcium gluconate & Inj. Vitamin K. With these above measures baby’s
respiration became normal, weaned from the C-PAP on 11.11.09 and started on
small tube feeds. Now baby is active, taking oral feeds, had no vomiting and
discharged today with the advice to continue further follow-up with the referral
doctor.
INVESTIGATION :
BLOOD BANK
BLOOD GROUPING & Rh TYPING
AB POSITIVE 07-11-2009 / 14:32
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC
5.11 07-11-2009 / 19:24
HAEMOGLOBIN 18.0 13.6 to 19.6 g/dL 07-11-2009 / 19:24
TOTAL WBC COUNT 25000 10000 to 25000 Cells/cumm 07-11-2009 / 19:24
DIFFERENTIAL COUNT
Polymorphs 75 40 - 70 % 07-11-2009 / 19:24
Lymphocytes 15 25 - 50 % 07-11-2009 / 19:24
Monocytes 06 01 - 06 % 07-11-2009 / 19:24
Eosinophils 04 01 - 10 % 07-11-2009 / 19:24
Basophils 00 00 - 01 % 07-11-2009 / 19:24
PLATELET COUNT 287000 150000 to 450000 Cells/cumm 07-11-2009 / 19:24
PCV (HEMATOCRIT) 55 44 to 62 % 07-11-2009 / 19:24
MCV 108 76 to 96 Fl 07-11-2009 / 19:24
MCH 35 27 to 32 pg/cell 07-11-2009 / 19:24
MCHC 32 32 to 36 % 07-11-2009 / 19:24
RDW 18.2 20 to 42 % 07-11-2009 / 19:24
MPV 8.0 6 to 10.2 Fl 07-11-2009 / 19:24
BIO CHEMISTRY
CREATININE (Jaffe Kinetic) 0.9 0.4 to 1.4 mg/dL 08-11-2009 / 20:10
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 07-11-2009 / 14:38
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes and macrocytes.
Nucleated RBCs 2/100WBCs.
WBC count shows neutrophilic leukocytosis.
No atypical or immature cells.
07-11-2009 / 19:24
DIFFERENTIAL COUNT : NeutroPhils :75%
Eosinophils :03%
Monocytes :05%
Lymphocytes :17%
07-11-2009 / 19:24
Platelets Count normal in Number and morphology 07-11-2009 / 19:24
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 07-11-2009 / 19:24
ADVICE ON DISCHARGE
Domstal drops 8 drops TID x 2 weeks
Name : B/o. Shajitha Banu Age/Sex : NB/ M Dept : NeonatologyHos.No: 434937 Mrd.No : 325899 Ward: IL.NB. NICUD.O.A : 28.10.09 D.O.D : 25.11.09 ************************************************************************
REF. BY : DR. VENKATESAN., PLACE : KARAIKUDI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME CHD-MODERATE SIZE ASD MILD VALVULAR PS BRONCHOPULMONARY DYSPLASIA
COURSE:
This term / AGA / male baby was born at private hospital by normal vaginal
delivery on 28.10.09. H/o. Thin meconium stained liquor +. H/o. Baby cried soon
after birth. H/o. Respiratory distress since birth for that referred to MMHRC on
28.10.09 for further management. Mother is on Antipsychiatric drugs Tab.
Olenzepine, Tab. Lorazepam & Tab. Oxycarbaine. No H/o. PIH, GDM &
Hypothyroidism. O/E. Baby activity & cry : weak, peripheral cynanosis +, CFT >
3 sec, dyspnoeic +, tachypnoeic +, no birth injury & no obvious external
anomaly. CVS: S1 & S2 heard, RS:RR @ 72/min, ICR +, SCR +. P/A: soft, CNS :
NNR sluggish. Baby was investigated : Peripheral smear, Blood sugar & serum
creatinine were normal. Chest x-ray (28.10.09) showed Bilateral meconium
infiltration. ECHO done which showed moderate size ASD with Mild Valvular PS.
Baby was managed with Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj.
Vitamin K & Ionotrophic support. As baby had raised Respiratory distress,
connected to mechnical ventilator support on 29.10.09. with these above measures,
baby’s respiratory distress reduced, weaned from the ventilator on 02.11.09 &
started on small tube feeds. As baby had desaturation on 05.11.09, again connected
to mechanical ventilator support. Baby had difficulty in weaning from the
ventilator, Repeat chest x-ray done - which suggestive of Bronchopulmonary
dysplasia. Baby was started on diuretics & steroids. With these above
management, baby’s respiration improved so weaned form the ventilator on
11.11.09 & ryles tube was gradually raised. Baby was slowly weaned from the
oxygen. Now baby’s activity improved, respiration became normal & taking oral
feeds. Baby is discharged today with the advice to conitnue further follow-up with
the referral doctor.
INVESTIGATION :
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 29-10-2009 / 09:51
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC
4.5 29-10-2009 / 15:07
HAEMOGLOBIN 16.6 13.6 to 19.6 g/dL 29-10-2009 / 15:07
TOTAL WBC COUNT 21600 10000 to 25000 Cells/cumm 29-10-2009 / 15:07
DIFFERENTIAL COUNT
Polymorphs 89 40 - 70 % 29-10-2009 / 15:07
Lymphocytes 07 25 - 50 % 29-10-2009 / 15:07
Monocytes 03 01 - 06 % 29-10-2009 / 15:07
Eosinophils 01 01 - 10 % 29-10-2009 / 15:07
Basophils 00 00 - 01 % 29-10-2009 / 15:07
PLATELET COUNT 150000 150000 to 450000 Cells/cumm 29-10-2009 / 15:07
PCV (HEMATOCRIT) 49 44 to 62 % 29-10-2009 / 15:07
MCV 110 76 to 96 Fl 29-10-2009 / 15:07
MCH 36 27 to 32 pg/cell 29-10-2009 / 15:07
MCHC 33 32 to 36 % 29-10-2009 / 15:07
RDW 18.3 20 to 42 % 29-10-2009 / 15:07
MPV 7.7 6 to 10.2 Fl 29-10-2009 / 15:07
BIO CHEMISTRY
CREATININE (Jaffe Kinetic) 0.6 0.4 to 1.4 mg/dL 30-10-2009 / 16:32
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes and macrocytes.
No nucleated RBCs or hemoparasites.
WBC count shows leukocytosis.
No atypical or immature cells.
29-10-2009 / 15:07
DIFFERENTIAL COUNT : NeutroPhils :88%
Eosinophils :01%
Monocytes :03%
Lymphocytes :08%
29-10-2009 / 15:07
Platelets Count normal in Number and morphology 29-10-2009 / 15:07
IMPRESSION : -- 29-10-2009 / 15:07
ADVICE ON DISCHARGE
Tab. Aldarline 25mg 1/5 th OD x 2 weeks
Syp. Deriphylline 8 drops TID x 2weeks
C-Pink drops 4 drops OD x 2 weeks
REVIEW AFTER 2 WEEKS
DR. A. KANNAN., MD., DCH., SR. CONSULTANT
Name : B/o. Tamilarasi Age/Sex : NB/ M Dept : NeonatologyHos.No: 438175 Mrd.No : 328083 Ward: IL.NB. NICUD.O.A : 24.11.09 D.O.D : 01.12.09 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA ( CORD AROUND THE NECK) MECONIUM ASPIRATION ACUTE RENAL FAILURE
COURSE:
This term / AGA / male baby was born at MMHRC by normal vaginal
delivery on 24.11.09 at 3.45am. H/o. Baby did not cried immedietly after birth.
H/o. Baby had weak cry after suctioning and tactle stimulation. H/o. Cord around
the neck +. H/o. Meconium stained liquor +. H/o. Baby had respiratory distress &
cyanosis after birth for that admitted at NICU for further management. M H/o.
Hypothyroidism +, on Tab. Eltroxin 100mg OD. No M h/o. PIH, GDM, PROM &
Maternal fever. O/E. Baby’s activity & cry – weak. Peripheral cyanosis +, CFT <
sec, dyspnoeic +, tachypnoeic +, no birth injury & no obvious external abamoly,
CVS : S1, S2 heard, RS : RR @ 70/mt, Inter costal & Sub constal retractions +,
P/A : Soft, CNS : NNR sluggish. Baby was investigated peripheral smear, Blood
sugar and serum creatinine (26.11.09) were normal. TSH : 1.29uu/ml. CRP :
Positive (24.11.09). Et tip culture showed no growth. Blood culture report awaited.
Baby was managed with mechanical ventilator support, Iv fluids, Iv antibiotics, Inj.
Calcium gluconate, Inj. Vitamin K & Ionotrophic support. On 30.11.09. baby had
convulsion, Inj. Gardenol was added. With these above measures, baby’s
respiratory ditress reduced weaned from the ventilator on 25.11.09 & was
extubated on 27.11.09. baby had again developed respiratory distress with
desaturation, intubated and connected to mechnical ventilator support on 30.11.09.
As baby had decreased urine output, serum creatinine checked which was 1.9mg/dl
so managed with Lasix infusion & fluid was restricted. Baby had GI bleed,
platelet count was only : 20,000 on 30.11.09, PRP transfusion was given. As
baby’s ABG showed acidosis (Hco3 – 13), corrected with Inj. NaHco3. Now baby
is in mechanical ventilator support, with Fio2 : 100%, maintaining Spo2 : 98%.
Since parents were not willing for further management, baby is discharged
AGAINST MEDICAL ADVICE on 01.12.09 @ 1pm.
INVESTIGATION :
HAEMATOLOGY & CLINICAL PATHOLOGY
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 01-12-2009 / 10:22
BLOOD BANK
BLOOD GROUPING & Rh TYPING
B POSITIVE 24-11-2009 / 13:44
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC
4.2 24-11-2009 / 18:36
HAEMOGLOBIN 15.7 13.6 to 19.6 g/dL 24-11-2009 / 18:36
TOTAL WBC COUNT 18000 10000 to 25000 Cells/cumm 24-11-2009 / 18:36
DIFFERENTIAL COUNT
Polymorphs 75 40 - 70 % 24-11-2009 / 18:36
Lymphocytes 18 25 - 50 % 24-11-2009 / 18:36
Monocytes 05 01 - 06 % 24-11-2009 / 18:36
Eosinophils 02 01 - 10 % 24-11-2009 / 18:36
Basophils 00 00 - 01 % 24-11-2009 / 18:36
PLATELET COUNT 264000 150000 to 450000 Cells/cumm 24-11-2009 / 18:36
PCV (HEMATOCRIT) 46 44 to 62 % 24-11-2009 / 18:36
MCV 108 76 to 96 Fl 24-11-2009 / 18:36
MCH 37 27 to 32 pg/cell 24-11-2009 / 18:36
MCHC 34 32 to 36 % 24-11-2009 / 18:36
RDW 18.4 20 to 42 % 24-11-2009 / 18:36
MPV 6.8 6 to 10.2 Fl 24-11-2009 / 18:36
BIO CHEMISTRY
CREATININE (Jaffe Kinetic) 0.7 0.4 to 1.4 mg/dL 26-11-2009 / 10:21
CREATININE (Jaffe Kinetic) 1.9 0.4 to 1.4 mg/dL 30-11-2009 / 18:23
TSH (CLIA) 1.29 0.34 to 5.6 µU/mL 24-11-2009 / 13:13
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 24-11-2009 / 11:08
C- Reactive Protein POSITIVE 48 MICROGRAM / ML 30-11-2009 / 22:19
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes.
No nucleated RBCs or hemoparasites.
WBC count shows mild neutrophilic leukocytosis.
No atypical or immature cells.
24-11-2009 / 18:36
DIFFERENTIAL COUNT : NeutroPhils :75%
Eosinophils :02%
Monocytes :05%
Lymphocytes :18%
24-11-2009 / 18:36
Platelets Count normal in Number and morphology 24-11-2009 / 18:36
IMPRESSION : -- 24-11-2009 / 18:36
Name : B/o. Annalakshmi Age/Sex : NB/ M Dept : NeonatologyHos.No: 437982 Mrd.No : 327931 Ward: IL.NB. NICUD.O.A : 22.11.09 D.O.D : 03.12.09 ************************************************************************
REF. BY : DR. ARIVALAHAN., PLACE : KARAIKUDI
DIAGNOSIS: MECONIUM ASPIRATION NEONATAL SEPSIS THROMBOCYTOPENIA
COURSE:
This term / AGA / male baby was born at private hospital by LSCS (Ind :
Mother had polioattak over legs) on 22.11.09. H/o. Meconium stained liquor +.
Ho. Baby cried soon after birth. H/o. Baby had respiratory distress & cyanosis.
since birth baby was referred to MMHRC on 22.11.09 as a case of ? cyanosis heart
disease for further management. No H/o. Cord around the neck. No MH/o. PIH,
GDM & Fever. O/E. Baby’s activity – sliuggish, cry : weak, peripheral cyanosis +,
CFT > 3 sec, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external
anomaly. CVS: S1 & S2 +, RS: RR @ 72 / mt, SCR +, ICR +, Bilateral air entry
equal, P/A : soft, CNS : Irritable, NNR sluggish. Baby was investigated peripheral
smear & Blood sugar were normal. Serum creatinine : 1.2mg/dl, (22.11.09),
0.7mg/dl (27.11.09). blood culture showed klebsiella growth. ECHO showed small
PFO, otherwise normal study. Baby was managed with Mechanical ventilator
support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K &
Ionotrophic support. With these above measures baby’s respiratory distress
reduced with the ventilator support. Ryles tube feeds started. Baby developed
icterus with petechial spots over the abdomen, serum bilirubin checked T :
20.1mg/dl, & D : 6.4mg/dl. At that time platelet count was only 20,000. Baby was
managed with FFP & PRP transfusion. As baby had abdominal distension, RTF
was gradually raised. Repeat blood culture sent, report awited. On 02.12.09, baby
had decreased urine output, fluid restricted & Inj. Lasix infusion was started. On
02.12.09 baby was pale, HB checked, it was – 6.7gms%, managed with whole
fresh blood transfusion. Now baby is in mechanical ventilator support with Fio2 :
35%, maintaining oxygen saturation of 98-100% & tolerating tube feeds. Since
parents were not willing for further management, baby is discharged AGAINST
MEDICAL ADVICE on 03.12.09 @ 5pm.
INVESTIGATION :
HAEMATOLOGY & CLINICAL PATHOLOGY
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 28-11-2009 / 15:42
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 29-11-2009 / 09:26
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 29-11-2009 / 20:04
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 30-11-2009 / 09:39
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 30-11-2009 / 19:56
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 01-12-2009 / 10:24
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 01-12-2009 / 21:29
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 02-12-2009 / 09:54
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 02-12-2009 / 20:13
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 03-12-2009 / 07:36
PLATELET COUNT 20000 150000 to 450000 Cells/cumm 03-12-2009 / 09:32
BLOOD BANK
BLOOD GROUPING & Rh TYPING
A POSITIVE 23-11-2009 / 09:58
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC
4.12 23-11-2009 / 17:16
HAEMOGLOBIN 14.2 13.6 to 19.6 g/dL 23-11-2009 / 17:16
TOTAL WBC COUNT 26600 10000 to 25000 Cells/cumm 23-11-2009 / 17:16
DIFFERENTIAL COUNT
Polymorphs 70 40 - 70 % 23-11-2009 / 17:16
Lymphocytes 19 25 - 50 % 23-11-2009 / 17:16
Monocytes 10 01 - 06 % 23-11-2009 / 17:16
Eosinophils 01 01 - 10 % 23-11-2009 / 17:16
Basophils 00 00 - 01 % 23-11-2009 / 17:16
PLATELET COUNT 381000 150000 to 450000 Cells/cumm 23-11-2009 / 17:16
PCV (HEMATOCRIT) 41 44 to 62 % 23-11-2009 / 17:16
MCV 99 76 to 96 Fl 23-11-2009 / 17:16
MCH 34 27 to 32 pg/cell 23-11-2009 / 17:16
MCHC 34 32 to 36 % 23-11-2009 / 17:16
RDW 16.1 20 to 42 % 23-11-2009 / 17:16
MPV 6.7 6 to 10.2 Fl 23-11-2009 / 17:16
BIO CHEMISTRY
CREATININE (Jaffe Kinetic) 1.2 0.4 to 1.4 mg/dL 22-11-2009 / 18:45
CREATININE (Jaffe Kinetic) 1.1 0.4 to 1.4 mg/dL 25-11-2009 / 16:00
CREATININE (Jaffe Kinetic) 0.7 0.4 to 1.4 mg/dL 27-11-2009 / 09:47
BILIRUBIN - TOTAL & DIRECT
BILIRUBIN - TOTAL (Diazo) 20.1 0.5 to 1.1 mg/dL 30-11-2009 / 18:32
BILIRUBIN - DIRECT (Diazo) 6.4 0.2 to 0.5 mg/dL 30-11-2009 / 18:32
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 23-11-2009 / 12:39
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes.
No nucleated RBCs or hemoparasites.
WBC count shows neutrophilic leukocytosis.
No atypical or immature cells.
23-11-2009 / 17:16
DIFFERENTIAL COUNT : NeutroPhils :70%
Eosinophils :01%
Monocytes :05%
Lymphocytes :24%
23-11-2009 / 17:16
Platelets Count normal in Number and morphology 23-11-2009 / 17:16
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 23-11-2009 / 17:16
ECHO SHOWED ON 24.11.09 : SITUS SOLITUS, LEVOCARDIA, PFO +,
GOOD LV FUNCTION, NO PDA / COARCTATION, NO PULMONARY
HYPERTENSION. IMPRESSION : PFO +, OTHERWISE NORMAL
STUDY.
Name : B/o. Dhanalakshmi Age/Sex : NB/ F Dept : NeonatologyHos.No: 439857 Mrd.No : 329084 Ward: IL.NB. NICUD.O.A : 05.12.09 D.O.D : 11.12.09 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA MECONIUM ASPIRATION SYNDROME
NEONATAL SEIZURE ACUTE RENAL FAILURE
COURSE:
This term / AGA / female baby was born at Private hospital by normal
vaginal delivery on 05.12.09. H/o. Birth asphyxia +, H/o. Baby developed
respiratory distress since birth. H/o. Meconium stained liquor +. Baby was referred
to MMHRC on 05.12.09 for further management, MH/o. Fever – 5 days before
delivery +. No MH/o. PIH & GDM. O/E Baby’s activity’s & cry – weak, CFT >
3sec, peripheral cyanosis +, dyspnoeic +, tachypnoeic +, no birth injury, no
obvious external anamoly. CVS: S1 & S2 heard, RS: RR @62/mt, Bilateral
crepitations +, SCR +. P/A: soft, CNS: NNR sluggish. Baby was investigated
peripheral smear showed HB : 17.4gms%, TC : 34,800cells & Platelet count : 2.3
lakhs. CRP : Positive. Serum creatinine : 1mg/dl, Blood culture showed no growth
(06.12.09). Repeat blood sugar sent, report awaited. Baby was managed with C-
PAP, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Dopamine
infusion. As baby had persisitent cyanosis. ECHO done shich showed IAS
Aneurysm, Small os ASD with L-> R shunt, No PAH. Baby had distress,
connected to ventilator support on 07.12.09. As baby had decreased urine output,
Repeat serum creatinine on 10.12.09, showed 1.7mg/dl, managed with Inj. Lasix
infusion. As baby had hypotension with low perfusion, Inj. Nor adrenaline infusion
was started on 10.11.09. Even with these above measures baby developed
bradycarida, followed by cardiac arrest. 3 deses of Inj. Atropine and Inj.
Adrenaline were given. CPR was carried out. But could not be revived &
DECLARED DEAD on 11.12.09 @ 10.25am.
INVESTIGATION :
BLOOD BANK
BLOOD GROUPING & Rh TYPING
A NEGATIVE 06-12-2009 / 13:22
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC
4.7 Cells/cumm 07-12-2009 / 16:54
HAEMOGLOBIN 17.4 13.6 to 19.6 g/dL 07-12-2009 / 16:54
TOTAL WBC COUNT 34800 10000 to 25000 Cells/cumm 07-12-2009 / 16:54
DIFFERENTIAL COUNT
Polymorphs 85 40 - 70 % 07-12-2009 / 16:54
Lymphocytes 11 25 - 50 % 07-12-2009 / 16:54
Monocytes 03 01 - 06 % 07-12-2009 / 16:54
Eosinophils 01 01 - 10 % 07-12-2009 / 16:54
Basophils 00 00 - 01 % 07-12-2009 / 16:54
PLATELET COUNT 230000 150000 to 450000 Cells/cumm 07-12-2009 / 16:54
PCV (HEMATOCRIT) 51 44 to 62 % 07-12-2009 / 16:54
MCV 106 76 to 96 Fl 07-12-2009 / 16:54
MCH 34 27 to 32 pg/cell 07-12-2009 / 16:54
MCHC 18.3 32 to 36 % 07-12-2009 / 16:54
RDW 7.4 20 to 42 % 07-12-2009 / 16:54
MPV 7.4 6 to 10.2 Fl 07-12-2009 / 16:54
BIO CHEMISTRY
CREATININE (Jaffe Kinetic) 1.0 0.4 to 1.4 mg/dL 07-12-2009 / 05:55
CREATININE (Jaffe Kinetic) 1.7 0.4 to 1.4 mg/dL 10-12-2009 / 13:17
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 48microgram/ml 06-12-2009 / 01:48
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes and
macrocytes.
Nucleated RBCs 2/100WBCs.
WBC count shows neutrophilic leukocytosis with
07-12-2009 / 16:54
shift to left.
No atypical cells.
DIFFERENTIAL COUNT : Myelocytes : 02%
Stab : 04%
NeutroPhils :78%
Eosinophils :01%
Monocytes :05%
Lymphocytes :10%
07-12-2009 / 16:54
Platelets Count normal in Number and
morphology
07-12-2009 / 16:54
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS WITH
SHIFT TO LEFT.
07-12-2009 / 16:54
Name : B/o. Malar vizhi Age/Sex : NB/ M Dept : NeonatologyHos.No: 441935 Mrd.No : 330591 Ward: IL.NB. NICUD.O.A : 23.12.09 D.O.D : 26.12.09 ************************************************************************
REF. BY : DR. GAYATHREE., PLACE : THENI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME
COURSE:
This 1 day male baby referred to MMHRC on 23.12.09 with respiratory
distress. Baby delivered by outlet forceps. H/o. Thick meconium stained liquor +
H/o. Baby cried soon after birth but soon developed grunting and respiratory
distress. Maternal History : H/o. Severe vaginal candidiasis - 1 week before
delivery. No Maternal H/o. GDM, PIH, PROM, Fever with rash. O/E. Baby’s cry
& activity – moderate, CFT < 3 sec, no pallor, not icteric, no cyanosis, no
clubbing, no edema, no generalized lymphadenopathy. RS : tachypnoeia + (RR :
66/min) mild LCI +, CVS : S1 S2 +, no murmur, P/A : soft, CNS : Intact. Baby
was investigated : Hb : 20%, TC : 16,400, Platelet count : 2.5lakhs, CRP : Positive,
serum creatinine : 0.7, Blood culture report awaited. Baby was managed with Iv
fluids, Iv antibiotics, Inj. Taxim, Inj. Amikacin and Inj. Fluconazole. With these
above measures baby activity and cry good, respiratory distress decreased hence
discharged today with advice to continue the further follow-up with the referral
doctor.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
B POSITIVE 23-12-2009 / 10:07
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC
5.72 23-12-2009 / 17:39
HAEMOGLOBIN 20.1 13.6 to 19.6 g/dL 23-12-2009 / 17:39
TOTAL WBC COUNT 16400 10000 to 25000 Cells/cumm 23-12-2009 / 17:39
DIFFERENTIAL COUNT
Polymorphs 80 40 - 70 % 23-12-2009 / 17:39
Lymphocytes 10 25 - 50 % 23-12-2009 / 17:39
Monocytes 08 01 - 06 % 23-12-2009 / 17:39
Eosinophils 02 01 - 10 % 23-12-2009 / 17:39
Basophils 00 00 - 01 % 23-12-2009 / 17:39
PLATELET COUNT 250000 150000 to 450000 Cells/cumm 23-12-2009 / 17:39
PCV (HEMATOCRIT) 62 44 to 62 % 23-12-2009 / 17:39
MCV 109 76 to 96 Fl 23-12-2009 / 17:39
MCH 35 27 to 32 pg/cell 23-12-2009 / 17:39
MCHC 32 32 to 36 % 23-12-2009 / 17:39
RDW 17.5 20 to 42 % 23-12-2009 / 17:39
MPV 8.1 6 to 10.2 Fl 23-12-2009 / 17:39
BIO CHEMISTRY
CREATININE (Jaffe Kinetic) 0.7 0.4 to 1.4 mg/dL 24-12-2009 / 13:47
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 24 MICROGRAM / ML 24-12-2009 / 10:54
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes and macrocytes.
Nucleated RBCs 2/100WBCs.
WBC count shows neutrophilic leukocytosis.
No atypical or immature cells.
23-12-2009 / 17:39
DIFFERENTIAL COUNT : NeutroPhils :80%
Eosinophils :02%
23-12-2009 / 17:39
Monocytes :05%
Lymphocytes :13%
Platelets Count normal in Number and morphology 23-12-2009 / 17:39
IMPRESSION : -- 23-12-2009 / 17:39
ADVICE ON DISCHARGE
Inj. Taxim 150mg IV BD x 6 days
Inj. Amikacin 40mg IV OD x 6 days
Inj. Fluconazole 18mg IV OD x 14 days
Name : B/o. Ayisha Banu Age/Sex : NB/ F Dept : NeonatologyHos.No: 442898 Mrd.No : 331137 Ward: IL.NB. NICUD.O.A : 29.12.09 D.O.D : 31.12.09 ************************************************************************
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISITENT PULMONARY HYPERTENSION (PPHN)
COURSE:
This Term / AGA female baby referred to MMHRC on 31.12.09 as a
case of respiratory distress, who delivered on 29.12.09 at 8.20am by normal
vaginal delivery. H/o. Meconium stained liquor +. No H/o. Cord around the neck
and baby cried immediately after birth but developed respiratory distress and
cyanosis about 2 hours after birth. No H/o. Vomiting, convulsion. O/E : Cry and
activity – moderate, CRT > 3 sec, cyanosis +, no pallor, no icterus,
lymphadenopathy, pedal edema. RS : 78/mnt, ICR +, SCR +, tachypnoeic, CVS :
S1, S2 +, P/A : Soft, CNS : intact. Baby was investigated HB : 19.5, TC : 18,200,
Platelet count : 1.2 lakhs, CRP : Negative. Repeat CRP done on 31.12.09 :
Positive, TC : 15,600 (31.12.09), serum creaitinine : 1.0. Chest x-ray showed MAS
– Meconium infiltrates. Baby was managed with Mechanical ventilator support,
Ionotropes, Iv. Antibiotics, Inj. Taxim, Inj. Ampicillin, Inj. Calcium gluconate, Inj.
Vitamin K and Tab. Sildenotil. Blood culture and sent report awaited. Even with
above measures baby’s general condition continuously deteriorated, baby went into
brady cardia & cardiac arrest on 31.12.09 at 2.10pm. baby was started on all
cardiac resuscitation, measures but could not be revived, so baby was
DECLARED DEAD on 31.12.09 at 2.30am.
INVESTIGATION HAEMATOLOGY & CLINICAL PATHOLOGY
TOTAL WBC COUNT 15600 6000 to 18000 Cells/cumm 31-12-2009 / 13:03
BLOOD BANK
BLOOD GROUPING & Rh TYPING
A POSITIVE 30-12-2009 / 10:27
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC
5.06 30-12-2009 / 17:37
HAEMOGLOBIN 19.5 13.6 to 19.6 g/dL 30-12-2009 / 17:37
TOTAL WBC COUNT 8200 10000 to 25000 Cells/cumm 30-12-2009 / 17:37
DIFFERENTIAL COUNT
Polymorphs 83 40 - 70 % 30-12-2009 / 17:37
Lymphocytes 10 25 - 50 % 30-12-2009 / 17:37
Monocytes 06 01 - 06 % 30-12-2009 / 17:37
Eosinophils 01 01 - 10 % 30-12-2009 / 17:37
Basophils 00 00 - 01 % 30-12-2009 / 17:37
PLATELET COUNT 122000 150000 to 450000 Cells/cumm 30-12-2009 / 17:37
PCV (HEMATOCRIT) 57 44 to 62 % 30-12-2009 / 17:37
MCV 113 76 to 96 Fl 30-12-2009 / 17:37
MCH 38 27 to 32 pg/cell 30-12-2009 / 17:37
MCHC 33 32 to 36 % 30-12-2009 / 17:37
RDW 21.5 20 to 42 % 30-12-2009 / 17:37
MPV 8.0 6 to 10.2 Fl 30-12-2009 / 17:37
BIO CHEMISTRY
CREATININE (Jaffe Kinetic) 1.0 0.4 to 1.4 mg/dL 31-12-2009 / 01:00
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 29-12-2009 / 22:56
C- Reactive Protein POSITIVE 12 MG / L 31-12-2009 / 13:14
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes and macrocytes.
Nucleated RBCs 2/100WBCs.
WBC count normal.
No atypical or immature cells.
30-12-2009 / 17:37
DIFFERENTIAL COUNT : NeutroPhils :83%
Eosinophils :01%
Monocytes :05%
Lymphocytes :11%
30-12-2009 / 17:37
Platelets Count normal in Number and morphology 30-12-2009 / 17:37
IMPRESSION : -- 30-12-2009 / 17:37
JAN 10Name : B/o. Kavitha Age/Sex : NB/ M Dept : NeonatologyHos.No: 442241 Mrd.No : 330772 Ward: IL.NB. NICUD.O.A : 25.12.09 D.O.D : 13.01.10 ************************************************************************
REF. BY : DR. ILAYARAJA., PLACE : ARANTHANGIE
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME NEONATAL SEIZURE
COURSE:
This term / AGA / male baby born at private hospital by normal vaginal
delivery on 25.12.09 at 3.05am with H/o. baby not cried immediately after birth,
and severe respiratory distress, and irritable cry since birth after resuscitation. No
convulsion. Maternal History of Thick meconium stained liquor. No maternal H/o.
PIH, GDM, Fever with rashes, recurrent UTI, PROM & Cord around the neck.
O/E. Baby’s activity & cry : weak, colour : cyanosis, CFT > 3sec, severe
respiratory distress +, no pallor, not icteric, no clubbing, no generalized edema, no
obvious external congenital anamolies and no birth injury. Spo2 : 60% with
oxygen therapy, CVS : S1 S2 Heard. No murmur, Rs : Bilateral air entry equal,
crepts +, P/A : Soft, no organomegaly, CNS : NNR sluggish. hence baby was
intubated and was shifted to NICU for mechanical ventilator support. Baby was
investigated HB: 17.8gms%, TC : 24,500, Platelet count : 2.6 lakhs, CRP :
Negative. Blood sugar & serum creatinine were normal. Serum potassium : 4.5,
Blood culture – no growth, ET Tip Culture sent on (25.12.09) : no growth. Chest x-
ray suggestive of meconium aspiration syndrome. Baby was managed with
Mechanical ventilator support, Ionodropes, Iv fluids, Iv antibiotics, ionodropes, Inj.
Rantac, Inj. Gardenol, Inj. Calcium gluconate, Domstal drops, Mucolite drops and
chest physiotherapy. With these above measures baby respiration became normal
and was weaned from ventilator on 09.01.09 and started on small tube feeds. Baby
tolerate feed well. Baby is on direct breast feeds, hence discharged today with
advice to continue the follow-up with the referral doctor.
INVESTIGATION HAEMATOLOGY & CLINICAL PATHOLOGY
TOTAL WBC COUNT (Coulter Principle) 21100 6000 to 18000 Cells/cumm 05-01-2010 / 13:34
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 25-12-2009 / 14:38
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC (Coulter Principle)
4.94 25-12-2009 / 14:10
HAEMOGLOBIN (Photometric Measurement) 17.8 13.6 to 19.6 g/dL 25-12-2009 / 14:10
TOTAL WBC COUNT (Coulter Principle) 24500 10000 to 25000 Cells/cumm 25-12-2009 / 14:10
DIFFERENTIAL COUNT (VCS Technology)
Polymorphs 80 40 - 70 % 25-12-2009 / 14:10
Lymphocytes 15 25 - 50 % 25-12-2009 / 14:10
Monocytes 04 01 - 06 % 25-12-2009 / 14:10
Eosinophils 01 01 - 10 % 25-12-2009 / 14:10
Basophils 00 00 - 01 % 25-12-2009 / 14:10
PLATELET COUNT (Plt Histogram) 261000 150000 to 450000 Cells/cumm 25-12-2009 / 14:10
PCV (Hct) (Calculated) 53 44 to 62 % 25-12-2009 / 14:10
MCV (RBC Histogram) 107 76 to 96 Fl 25-12-2009 / 14:10
MCH (Calculated) 36 27 to 32 pg/cell 25-12-2009 / 14:10
MCHC (Calculated) 33 32 to 36 % 25-12-2009 / 14:10
RDW (RBC Histogram) 17.7 20 to 42 % 25-12-2009 / 14:10
MPV (Plt Histogram) 7.4 6 to 10.2 Fl 25-12-2009 / 14:10
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) 0.8 0.4 to 1.4 mg/dL 27-12-2009 / 07:28
POTASSIUM (ISE) 4.5 3.5 to 5 mEq/L 25-12-2009 / 13:14
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 25-12-2009 / 15:57
ADVICE ON DISCHARGE
Tab. Gardenol 20mg HS x Till further advice
Domstal drops 8 drops TID x 2 weeks
Mucolite drops 5 drops TID x 2 weeks
Name : B/o. Ponnulakshmi Age/Sex : NB/ M Dept : NeonatologyHos.No: 443456 Mrd.No : 331480 Ward: IL.NB. NICUD.O.A : 03.01.10 D.O.D : 12.01.10 ************************************************************************REF.BY.DR.SUNITHA., PLACE : MADURAI
DIAGNOSIS: PRETERM (30-32 WEEKS) WITH RDS (SURFACTANT GIVEN) NEONATAL ENCEPHALOPATHY WITH SEIZURE
Name : B/o. Deepa Age/Sex : NB/ M Dept : NeonatologyHos.No: 444326 Mrd.No : 332105 Ward: IL.NB. NICUD.O.A : 11.11.10 D.O.D : 11.01.10 ************************************************************************
REF. BY : DR. SUNITHA., PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION CONGENITAL HEART DISEASE – SMALL ASD, SMALL PDA, PPHN ACUTE RENAL FAILURE
COURSE:
This postdated /AGA/ baby referred to MMHRC as a case of meconium
aspiration syndrome, baby delivered by LSCS (Indication : post dated preganacy)
on 10.01.10 at 10.35pm. H/o. baby resuscitated at birth. No H/o. convulsions, No
Maternal H/o. PIH, GDM, Hypothyroid, fever with rash. O/E. Baby’s activity &
cry : weak, no obvious external congenital anamolies, CVS : S1 S2 +, RS : Nasal
flaring +, SCR +, ICR +, Bilateral air entry +, bilateral crepts +, P/A : Soft, CNS :
NNR sluggish. Baby was intubated and connected to mechanical ventilator. Baby
was investigated HB : 17.8, Tc : 21,600, platelets : 1.3 lakhs, CRP : Negative.
Blood sugar : 68mg/dl, serum creatinine : 1.3 lakhs (11.01.10), serum creatinine :
1.2. blood urea : 39 (14.01.10), TC : 11,800 (15.01.10). serum creatinine : 2.8
(16.01.10). Blood culture and ET aspiration culture showed no growth. ECHO
showed CHD, Small ASD, Mild PAH, Small PDA. Baby’s Pco2 ventilator
settings changed accordingly. Baby had hypotension and was managed with
Inotropes. Depite treatment baby had persistent hypoglycemia. Blood sugar
monitored 6th hourly and correction given. Baby was planned for dialysis as baby’s
attenders not willing to continue treatment baby is discharge AT REQUEST on
10.01.10.
Name : B/o. Patchaiammal Age/Sex : NB/ F Dept : NeonatologyHos.No: 445995 Mrd.No : 333193 Ward: IL.NB. NICUD.O.A : 24.01.10 D.O.D : 25.01.10 ************************************************************************
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME BIRTH ASPHYXIA
COURSE:
This term / AGA / female baby was born at MMHRC by normal vaginal
delivery on 24.01.10. H/o. Thick meconium stained liquor + ( foul smelling). H/o.
Baby did not cry immedietly after birth. Baby cried after tactle stimulation &
suctioning. H/o. Baby developed respiratory distress since birth for that admitted at
NICU for further management. H/o. Peripheral cyanosis +. MH/o. Eclampsia + -
on MgSo4 therapy. Unhealthy placenta +. No MH/o. GDM. O/E. After
resuscitation, baby’s activity & cry : weak, peripheral cyanosis +, CFT > 3sec,
dyspnoeic +, tachypnoeic +, grunting +, not anaemic, not icteric, no birth injury,
no obvious external anomaly. CVS: S1 & S2 heard, RS: RR @ 68 / mt, Lower
chest indrawing +, SCR +, P/A : soft, CNS : NNR sluggish. Baby was investigated
peripheral smear showed HB : 17.1gms%, TC : 10,300cells & platelet count 2.2
lakhs. CRP : Positive. Blood culture sent, report awaited. Chest x-ray suggestive of
Bilateral meconium infiltration. Baby was managed with mechanical ventilator
support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K &
Ionotrophic support. ABG’s done which showed (Pco2 – 50, Po2 : 35 with
Hyperkalemia), ventilator settings were adjusted & corrected with calcium
gluconate & asthalin nebulization. serum K+ : 3.9 (25.01.10). Now baby is in
mechanical ventilator support with Fio2 : 100%, with maintaining oxygen
saturation (Spo2 : 99%). Since parents were not willing for further management,
baby is discharged AGAINST MEDICAL ADVICE on 25.01.10 at 8pm.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 25-01-2010 / 09:55
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC (Coulter Principle)
4.4 25-01-2010 / 11:42
HAEMOGLOBIN (Photometric Measurement) 17.1 13.6 to 19.6 g/dL 25-01-2010 / 11:42
TOTAL WBC COUNT (Coulter Principle) 10300 10000 to 25000 Cells/cumm 25-01-2010 / 11:42
DIFFERENTIAL COUNT (VCS Technology)
Polymorphs 63 40 - 70 % 25-01-2010 / 11:42
Lymphocytes 33 25 - 50 % 25-01-2010 / 11:42
Monocytes 03 01 - 06 % 25-01-2010 / 11:42
Eosinophils 01 01 - 10 % 25-01-2010 / 11:42
Basophils 00 00 - 01 % 25-01-2010 / 11:42
PLATELET COUNT (Plt Histogram) 225000 150000 to 450000 Cells/cumm 25-01-2010 / 11:42
PCV (Hct) (Calculated) 48 44 to 62 % 25-01-2010 / 11:42
MCV (RBC Histogram) 107 76 to 96 Fl 25-01-2010 / 11:42
MCH (Calculated) 38 27 to 32 pg/cell 25-01-2010 / 11:42
MCHC (Calculated) 35 32 to 36 % 25-01-2010 / 11:42
RDW (RBC Histogram) 16.6 20 to 42 % 25-01-2010 / 11:42
MPV (Plt Histogram) 6.7 6 to 10.2 Fl 25-01-2010 / 11:42
BIO CHEMISTRY
POTASSIUM (ISE) 3.9 3.5 to 5 mEq/L 25-01-2010 / 08:43
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 24 MICROGRAM /ML 24-01-2010 / 22:30
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show macrocytic normochromic.
Nucleated RBCs+
Hemoparasites Nil.
WBC count shows neutrophilic shift to left +.
No atypical or immature cells.
25-01-2010 / 11:42
DIFFERENTIAL COUNT : NeutroPhils :63% 25-01-2010 / 11:42
Eosinophils :01%
Monocytes :03%
Lymphocytes :33%
Platelets Count Adequate 25-01-2010 / 11:42
IMPRESSION : --- 25-01-2010 / 11:42
FEB 10Name : B/o. MuthuMari Age/Sex : NB/ F Dept : NeonatologyHos.No: 448623 Mrd.No : 334770 Ward: IL.NB. NICUD.O.A : 13.02.10 D.O.D : 17.02.10 ************************************************************************REF.BY.DR.PRABAKAR NAVAMANI., PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH PERSISTENT PULMONARY HYPERTENSION ? SEPTICEMIA
COURSE: This term / AGA / female baby born at private hospital on 13.02.10 at 6.15am by normal vaginal delivery with H/o. Cried immediately after birth and developed respiratory distress after 2 hours and was sent to the referral doctor hospital. Since baby had increased respiratory distress, was referred to MMHRC for further management. No H/o. Cord around the neck and convulsion. Maternal H/o: Mother had fever at 32 weeks of gestation. H/o. Meconiums stained liquor +. No H/o. UTI, PIH, GDM, Bronchial Asthma and hypothyroidism. O/E : Baby’s activity and cry : weak, CFT > 3sec, Respiratory distress +, Tachypnoea +, Nasal flaring +, no pallor, no birth injury, no cyanosis, no clubbing, no obvious external anomaly. CVS : S1 S2 heard, RS : Bilateral air entry +, dysnoea +, sub costal retraction +, P/A : Soft, CNS : NNR sluggish. Since baby had a weak cry / activity with increased respiratory distress. Baby was investigated HB : 19gms%, Tc : 37,300, Platelet count : 2.2 lakhs, CRP : Negative. Micro ESR : 1mm, Blood sugar was normal, serum creaitnine : 1.1 (15.02.10) 1 (16.02.10). serum potassium : 5.2 (15.02.10), 4.4 (17.02.10). Blood culture showed no growth. ET aspiration culture showed Klebseila growth. According to the culture and sensitivity Iv. Antibiotics changed. Planned for ECHO but baby’s parents were not willing. Baby was managed with mechanical ventilator support, Iv. Flduis, Iv. Antibitoics, Inj. Dopamine infusion, Inj. Gardenol started since baby had convulsion after admission, Inj. Rantac and Syp. Osteocalcium & Inj. Vitamin K. Since baby had tachypnoea planned for ECHO but baby’s parents were not willing for further management and baby was discharged today AGAINST MEDICAL ADVICE on 17.02.10.
INVESTIGATION BLOOD BANK
BLOOD GROUPING & Rh TYPING
A POSITIVE 14-02-2010 / 15:41
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC (Coulter Principle)
5.34 15-02-2010 / 13:18
HAEMOGLOBIN (Photometric Measurement) 19.0 13.6 to 19.6 g/dL 15-02-2010 / 13:18
TOTAL WBC COUNT (Coulter Principle) 37300 10000 to 25000 Cells/cumm 15-02-2010 / 13:18
PLATELET COUNT (Plt Histogram) 220000 150000 to 450000 Cells/cumm 15-02-2010 / 13:18
PCV (Hct) (Calculated) 58 44 to 62 % 15-02-2010 / 13:18
MCV (RBC Histogram) 108 76 to 96 Fl 15-02-2010 / 13:18
MCH (Calculated) 35.5 27 to 32 pg/cell 15-02-2010 / 13:18
MCHC (Calculated) 32 32 to 36 % 15-02-2010 / 13:18
RDW (RBC Histogram) 23.3 20 to 42 % 15-02-2010 / 13:18
MPV (Plt Histogram) 8.4 6 to 10.2 Fl 15-02-2010 / 13:18
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) 1.1 0.4 to 1.4 mg/dL 15-02-2010 / 13:44
Plasma CREATININE (Jaffe Kinetic) 1.0 0.4 to 1.4 mg/dL 16-02-2010 / 17:43
POTASSIUM (ISE) 5.2 3.5 to 5 mEq/L 15-02-2010 / 16:15
POTASSIUM (ISE) 4.4 3.5 to 5 mEq/L 17-02-2010 / 11:32
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 14-02-2010 / 07:42
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show macrocytic normochromic.
No nucleated RBCs or hemoparasites.
WBC count neutrophilic leukocytosis with
shift to left.
No atypical or immature cells.
15-02-2010 / 13:18
DIFFERENTIAL COUNT : NeutroPhils :68%
Eosinophils :01%
Monocytes :05%
Lymphocytes :26%
15-02-2010 / 13:18
Platelets count Adequate. 15-02-2010 / 13:18
IMPRESSION : -- 15-02-2010 / 13:18
INVESTIGATION
HAEMATOLOGY & CLINICAL PATHOLOGY
TOTAL WBC COUNT (Coulter Principle) 11800 6000 to 18000 Cells/cumm 15-01-2010 / 13:50
DIFFERENTIAL COUNT (VCS Technology)
Polymorphs 65 40 - 70 % 15-01-2010 / 13:50
Lymphocytes 20 25 - 50 % 15-01-2010 / 13:50
Monocytes 14 01 - 06 % 15-01-2010 / 13:50
Eosinophils 01 01 - 10 % 15-01-2010 / 13:50
Basophils 00 00 - 01 % 15-01-2010 / 13:50
PERIPHERAL BLOOD SMEAR STUDY
RBC (Coulter Principle)
4.8 11-01-2010 / 21:26
HAEMOGLOBIN (Photometric Measurement) 17.9 13.6 to 19.6 g/dL 11-01-2010 / 21:26
TOTAL WBC COUNT (Coulter Principle) 21600 10000 to 25000 Cells/cumm 11-01-2010 / 21:26
DIFFERENTIAL COUNT (VCS Technology)
Polymorphs 67 40 - 70 % 11-01-2010 / 21:26
Lymphocytes 22 25 - 50 % 11-01-2010 / 21:26
Monocytes 10 01 - 06 % 11-01-2010 / 21:26
Eosinophils 01 01 - 10 % 11-01-2010 / 21:26
Basophils 00 00 - 01 % 11-01-2010 / 21:26
PLATELET COUNT (Plt Histogram) 138000 150000 to 450000 Cells/cumm 11-01-2010 / 21:26
PCV (Hct) (Calculated) 54 44 to 62 % 11-01-2010 / 21:26
MCV (RBC Histogram) 112 76 to 96 Fl 11-01-2010 / 21:26
MCH (Calculated) 36 27 to 32 pg/cell 11-01-2010 / 21:26
MCHC (Calculated) 32 32 to 36 % 11-01-2010 / 21:26
RDW (RBC Histogram) 18.8 20 to 42 % 11-01-2010 / 21:26
MPV (Plt Histogram) 6.9 6 to 10.2 Fl 11-01-2010 / 21:26
BLOOD UREA (Urease GLDH ) 39 15 to 40 mg/dL 14-01-2010 / 09:20
Plasma CREATININE (Jaffe Kinetic) 1.3 0.4 to 1.4 mg/dL 13-01-2010 / 06:11
Plasma CREATININE (Jaffe Kinetic) 1.2 0.4 to 1.4 mg/dL 14-01-2010 / 09:20
Plasma CREATININE (Jaffe Kinetic) 2.1 0.4 to 1.4 mg/dL 15-01-2010 / 10:26
Plasma CREATININE (Jaffe Kinetic) 2.8 0.4 to 1.4 mg/dL 16-01-2010 / 08:18
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 11-01-2010 / 20:35
RBCs show normochromic normocytes and macrocytes.
Nucleated RBCs 2/100WBCs.
WBC count shows neutrophilic leukocytosis.
No atypical or immature cells.
11-01-2010 / 21:26
DIFFERENTIAL COUNT : NeutroPhils :67%
Eosinophils :01%
Monocytes :05%
Lymphocytes :27%
11-01-2010 / 21:26
Platelets Count normal in Number and morphology 11-01-2010 / 21:26
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 11-01-2010 / 21:26
TREATMENT GIVEN :
Weight : 2.675kg
Mechanical ventilator (IMV + HEV + IRV )
Iv. Fluids
Inj. Dopamine 48mg in 50ml IVF - 2/min
Inj. Lasix
Inj. Taxim 130mg IV BD
Inj. Ampicillin 130mg IV BD
RTF 5ml Q12 hourly
Name : B/o. Sabeela Banu Age/Sex : NB/ M Dept : NeonatologyHos.No: 446597 Mrd.No : 333598 Ward: IL.NB. NICUD.O.A : 29.01.2010 D.O.D : 19.02.2010 ******************************************************************************REF.BY.DR.PUSHPALATHA GOKULNATH., PLACE : MADURAI
DIAGNOSIS: PRETERM (30 WEEKS) / SURFACTANT GIVEN ON 29.01.10/ CHD : OS ASD, L-> R SHUNT 2:1, MILD TR, MILD PAH NEONATAL SEIZURE
M AR 10Name : B/o. Shanthi Age/Sex : NB/ M Dept : NeonatologyHos.No: 452750 Mrd.No : 337266 Ward: IL.NB. NICUD.O.A : 15.03.10 D.O.D : 16.03.10 ************************************************************************REF.BY.DR. JAYA LAKSHMI., PLACE : THIRUMANGALAM
DIAGNOSIS: PERINATAL ASPHYXIA WITH MECONIUM ASPIRATION SYNDROME
COURSE:
This Term male baby was referred to MMHRC on 15.03.10 with H/o. severe
respiratory distress since birth. Maternal History : 22 years, Primi, No H/o. PIH,
GDM, hypothyroidism UTI. H/o. Fever 2 days before delivery lasted for 1 day
took Iv. Antibiotics. Delivered by LSCS (Ind: Poor progression of labour) No H/o.
PROM, Cord around the neck. H/o. Thick Meconium stained liquor +. Baby did
not cry after birth and developed severe respiratory distress soon after birth and
referred here for further management. O/E: Baby cry and activity – weak, severe
respiratory distress +, cyanosis of both palms & soles +, CFT > 3sec, HR : 130/m,
RR : 70/m, Temp : 98.6oF, no pallor, not icteric, no external anomalies seen, CVS :
S1 S2 heard, systolic murmur in pulm area +, RS : Tachypnea +, dyspnea +, ICR,
SCR, supra sternal retractions +, P/A : soft, hepatomegaly +, BS +, CNS : AF :
Normal, NNR : Sluggish. baby was intubated and connected to mechanical
ventilator and investigated HB : 14.9gm%, TC : 31,000cells/mm, Platelet count :
1.4 lakhs, CRP : Negative, Blood culture sent, ABG showed severe metabolic
acidosis, Hco3 correction given, ventilator settings changed accordingly baby was
managed with IV. Fluids, Iv. Antibiotics, Inj. Dopamine infusion, Inj. Vitamin K,
Inj. Gardenol. As baby continued to have hypotension, Inj. Noradrenaline started.
ECHO done showed normal study. Repeat ABG taken also showed severe
metabolic acidosis for which correction given Inspite of above measures baby
continued to have cyanosis. Prognosis of the condition was well explained to the
parents. Since they are not willing for further management, baby was discharged
AGAINST MEDICAL ADVICE on 16.03.10.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
B POSITIVE 16-03-2010 / 10:16
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC (Coulter Principle)
4.53 16-03-2010 / 13:21
HAEMOGLOBIN (Photometric Measurement) 14.9 13.6 to 19.6 g/dL 16-03-2010 / 13:21
TOTAL WBC COUNT (Coulter Principle) 31000 10000 to 25000 Cells/cumm 16-03-2010 / 13:21
PLATELET COUNT (Plt Histogram) 141000 150000 to 450000 Cells/cumm 16-03-2010 / 13:21
PCV (Hct) (Calculated) 47 44 to 62 % 16-03-2010 / 13:21
MCV (RBC Histogram) 103 76 to 96 Fl 16-03-2010 / 13:21
MCH (Calculated) 32 27 to 32 pg/cell 16-03-2010 / 13:21
MCHC (Calculated) 31 32 to 36 % 16-03-2010 / 13:21
RDW (RBC Histogram) 17.1 20 to 42 % 16-03-2010 / 13:21
MPV (Plt Histogram) 7.2 6 to 10.2 Fl 16-03-2010 / 13:21
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 16-03-2010 / 03:16
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show macrocytic normochromic .
Nucleated RBCs+
Hemoparasites Nil.
WBC count neutrophilic leukocytosis with
shift to left
No atypical or immature cells.
16-03-2010 / 13:21
DIFFERENTIAL COUNT : NeutroPhils :67%
Eosinophils :04%
Monocytes :05%
Lymphocytes :24%
16-03-2010 / 13:21
Platelets Count Adequate 16-03-2010 / 13:21
IMPRESSION : -- 16-03-2010 / 13:21
Name : B/o. Devi Age/Sex : NB/ M Dept : NeonatologyHos.No: 453050 Mrd.No : 337403 Ward: IL.NB. NICUD.O.A : 17.03.10 D.O.D : 20.03.10 ************************************************************************REF.BY.DR.MUTHU PANDIAN., PLACE : MANAMADURAI
DIAGNOSIS: PERINATAL ASPHYXIA WITH MECONIUM ASPIRATION SYNDROME WITH SEVERE PULMONARY HYPERTENSION
COURSE:
This Term new born male baby delivered by LSCS (Ind : Fetal distress) on
17.03.10 at 2.45pm referred to MMHRC with H/o. baby did not cry soon after
birth and developed severe respiratory distress since birth. Maternal history : Primi,
23 years. No H/o. PIH, GDM, recurrent UTI, fever with rash, bleeding PV. H/o.
Thick Meconium staining of liquor +. O/E : Baby cry & activity – weak, colour :
peripherial cyanosis +, CFT < 3sec, severe respiratory distress +, (Nasal flaring,
sub costal & intercostal indrawing +), no external congenital anomalies seen. HR :
148/m, RR : 68/m, Temp : 98.6oF, Spo2 : 75% with 5 liters of Oxygen, RS :
Bilateral crepts +, CVS : S1 S2 +, no murmurs +, P/A : Soft, CNS : NNR sluggish.
Baby was intubated and connected to mechanical ventilator support and
investigated HB : 17gms%, TC : 23,000cells, Platelet count : 2.6 lakhs, CRP :
negative, serum creatinine : 0.9mg%. ECHO showed severe TR with severe PAH.
Baby was started on Iv. Fluids, Iv. Antibiotics, Iv. Inotropes, Inj. Calcium
gluconate, Pulmonary vasodilators. ABG showed severe respiratory acidosis and
hypercarbia, hence treated with high frequency ventilation. Since baby had fresh
bleeding from ET Tube FFP transfusion given. But baby continued to have
desaturation. Condition of the baby was well explained to the parents. As they are
not willing for further management, discharged AGAINST MEDICAL ADVICE
on 20.03.10.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 18-03-2010 / 10:53
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC (Coulter Principle)
4.6 18-03-2010 / 12:42
HAEMOGLOBIN (Photometric Measurement) 17.0 13.6 to 19.6 g/dL 18-03-2010 / 12:42
TOTAL WBC COUNT (Coulter Principle) 23400 10000 to 25000 Cells/cumm 18-03-2010 / 12:42
PLATELET COUNT (Plt Histogram) 260000 150000 to 450000 Cells/cumm 18-03-2010 / 12:42
PCV (Hct) (Calculated) 53 44 to 62 % 18-03-2010 / 12:42
MCV (RBC Histogram) 115 76 to 96 Fl 18-03-2010 / 12:42
MCH (Calculated) 36 27 to 32 pg/cell 18-03-2010 / 12:42
MCHC (Calculated) 31 32 to 36 % 18-03-2010 / 12:42
RDW (RBC Histogram) 19.3 20 to 42 % 18-03-2010 / 12:42
MPV (Plt Histogram) 6.9 6 to 10.2 Fl 18-03-2010 / 12:42
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) 0.9 0.4 to 1.4 mg/dL 19-03-2010 / 18:50
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 17-03-2010 / 21:51
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show microcytic normochromic .
Nucleated RBCs+
Hemoparasites Nil .
WBC count neutrophilic leukocytosis with
shift to left .
No atypical or immature cells.
18-03-2010 / 12:42
DIFFERENTIAL COUNT : NeutroPhils :81%
Eosinophils :01%
Monocytes :3%
Lymphocytes :15%
18-03-2010 / 12:42
Platelets Count Adequate 18-03-2010 / 12:42
IMPRESSION : -- 18-03-2010 / 12:42
Name : B/o. Bagavidhya Age/Sex : NB/ M Dept : NeonatologyHos.No: 451650 Mrd.No : 336564 Ward: IL.NB. NICUD.O.A : 08.03.2010 D.O.D : 24.03.2010
*****************************************************************************
DIAGNOSIS: PRETERM (33 – 34 WEEKS) WITH RESPIRATORY DISTRESS SYNDROME SURFACTANT II DOSES GIVEN ON 08.03.10
Name : B/o. Suguna devi Age/Sex : NB/ M Dept : NeonatologyHos.No: 453027 Mrd.No : 337394 Ward: IL.NB. NICUD.O.A : 17.03.2010 D.O.D : 23.03.2010 ************************************************************************
DIAGNOSIS: PRETERM WITH RESPRIATORY DISTRESS SYNDROME (SURFACTANT THERAPY GIVEN) SEPTICEMIA
APR 10
Name : B/o. Karthiga Age/Sex : NB/ M Dept : NeonatologyHos.No: 456014 Mrd.No : 339461 Ward: IL.NB. NICUD.O.A : 12.04.10 D.O.D : 18.04.10 ************************************************************************
DIAGNOSIS: PERINATAL ASPHYXIA
NEONATAL SEIZURE
MECONIUM ASPIRATION SYNDROME
RIGHT SIDED PNEUMOTHORAX
CHD (OS ASD WITH PULMONARY HYPERTENSION)
ACUTE RENAL FAILURE
COURSE:
This Term / AGA / male baby was born at private hospital by LSCS (Ind:
Cord around the neck with fetal distress) on 10th April 2010 @ 11p.m. Baby was
said to have cried soon after birth but developed poor activity and had cyanosis
followed by respiratory distress and convulsion on 1st day of life and hence referred
to MMHRC for further management. H/o. Cord around the neck and thick
meconium staining of liquor+. O/E: No cry or activity, CRT > 3 sec, cyanosis+. No
pallor / icterus / edema. No obvious external congenital anomalies seen. HR:
160/min, regular, Resp. rate: 74/min, Afebrile. RS: Tachypneic. ICR and SCR+.
Air entry diminished on right side. No adventitious sounds. CVS : S1 & S2+,
Normal. No murmurs. P/A: Soft, No organomegaly. CNS: Neonatal reflexes could
not be elicited. Anterior fontanelle – Normal. Baby was investigated Hb: 14.8gm
%, TC: 22,700cells/mm3. Platelet count: 2.9 lakhs/mm3. CRP – Positive (48mg/dl).
Chest X – ray right sided Pneumothorax. Blood Culture revealed No growth of
Organisms. Baby was endrotracheally intubated, connected to Mechanical
Ventilator. Chest tube was placed on right side on 12th April 2010. 2D ECHO was
suggestive of small OS ASD with LR shunt and moderate pulmonary
hypertension (on 17 April 2010). Baby was managed with Iv. Fluids, Iv.
Antibiotics, Inj. Calcium gluconate, Inj. Gardenal, Inj. Eptoin and Tab. Cavetra.
Inj. Aminophyllin and Inj. Lasix infusion was given to treat acute renal failure.
Even with these above management, general condition of baby kept deteriorating
and on 18 April, 2010, baby developed cardiac arrest was resuscitated as per latest
guidelines but couldn’t be reviewed and was “DECLARED DEAD” on 18 April
2010 at 5.45a.m.
INVESTIGATION:
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 13-04-2010 / 09:37
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 14.8 11.2 to 19.6 g/dL 13-04-2010 / 11:25
TOTAL WBC COUNT (Coulter
Principle)
2270
0 6000 to 18000 Cells/cumm 13-04-2010 / 11:25
PLATELET COUNT (Plt Histogram) 29000
0
150000 to 450000 Cells/
cumm 13-04-2010 / 11:25
PCV (Hct) (Calculated) 45 35 to 62 % 13-04-2010 / 11:25
TOTAL RBC COUNT (Coulter
Principle) 4.5 4.9 to 5.6 Mill/Cumm 13-04-2010 / 11:25
MCV (RBC Histogram) 101 76 to 96 Fl 13-04-2010 / 11:25
MCH (Calculated) 32 27 to 32 pg/cell 13-04-2010 / 11:25
MCHC (Calculated) 32 32 to 36 % 13-04-2010 / 11:25
RDW (RBC Histogram) 15.7 11 to 15 % 13-04-2010 / 11:25
MPV (Plt Histogram) 6.8 6 to 10.2 Fl 13-04-2010 / 11:25
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) 1.8 0.4 to 1.4 mg/dL 13-04-2010 / 00:26
Plasma CREATININE (Jaffe Kinetic) 1.5 0.4 to 1.4 mg/dL 14-04-2010 / 09:28
Plasma CREATININE (Jaffe Kinetic) 0.6 0.4 to 1.4 mg/dL 16-04-2010 / 10:26
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 48 MICROGRAM / ML 12-04-2010 / 17:29
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show macrocytic
normochromic.
No nucleated RBCs or
hemoparasites.
WBC count neutrophilic leukocytosis
with shift to left.
No atypical or immature cells.
13-04-2010 / 11:25
DIFFERENTIAL COUNT : NeutroPhils :76%
Eosinophils :01%
Monocytes :05%
Lymphocytes :18%
13-04-2010 / 11:25
Platelets Count Adequate 13-04-2010 / 11:25
IMPRESSION : -- 13-04-2010 / 11:25
Name : B/o. Gomathi Age/Sex : NB/ M Dept : NeonatologyHos.No: 455561 Mrd.No : 339172 Ward: IL.NB. NICUD.O.A : 08.04.10 D.O.D : 18.04.10 ************************************************************************
DIAGNOSIS: PRETERM (32 WEEKS) / LBW / MALE RESPIRATORY DISTRESS SYNDROME /
SURFACTANT 1 DOSE GIVEN ON 08.04.10 BIRTH ASPHYXIA ? SEPTICEMIA
Name : B/o. Jeyaleela Age/Sex : NB/ F Dept : NeonatologyHos.No: 456647 Mrd.No : 339837 Ward: IL.NB. NICUD.O.A : 16.04.2010 D.O.D : 24.04.2010 *****************************************************************************REF.BY.DR.JOSPHINE CHANDRAKALA., PLACE : MADURAI
DIAGNOSIS:PRETERM WITH BIRTH ASPHYXIA RESPIRATORY DISTRESS SYNDROME (SURFACTANT 2 DOSES GIVEN) ACUTE RENAL FAILURE
Name : B/o. Vajila Banu Age/Sex : NB/ F Dept : NeonatologyHos.No: 458208 Mrd.No : 340972 Ward: IL.NB. NICUD.O.A : 28.04.2010 D.O.D : 29.04..2010 ************************************************************************
DIAGNOSIS: RESPIRATORY DISTRESS SYNDROME WITH HYPOTENSION SURFACTANT 1ST DOSE GIVEN ON 28.04.10
MAY 10Name : B/o. Anandhavalli Age/Sex : NB/ M Dept : NeonatologyHos.No: 457491 Mrd.No : 340495 Ward: IL.NB. NICUD.O.A : 23.04.10 D.O.D : 03.05.10************************************************************************
DIAGNOSIS: PRETERM WITH RESPIRATORY DISTRESS SYNDORME (33-34 WEEKS) SEPTICEMIA SURFACTANT THERAPHY GIVEN ON 23.04.10
JUNE 10Name : B/o. Nithya Age/Sex : NB/ F Dept : NeonatologyHos.No: 464105 Mrd.No : 344685 Ward: IL.NB. NICUD.O.A : 08.06.10 D.O.D : 09.06.10************************************************************************REF.BY.DR. REVATHI JANAKIRAM., PLACE : MADURAI
DIAGNOSIS: PRETERM (27-28 WEEKS) / ELBW / TWIN II RESPIRATORY DISTRESS SYNDORME SURFACTANT GIVEN ON 08.06.10
Name : B/o. Selvi Age / Sex: NB/M Dept : NeonatologyHos.No : 462757 Mrd.No : 343880 Ward : I NB NICUD.O.A : 30.05.10 D.O.D :17.06.10************************************************************************REF.BY.DR. MANIMEGALAI., PLACE : KARAIKUDI
DIAGNOSIS: TERM / MALE / BIRTH ASPHYXIA
MECONIUM ASPIRATION SYNDROME
COURSE:
This Term two days old Male baby was referred to MMHRC on 30.05.10 as
a case of ? Meconium aspiration syndrome. Baby delivery by emergency LSCS
(Ind: MSAF with fetal bradycardia) on 29.05.2010 @ 5.35p.m., H/o. Baby didn’t
cry immediately after birth, cried after initial resuscitation. H/o. Baby developed
respiratory distress since birth. H/o. Meconium aspiration+. No H/o. cyanosis,
convulsions, jaundice. No Maternal H/o. PIH, GDM, PROM, fever with rash, UTI,
Hypothyroidism. Baby was initially managed with oxygen in the referral hospital,
but respiratory distress increased with cyanosis baby was referred here for further
management. O/E: Baby cry and activity – weak, peripheral cyanosis+, CFT > 3
sec, no pallor, no icterus, no birth injury, no obvious external anamoly. CVS: S1
S2 heard, no murmurs, RS: Dyspnoea+, RR @ 70/mt, Bilateral air entry reduced,
SCR+, ICR+, P/A: Soft, no organomegaly, CNS : NNR +. Baby was investigated
peripheral smear showed HB : 14.1mg/dl, TC : 19,200 cells/mm3 & Platelet count :
2.5 lakhs. CRP : Positive. Blood culture no growth. ET aspiration culture no
growth. Serum creatinine 0.6 mg/dl (31.05.10), Serum Bilirubin T: 5.1mg%, D:
0.6mg%. Chest x – ray showed features of MAS. ECHO showed normal study.
Baby was intubated and connected to mechanical ventilator support, series of ABG
taken, ventilator settings changed accordingly. Baby was managed with Iv. Fluids,
Iv. Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Deriphylline drops and
single side phototheraphy. Baby was weaned from the ventilator, managed with
oxygen. With these above measures baby’s respiratory distress settled. Baby was
started on ryles tube feeds, initially not tolerating the feeds, had vomiting managed
with Anti emetic drops. Now baby is active tolerating the feeds, hence baby is
discharged today with advice to continue the further follow-up with the referral
doctor.
INVESTIGATION:
HAEMATOLOGY & CLINICAL PATHOLOGY
TOTAL WBC COUNT (Coulter Principle) 13300 6000 to 18000 Cells/cumm 04-06-2010 / 17:46
BLOOD BANK
BLOOD GROUPING & Rh TYPING
AB POSITIVE 31-05-2010 / 11:26
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 14.1 13.6 to 19.6 g/dL 31-05-2010 / 11:12
TOTAL WBC COUNT (Coulter Principle) 19200 10000 to 25000 Cells/cumm 31-05-2010 / 11:12
PLATELET COUNT (Plt Histogram) 25300
0
150000 to 450000 Cells/
cumm 31-05-2010 / 11:12
PCV (Hct) (Calculated) 42 44 to 62 % 31-05-2010 / 11:12
TOTAL RBC COUNT (Coulter Principle) 4.7 4.9 to 5.6 Mill/Cumm 31-05-2010 / 11:12
MCV (RBC Histogram) 110 76 to 96 Fl 31-05-2010 / 11:12
MCH (Calculated) 36 27 to 32 pg/cell 31-05-2010 / 11:12
MCHC (Calculated) 32 32 to 36 % 31-05-2010 / 11:12
RDW (RBC Histogram) 15.9 11 to 15 % 31-05-2010 / 11:12
MPV (Plt Histogram) 6.9 6 to 10.2 Fl 31-05-2010 / 11:12
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) 0.6 0.4 to 1.4 mg/dL 31-05-2010 / 22:36
POTASSIUM (ISE) 3.9 3.5 to 5 mEq/L 04-06-2010 / 08:03
BILIRUBIN - TOTAL & DIRECT
Plasma BILIRUBIN - TOTAL (Diazo) 5.1 0.4 to 1.1 mg/dL 30-05-2010 / 22:46
Plasma BILIRUBIN - DIRECT (Diazo) 0.6 0.1 to 0.5 mg/dL 30-05-2010 / 22:46
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 48 MICRO GRAM/ML 30-05-2010 / 22:32
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show macrocytic
normochromic .
No nucleated RBCs or hemoparasites.
WBC count neutrophilic leukocytosis
with shift to left.
No atypical or immature cells.
31-05-2010 / 11:12
DIFFERENTIAL COUNT : NeutroPhils :88%
Eosinophils :00%
Monocytes :03%
Lymphocytes :09%
31-05-2010 / 11:12
Platelets Count Adequate 31-05-2010 / 11:12
IMPRESSION : -- 31-05-2010 / 11:12
ADVICE ON DISCHARGE
Inj. Ronem 125mg IV BD x 5 days
Tab. Caverta 25mg 1/5 BD x 5 days
Deriphylline drops 8 drops TID x 1 week
Admission weight : 2.900 kg
Discharge weight : 2.825 kg
Name : B/o. Malathy Age/Sex : NB/ F Dept : NeonatologyHos.No: 464931 Mrd.No : 345118 Ward: IL.NB. NICUD.O.A : 14.06.10 D.O.D : 25.06.10 ************************************************************************REF.BY.DR. RAJINI PREMATLATHA., PLACE : MADURAI
DIAGNOSIS: TERM / FEMALE / MECONIUM ASPIRATION SYNDROME CONGENITAL HEART DISEASE (OS ASD)
COURSE:
This term female baby was referred to MMHRC on 14.06.10 with H/o.
Respiratory distress since birth. Baby born by normal vaginal delivery on 14.06.10
at 5.30am. H/o. Baby didn’t cry immediately after birth, cried after tactile
stimulation, H/o. Baby developed respiratory distress since birth. H/o. Meconium
aspiration +. No H/o. cord around the neck, cyanosis, convulsions. Maternal H/o.
GDM, 3rd month of gestation., treated with insulin. Maternal H/o. PIH, treated with
drugs. No maternal H/o. Hypothyroidism, fever with rash / UTI. Baby was initially
managed in referral hospital, as respiratory distress increased, referred here for
further management. O/E : Baby’s activity & cry : weak, CFT > 3sec, CVS : S1 S2
+, RS : RR @ 68/min, grunting, dyspnoea +, SCR +, ICR +, P/a : Soft, CNS : NNR
+. Baby was intubated and connected to mechanical ventilator support. Series of
ABG taken, ventilator settings changed accordingly. Baby was investigated
showed HB : 15.5gms%, TC : 19,200 cells/mm3 & Platelet count : 3 lakhs. CRP :
Negative. ECHO showed congenital heart disease, OS ASD (5-6mm). Baby was
managed with Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, antiemetics drops,
ionotropes. Baby was slowly weaned from ventilator & started on ryles tube feeds.
With these above measures, baby’s active, respiratory distress settled, tolerating
feeds well and discharged today with advice to continue further follow-up with the
referral doctor.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
B POSITIVE 14-06-2010 / 17:02
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 15.5 13.6 to 19.6 g/dL 15-06-2010 / 09:52
TOTAL WBC COUNT (Coulter Principle) 19200 10000 to 25000 Cells/cumm 15-06-2010 / 09:52
PLATELET COUNT (Plt Histogram) 30800
0
150000 to 450000 Cells/
cumm 15-06-2010 / 09:52
PCV (Hct) (Calculated) 48 44 to 62 % 15-06-2010 / 09:52
TOTAL RBC COUNT (Coulter Principle) 4.5 4.9 to 5.6 Mill/Cumm 15-06-2010 / 09:52
MCV (RBC Histogram) 106 76 to 96 Fl 15-06-2010 / 09:52
MCH (Calculated) 34 27 to 32 pg/cell 15-06-2010 / 09:52
MCHC (Calculated) 32 32 to 36 % 15-06-2010 / 09:52
RDW (RBC Histogram) 18.0 11 to 15 % 15-06-2010 / 09:52
MPV (Plt Histogram) 6.7 6 to 10.2 Fl 15-06-2010 / 09:52
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) 0.8 0.4 to 1.4 mg/dL 16-06-2010 / 08:19
Plasma CREATININE (Jaffe Kinetic) 0.4 0.4 to 1.4 mg/dL 18-06-2010 / 08:33
BILIRUBIN - TOTAL & DIRECT
Plasma BILIRUBIN - TOTAL (Diazo) 9.6 0.4 to 1.1 mg/dL 16-06-2010 / 17:37
Plasma BILIRUBIN - DIRECT (Diazo) 0.5 0.1 to 0.5 mg/dL 16-06-2010 / 17:37
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 14-06-2010 / 17:03
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show macrocytic
normochromic .
No nucleated RBCs or hemoparasites.
WBC count neutrophilic leukocytosis
with shift to left.
No atypical or immature cells.
15-06-2010 / 09:52
DIFFERENTIAL COUNT : NeutroPhils :79%
Eosinophils :00%
Monocytes :05%
Lymphocytes :16%
15-06-2010 / 09:52
Platelets Count Adequate 15-06-2010 / 09:52
IMPRESSION : -- 15-06-2010 / 09:52
ADVICE ON DISCHARGE
Domstal drops 8 drops TID x 2 weeks
Mucolite drops 5 drops TID x 2 weeks
Admission weight : 3.6 kg
Discharge weight : 3.6 kg
JULY 10Name : B/o. Fathu munisha Age/Sex : NB/ M Dept : NeonatologyHos.No: 467629 Mrd.No : 346802 Ward: IL.NB. NICUD.O.A : 03.07.10 D.O.D : 03.07.10 ************************************************************************
DIAGNOSIS: TERM / BIRTH ASPHYXIA / MECONIUM ASPIRATION SYNDROME / (L) CTEV ? ARTHROGRYPOSIS
COURSE:
This term male baby was born by emergency LSCS (Ind : PIH with
oligohydraminos with breech presentation) on 02.07.10 @ 10.23 pm (EDD :
23.07.10) H/o. Baby didn’t cry after birth, H/o. Meconium aspiration +. Baby was
intubated and aspiration of meconium done. Apgar of 5min – 6/10, after these
initial resuscitation measures, baby developed spontaneous respiration, but had
severe distress. Baby was reintubated and connected to mechanical ventilator. H/o.
thick meconium stained liquor +. Maternal H/o. PIH. Past 3 months. H/o. PROM
for 7hrs. No maternal H/o. GDM, fever with rash UTI. O/E : Baby’s on ventilator
support. Peripheries cold, peripheral cyanosis +, not icteric, not anaemic, webbing
of neck + restricted movement of right and left elbow joint, knee joints (L) CTEV
with over lapping of 2nd digit over thumb. CVS : S1 S2 +, no murmurs, RS :
Bilateral air entry +, P/A : Soft, CNS : NNR absent. Baby was managed with
ventilator support, (series of ABG taken, ventilator settings changed accordingly),
Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, ionotropes. Condition of the
baby and prognosis was well explained to parents. Since parents were not willing
for further management, baby is discharged AGAINST MEDICAL ADVICE on
03.07.10.
INVESTIGATIONBLOOD BANK
BLOOD GROUPING & Rh TYPING
B POSITIVE 03-07-2010 / 10:05
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 14.6 13.6 to 19.6 g/dL 03-07-2010 / 13:04
TOTAL WBC COUNT (Coulter Principle) 23000 10000 to 25000 Cells/cumm 03-07-2010 / 13:04
PLATELET COUNT (Plt Histogram) 11000
0
150000 to 450000 Cells/
cumm 03-07-2010 / 13:04
PCV (Hct) (Calculated) 41 44 to 62 % 03-07-2010 / 13:04
TOTAL RBC COUNT (Coulter Principle) 3.6 4.9 to 5.6 Mill/Cumm 03-07-2010 / 13:04
MCV (RBC Histogram) 112 76 to 96 Fl 03-07-2010 / 13:04
MCH (Calculated) 39 27 to 32 pg/cell 03-07-2010 / 13:04
MCHC (Calculated) 35 32 to 36 % 03-07-2010 / 13:04
RDW (RBC Histogram) 18.7 11 to 15 % 03-07-2010 / 13:04
MPV (Plt Histogram) 6.5 6 to 10.2 Fl 03-07-2010 / 13:04
PATHOLOGY
.
RBCs show macrocytic normochromic .
No nucleated RBCs or hemoparasites.
WBC count neutrophilic leukocytosis.
No atypical or immature cells.
03-07-2010 / 13:04
DIFFERENTIAL COUNT : NeutroPhils :74%
Eosinophils :00%
Monocytes :05%
Lymphocytes :21%
03-07-2010 / 13:04
Plalets Count adequate ( seen in
clumps).
03-07-2010 / 13:04
IMPRESSION : -- 03-07-2010 / 13:04
Name : B/o. Sathiya Age/Sex : NB/ M Dept : NeonatologyHos.No: 467798 Mrd.No : 346877 Ward: IL.NB. NICUD.O.A : 03.07.10 D.O.D : 05.07.10 ************************************************************************REF.BY.DR.MURUGADASS., PLACE : MADURAI
DIAGNOSIS: TERM / MECONIUM ASPIRATION SYNDROME / SEVERE PERSISTENT PULMONARY HYPERTENSION OF NEWBORN
COURSE:
This term male baby was referred to MMHRC on 03.07.10 as a case of
meconium aspiration with birth asphyxia. Baby born by normal vaginal delivery
on 03.07.10 at 8.40pm. H/o. Baby didn’t cry after birth (resuscitation details not
known). H/o. Thick Meconium stained liquor and aspiration +. H/o. Baby
developed respiratory distress since birth. No H/o. cyanosis, convulsions, cord
around the neck. No Maternal H/o. PIH, GDM, Hypothyroidism, fever with rash.
O/E : Baby’s cry and activity : weak, CFT > 3 sec, peripheral cyanosis +, not
icteric, not anaemic, no external anamoly, CVS : S1 S2 +, no murmurs, RS :
Bilateral air entry equal, RR : 90/mt, SCR +, ICR +, grunting +, P/A : Soft, CNS :
NNR sluggish. Baby was intubated & connected to mechanical ventilator support.
ABG showed progressive, hypercarbia with hypoxia. ventilator settings changed
accordingly. Baby was investigated showed Hb : 18.7gm%, TC : 26,000, platelet :
2.3 lakhs. Chest x-ray showed features of meconium aspiration. Baby was
managed with ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium
gluconate, inotropes & pulmonary vasodilators. Since parents wants to continue
the further treatment in Government Hospital, baby is discharged AT REQUEST
on 05.07.10
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 04-07-2010 / 12:48
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 18.7 13.6 to 19.6 g/dL 05-07-2010 / 12:25
TOTAL WBC COUNT (Coulter Principle) 26600 10000 to 25000 Cells/cumm 05-07-2010 / 12:25
PLATELET COUNT (Plt Histogram) 23000
0
150000 to 450000 Cells/
cumm 05-07-2010 / 12:25
PCV (Hct) (Calculated) 56 44 to 62 % 05-07-2010 / 12:25
TOTAL RBC COUNT (Coulter Principle) 5.3 4.9 to 5.6 Mill/Cumm 05-07-2010 / 12:25
MCV (RBC Histogram) 106 76 to 96 Fl 05-07-2010 / 12:25
MCH (Calculated) 35 27 to 32 pg/cell 05-07-2010 / 12:25
MCHC (Calculated) 33 32 to 36 % 05-07-2010 / 12:25
RDW (RBC Histogram) 17.7 11 to 15 % 05-07-2010 / 12:25
MPV (Plt Histogram) 7.4 6 to 10.2 Fl 05-07-2010 / 12:25
PATHOLOGY
.
RBCs show macrocytic normochromic.
Nucleated RBCs 3/100WBCs.
Hemoparasites Nil.
WBC count neutrophilic leukocytosis.
No atypical or immature cells.
05-07-2010 / 12:25
DIFFERENTIAL COUNT : NeutroPhils :60%
Eosinophils :04%
Monocytes :02%
Lymphocytes :34%
05-07-2010 / 12:25
Platelets Count Adequate 05-07-2010 / 12:25
IMPRESSION : -- 05-07-2010 / 12:25
AUGUST 10Name : B/o. Sathya Priya Age/Sex : NB/ M Dept : NeonatologyHos.No: 473753 Mrd.No : 350618 Ward: IL.NB. NICUD.O.A : 12.08.10 D.O.D : 14.08.10 ************************************************************************REF.BY.DR. SAVITHRI., PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PPHN ? CONGENITAL HEART DISEASE COURSE:
This term AGA, male baby was born by normal vaginal delivery on
12.08.2010 at 10.45p.m., H/o. Baby cried soon after birth, developed respiratory
distress since birth. H/o. Thick meconium stained liquor +. No H/o. convulsion /
cyanosis at birth. Maternal history: Primi, 25 years. H/o. Fever 2 days back before
delivery. No H/o. GDM / PIH / Hypothyroidism / fever with rash / eclampsia.
O/E: Baby cry – weak, activity – weak, colour – pale, CFT > 2 sec. Severe
respiratory distress +. Saturation was 70% with 5 liters of O2, tachypnea +,
dyspnea +. CVS: S1 S2 heard, no murmur, RS : Tachypnea +, ICR, SCR +,
Bilateral crept +. P/A: Soft, CNS: NNR. Sluggish. Baby was immediately
intubated and connected to mechanical ventilator. Baby was investigated HB:
13.7gm%, TC: 20,500cells/mm, Platelet count: 2.5lakhs. Chest x – ray was
showing bilateral infiltrates. ABG taken, showed severe respiratory acidosis,
ventilator settings changed accordingly. Baby was treated with Iv Fluids, Iv.
Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K. Baby developed 2 episodes of
convulsions managed with anticonvulsants. As baby had hypotension, inotropes
were started. ABG periodically monitored showed persistently high PcO2, low
PO2 inspite of maximum ventilator support. Baby had persistent hypotension,
Noradrenaline infusion started. PPHN was suspected hence pulmonary vasodilators
were started and planned for Echo to rule out CHD. Now baby is on high
frequency ventilatory support maintained Spo2 of 85% only. The condition of the
baby and the prognosis were explained to the parents. They were not willing for
further management, baby was discharged AGAINST MEDICAL ADVICE on
14.08.10.
INVESTIGATION:BLOOD BANK
BLOOD GROUPING & Rh TYPING
A POSITIVE 13-08-2010 / 15:54
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 13.7 13.6 to 19.6 g/dL 13-08-2010 / 18:31
TOTAL WBC COUNT (Coulter Principle) 20500 10000 to 25000 Cells/cumm 13-08-2010 / 18:31
PLATELET COUNT (Plt Histogram) 20500
0
150000 to 450000 Cells/
cumm 13-08-2010 / 18:31
PCV (Hct) (Calculated) 42 44 to 62 % 13-08-2010 / 18:31
TOTAL RBC COUNT (Coulter Principle) 3.8 4.9 to 5.6 Mill/Cumm 13-08-2010 / 18:31
MCV (RBC Histogram) 111 76 to 96 Fl 13-08-2010 / 18:31
MCH (Calculated) 35 27 to 32 pg/cell 13-08-2010 / 18:31
MCHC (Calculated) 32 32 to 36 % 13-08-2010 / 18:31
RDW (RBC Histogram) 18.4 11 to 15 % 13-08-2010 / 18:31
MPV (Plt Histogram) 6.8 6 to 10.2 Fl 13-08-2010 / 18:31
PATHOLOGY
RBCs show normochromic normocytes
and macrocytes.
Nucleated RBCs 7/100WBCs.
WBC count shows leukocytosis with
shift to left.
No atypical or immature cells.
13-08-2010 / 18:31
DIFFERENTIAL COUNT : NeutroPhils :76%
Eosinophils :02%
Monocytes :03%
Lymphocytes :19%
13-08-2010 / 18:31
Platelets Count normal in Number and
morphology
13-08-2010 / 18:31
IMPRESSION : LEUKOERYTHROBLASTIC BLOOD
PICTURE.
13-08-2010 / 18:31
Name : B/o. Prabavathy Age/Sex : NB/ M Dept : NeonatologyHos.No: 474061 Mrd.No : 350824 Ward: IL.NB. NICUD.O.A : 16.08.2010 D.O.D : 17.08.2010 ************************************************************************REF.BY. DR.UMAMAHESWARI., PLACE : SINGAMPUNARI
DIAGNOSIS: PRETERM (31 – 32 WEEKS) VERY LOW BIRTH WEIGHT RESPIRATORY DISTRESS SYNDROME
( ONE DOSE OF SURFACTANT GIVEN)
Name : B/o. Shanthi Age/Sex : NB/ M Dept : NeonatologyHos.No: 470943 Mrd.No : 348818 Ward: IL.NB. NICUD.O.A : 24.07.10 D.O.D : 10.08.10 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA WITH SEIZURE HIE STAGE II MECONIUM ASPIRATION SYNDORME
COURSE:
This Term / AGA / male baby born on 23.07.10 at 9.50am via labour
naturalis was referred to MMHRC with H/o. Baby didn’t cry after birth and H/o.
Meconium stained liquor. Mother is a primi para with no H/o. PIH, GDM,
Recurrent UTI or fever with rash. H/o. Difficult second stage of labour. Baby
didn’t cry soon after birth and was resuscitated with O2 and suctioning. Baby had
weak cry after that. H/o. meconium staining of liquor with ? aspiration. No H/o.
cyanosis, cord around the neck. Baby had 2-3 episodes of convulsions at referral
hospital. O/E : Baby had poor activity and no cry. Colour : Pink, CFT < 3 sec, HR :
156/min, regular RR : 68/min, Spo2 : 96% with O2, No Pallor, cyanosis, edema,
no birth injuries, no external congenital anomalies, CVS : S1 S2 +, normal, no
murmurs, RS : Distress + (ICR, SCR and nasal flaring +), Tachypnea +, Bilateral
air entry equal, No adventitious sounds, P/A : soft, no organomegaly, CNS :
Sluggish reflexes and hypotonia suggestive of encephalopathy. In emergency
department baby had apnea with Spo2 falling to 55% with cyanosis. Baby was first
given ambu – mask ventilation and then intubated and connected to mechanical
ventilator. Baby had one more episode of convulsion there. Baby was managed
with Iv. Fluid, Iv. Antibiotics, anticonvulsants and other supportive and
symptomatic treatment measures. With these baby’s general condition improved,
started on oral feeds and discharged with following advice.
INVESTIGATION
Glucometer
GLUCOMETER SUGAR
10am 115 mg/dl 06-08-2010 / 14:54
10pm 95 mg/dl 06-08-2010 / 14:55
10am 99 mg/dl 06-08-2010 / 14:57
10PM 88 mg/dl 11-08-2010 / 09:30
10AM 86mg/dl 11-08-2010 / 12:13
10AM 84 mg/dl 11-08-2010 / 13:00
10PM 102 mg/dl 11-08-2010 / 13:01
BLOOD BANK
BLOOD GROUPING & Rh TYPING
APOSITIVE 25-07-2010 / 12:28
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 11.8 13.6 to 19.6 g/dL 26-07-2010 / 11:50
TOTAL WBC COUNT (Coulter Principle) 15700 10000 to 25000 Cells/
cumm 26-07-2010 / 11:50
PLATELET COUNT (Plt Histogram) 18500
0
150000 to 450000 Cells/
cumm 26-07-2010 / 11:50
PCV (Hct) (Calculated) 35 44 to 62 % 26-07-2010 / 11:50
TOTAL RBC COUNT (Coulter Principle) 3.2 4.9 to 5.6 Mill/Cumm 26-07-2010 / 11:50
MCV (RBC Histogram) 109 76 to 96 Fl 26-07-2010 / 11:50
MCH (Calculated) 36 27 to 32 pg/cell 26-07-2010 / 11:50
MCHC (Calculated) 32 32 to 36 % 26-07-2010 / 11:50
RDW (RBC Histogram) 17.7 11 to 15 % 26-07-2010 / 11:50
MPV (Plt Histogram) 6.6 6 to 10.2 Fl 26-07-2010 / 11:50
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) 1.7 0.4 to 1.4 mg/dL 24-07-2010 / 20:46
Plasma CREATININE (Jaffe Kinetic) 0.8 0.4 to 1.4 mg/dL 27-07-2010 / 07:43
POTASSIUM (ISE) 2.6 3.5 to 5 mEq/L 29-07-2010 / 09:10
POTASSIUM (ISE) 4.5 3.5 to 5 mEq/L 30-07-2010 / 16:20
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 12 MICRO GRAM/ML 24-07-2010 / 21:02
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show macrocytic
normochromic.
Nucleated RBCs+.
Hemoparasites Nil.
WBC count normal in number
morphology with neutrophilic
preponderance.
No atypical or immature cells.
26-07-2010 / 11:50
DIFFERENTIAL COUNT : NeutroPhils :87% 26-07-2010 / 11:50
Eosinophils :01%
Monocytes :02%
Lymphocytes :10%
Platelets Count Adequate 26-07-2010 / 11:50
IMPRESSION : -- 26-07-2010 / 11:50
ADVICE ON DISCHARGE
Tab. Gardenol 20mg HS x Till further advice
Tab. Fluconazole 50mg ½ OD x 7 days
DR. A. KANNAN., MD., DCH., SR. CONSULTANT
Name : B/o.Kaladevi Age/Sex : NB/ M Dept : NeonatologyHos.No: 472829 Mrd.No : 350061 Ward: IL.NB. NICUD.O.A : 07.08.10 D.O.D : 15.08.10 ************************************************************************DIAGNOSIS: BIRTH ASPHYXIA WITH SEIZURE MECONIUM ASPIRATION SYNDORME ACUTE RENAL FAILURE
HIE STAGE 2
COURSE:
This 2 days old Term / AGA / Male baby was born at private hospital by
LSCS (Ind : Previous LSCS) on 05.08.10 @ 10.30am. H/o. Birth asphyxia +. H/o.
Baby had respiratory distress since birth. H/o. Poor feeding, fever & drowsiness
since 2nd day of life. H/o. Convulsion – 5 episodes on 2nd day of life. H/o.
Meconium aspiration +. Baby was treated as meconium aspiration syndrome /
septicemia / meningitis at GH (Paramakudi) & brought to MMHRC on 07.08.10
for further management. MH/o. Typhoid in fever 2nd trimester +. No MH/o. PIH,
GDM & PROM. O/E : Baby’s activity & cry : poor, grunting respiration +,
dyspnoeic +, CFT > 3 sec, peripheral cyanosis, tachypneia +, no obvious external
anomaly, CVS : S1 S2 heard, RS : RR @ 72/mt, LCI +, Grunting +, P/A : Liver 3
cm palpable, spleen 1cm +, CNS : Hypotonia +, NNR sluggish. Baby was
investigated peripheral smear showed Hb : 14.4gms%, TC : 33,100 cells/mm3 &
platelet count : 2.2 lakhs, PCV : 44. Serum creatinine : 1.3mg/dl (07.08.10),
0.8mg/dl (09.08.10) & 0.4mg/dl (14.08.10). CRP : Positive. Serum K+ : 2.9mg/dl.
Blood culture showed no growth. Chest x-ray suggestive of bilateral infiltrations.
Baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics,
Inj. Calcium gluconate, Inj. Dopamine infusion & Inj. Gardenol. As baby had
decreased urine output with increased renal parameters managed with Inj. Lasix &
Hypokalemia was corrected with oral KCl. Series of ABG’s were done, ventilator
settings were adjusted accordingly to that. Baby was started on small ryles tube
feeds, but had abdominal distension so feeding withheld. Baby’s repeat serum
creatinine became normal & urine output improved. Now baby is in mechanical
ventilator support with Fio2 70%, maintaining Spo2 98% & in NPO. Since parents
were not willing for further management, baby is discharged AGAINST
MEDICAL ADVICE on 15.08.10 @ 9pm.
INVESTIGATION
Glucometer
GLUCOMETER SUGAR
6AM 41mg/dl 11-08-2010 / 12:26
12PM HI 11-08-2010 / 12:27
2PM HI 11-08-2010 / 12:27
5PM 329mg/dl 11-08-2010 / 12:28
BLOOD BANK
BLOOD GROUPING & Rh TYPING
B POSITIVE 07-08-2010 / 10:08
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 14.4 11.2 to 19.6 g/dL 07-08-2010 / 10:17
TOTAL WBC COUNT (Coulter Principle) 33100 6000 to 18000 Cells/cumm 07-08-2010 / 10:17
PLATELET COUNT (Plt Histogram) 22200
0
150000 to 450000 Cells/
cumm 07-08-2010 / 10:17
PCV (Hct) (Calculated) 44 35 to 62 % 07-08-2010 / 10:17
TOTAL RBC COUNT (Coulter Principle) 4.1 4.9 to 5.6 Mill/Cumm 07-08-2010 / 10:17
MCV (RBC Histogram) 108 76 to 96 Fl 07-08-2010 / 10:17
MCH (Calculated) 35 27 to 32 pg/cell 07-08-2010 / 10:17
MCHC (Calculated) 32 32 to 36 % 07-08-2010 / 10:17
RDW (RBC Histogram) 19.4 11 to 15 % 07-08-2010 / 10:17
MPV (Plt Histogram) 8.0 6 to 10.2 Fl 07-08-2010 / 10:17
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) 1.3 0.4 to 1.4 mg/dL 07-08-2010 / 08:01
Plasma CREATININE (Jaffe Kinetic) 0.8 0.4 to 1.4 mg/dL 09-08-2010 / 13:18
Plasma CREATININE (Jaffe Kinetic) 0.4 0.4 to 1.4 mg/dL 14-08-2010 / 21:30
POTASSIUM (ISE) 2.9 3.5 to 5 mEq/L 09-08-2010 / 13:35
POTASSIUM (ISE) 7.7 3.5 to 5 mEq/L 15-08-2010 / 15:28
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 12 MICROGRAM/ML 07-08-2010 / 08:44
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show macrocytic normochromic.
Nucleated RBCs+
Hemoparasites Nil.
WBC count neutrophilic leukocytosis
with shift to left .
No atypical or immature cells.
07-08-2010 / 10:17
DIFFERENTIAL COUNT : NeutroPhils :80%
Eosinophils :01%
Monocytes :03%
Lymphocytes :16%
07-08-2010 / 10:17
Platelets Count Adequate 07-08-2010 / 10:17
IMPRESSION : -- 07-08-2010 / 10:17
Name : B/o. Kavitha Age/Sex : NB/ M Dept : NeonatologyHos.No: 473705 Mrd.No : 350602 Ward: IL.NB. NICUD.O.A : 13.08.10 D.O.D : 17.08.10 ************************************************************************REF.BY.DR. BASKAR., PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH HIE COURSE:
This term male new born baby was referred to MMHRC an 13.08.10 as a
case of birth asphyxia with respiratory distress. Baby was born by normal vaginal
delivery on 11.08.10 @ 4.30 a.m. H/o. Meconium staining of liquor (thick) +. No
H/o. PROM, cord around the neck. Baby had weak cry after birth with H/o.
meconium aspiration.. H/o. respiratory distress since birth. Hence referred to
MMHRC for further management. No H/o. cyanosis, convulsion, jaundice,
bleeding manifestations. Maternal history: 23 years. No H/o. PIH, GDM, fever
with rash, seizure, hypothyroidism in antenatal period. O/E: Baby cry & activity –
weak, CFT < 3sec, colour: central cyanosis+, SpO2 : 70% with O2 5lit//min.
severe respiratory distress +, tachypnea with RR of 80/min. IC and SC retractions
+. No signs of dehydration / No external congenital anamolies. HR : 146/min,
regular, BP : 71 mmHg, CVS : S1 S2 heard, no murmur, RS : Bilateral air entry
equal, severe respiratory distress +, P/A : soft, no organomegaly, CNS :
encephalopathy +, NNR sluggish. Baby was investigated Hb : 21.8mg%, Tc :
14,900cells, Platelet count : 1.6 lakhs, PCV : 60, CRP : Negative. Serum creatinine
: 0.4mg%. Peripheral smear showed neutrophilic preponderance with shift to left.
Baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics,
Inj. Calcium gluconate and Inj. Vit K. ABG was periodically monitored, ventilator
settings changed accordingly. Baby’s continued to be dusky and cyanosis, BP was
falling, Inotropes were started and planned for ECHO. The condition of the baby
and prognosis were explained to the attenders. As they were not willing for the
further management, child discharged “AGAINST MEDICAL ADVICE” on
17.08.10 @ 3.p.m.
INVESTIGATIONBLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 13-08-2010 / 09:22
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 21.8 11.2 to 19.6 g/dL 13-08-2010 / 10:32
TOTAL WBC COUNT (Coulter Principle) 14900 6000 to 18000 Cells/cumm 13-08-2010 / 10:32
PLATELET COUNT (Plt Histogram) 16100
0
150000 to 450000 Cells/
cumm 13-08-2010 / 10:32
PCV (Hct) (Calculated) 60 35 to 62 % 13-08-2010 / 10:32
TOTAL RBC COUNT (Coulter Principle) 5.7 4.9 to 5.6 Mill/Cumm 13-08-2010 / 10:32
MCV (RBC Histogram) 108 76 to 96 Fl 13-08-2010 / 10:32
MCH (Calculated) 38 27 to 32 pg/cell 13-08-2010 / 10:32
MCHC (Calculated) 35 32 to 36 % 13-08-2010 / 10:32
RDW (RBC Histogram) 17.7 11 to 15 % 13-08-2010 / 10:32
MPV (Plt Histogram) 7.8 6 to 10.2 Fl 13-08-2010 / 10:32
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) 0.4 0.4 to 1.4 mg/dL 13-08-2010 / 11:56
POTASSIUM (ISE) 4.4 3.5 to 5 mEq/L 13-08-2010 / 11:56
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 13-08-2010 / 11:42
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show erthrocytosis.Macrocytic
normochromic .
No nucleated RBCs or hemoparasites.
WBC count neutrophilic
prepondrance shift to left.
No atypical or immature cells.
13-08-2010 / 10:32
DIFFERENTIAL COUNT : NeutroPhils :75%
Eosinophils :00%
Monocytes :01%
Lymphocytes :24%
13-08-2010 / 10:32
Platelets Count Adequate 13-08-2010 / 10:32
IMPRESSION : -- 13-08-2010 / 10:32
Name : B/o. Sonia Age/Sex : NB/ F Dept : NeonatologyHos.No: 473335 Mrd.No : 350386 Ward: IL.NB. NICUD.O.A : 11.08.10 D.O.D : 19.08.10 ************************************************************************REF.BY.DR.GURUSUNDAR., PLACE : MADURAI
DIAGNOSIS: TERM / AGA / BIRTH ASPHYXIA MECONIUM ASPIRATON SYNDROME
COURSE:
This Term / AGA / female baby was referred to MMHRC on 11.08.10 as a
case of birth asphyxia with meconium aspiration syndrome. Baby was born by
normal vaginal delivery on 10.08.10 at 3.26am. H/o. baby didn’t cry immediately
after birth, cried after 10 mints of resuscitation with O2, tactile stimulation, baby
and mask ventilation. H/o. Respiratory distress +. Baby was treated with Iv. Fluids,
Inj. Vitamin K, Inj. Gardenol and referred here for further management. No H/o.
cyanosis, convulsion at admission. Maternal History : Primi, 24 years. No Maternal
H/o. GDM, PIH, Hypothyroidism, fever with rash. No H/o. PROM, Cord around
the neck. H/o. Meconium stained liquor. O/E : Baby’s cry – irritable, activity :
moderate, CFT < 3 sec, HR : 150/m, RR : 76/min. No pallor, not icteric, no
cyanosis, no external anomaly, CVS : S1 S2 heard, RS : dyspnoea +, tachypnoea +,
Bilateral air entry +, Bilateral crepts +, P/A : Soft, CNS : NNR sluggish. Baby was
admitted at NICU investigated which showed normal haemogram, CRP : Positive.
(12 meq), serum creatinine : 0.8mg/dl. Blood culture showed no growth. Chest x-
ray showed bilateral infiltrations. ECHO showed 2-3 mm PDA. No pulmonary
hypertension. Baby was started on treatment with Nasal C-PAP with 5 liters of O2,
Iv. Fluids, Iv. Antibiotics, Iv. Anticonvulsants. Baby’s respiratory distress was
increasing, hence intubated and connected to mechanical ventilator after 4hrs of
admission. ABG showed metabolic acidosis. Bicarbonate correction given. On
13.08.10, baby had poor perfusion with hypotension, hence Inotropic support
started. ABG taken showed severe respiratory acidosis, ventilatory settings
changed accordingly, and ABG periodically recorded. Baby was having
persistently high PCO2 with high frequency ventilation, baby
respiratory distress mildly decreased. Baby was started on RTF and gradually
increased, tolerating well. Now baby is on SIMV mode of ventilation with FIO2 :
35%, Freq: 50, P max – 25, PeeP : 6. As the parents were not willing for further
management discharged AGAINST MEDICAL ADVICE on 19.08.10.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
AB POSITIVE 11-08-2010 / 09:58
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 21.4 13.6 to 19.6 g/dL 11-08-2010 / 12:31
TOTAL WBC COUNT (Coulter Principle) 27500 10000 to 25000 Cells/cumm 11-08-2010 / 12:31
PLATELET COUNT (Plt Histogram) 25600
0
150000 to 450000 Cells/
cumm 11-08-2010 / 12:31
PCV (Hct) (Calculated) 59 44 to 62 % 11-08-2010 / 12:31
TOTAL RBC COUNT (Coulter Principle) 7.1 4.9 to 5.6 Mill/Cumm 11-08-2010 / 12:31
MCV (RBC Histogram) 101 76 to 96 Fl 11-08-2010 / 12:31
MCH (Calculated) 36 27 to 32 pg/cell 11-08-2010 / 12:31
MCHC (Calculated) 35 32 to 36 % 11-08-2010 / 12:31
RDW (RBC Histogram) 16.6 11 to 15 % 11-08-2010 / 12:31
MPV (Plt Histogram) 6.8 6 to 10.2 Fl 11-08-2010 / 12:31
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 0.7 0.4 to 1.4 mg/dL 12-08-2010 / 14:07
POTASSIUM (ISE) 3.9 3.5 to 5 mEq/L 15-08-2010 / 09:42
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 12 MICROGRAM / ML 12-08-2010 / 15:24
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show erythrocytosis with poorly
preserved morphology.
No nucleated RBCs or hemoparasites.
WBC count neutrophilic leukocytosis
with shift to left.
No atypical or immature cells.
11-08-2010 / 12:31
DIFFERENTIAL COUNT : NeutroPhils :83%
Eosinophils :01%
Monocytes :05%
11-08-2010 / 12:31
Lymphocytes :11%
Platelets Count Adequate 11-08-2010 / 12:31
IMPRESSION : -- 11-08-2010 / 12:31
Name : B/o. Karpagam Age/Sex : NB/ F Dept : NeonatologyHos.No: 472617 Mrd.No : 349874 Ward: IL.NB. NICUD.O.A : 05.08.10 D.O.D : 20.08.10 ************************************************************************REF.BY.DR. AMUTHAKALAVALLI., PLACE : MELUR
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME BIRTH ASPHYXIA
HIE STAGE 2 COURSE:
This term (4 days post dated) / AGA / female baby / delivered by LSCS (Ind
: Post dated with fetal distress) on 05.08.10 at 7.34am in a private hospital was
admitted with H/o. respiratory distress since birth. Mother is 28 years old, para 2,
second degree consanguinously married with no significant antenatal
conmplications. Baby had 3 rounds of cord around the neck and liquor was
meconium stained with ? aspiration of meconium. Baby cried soon after birth. H/o.
Respiratory distress since birth that increased gradually, hence baby was referred
here for further management. No H/o. Convulsion, cyanosis, jaundice. After
admission, baby had one episode of convulsion. O/E: Baby’s cry & activity –
weak, severe respiratory distress +, CFT > 3 sec, peripheral cyanosis +. No pallor,
icterus, edema, no external anomalies seen. CVS : S1 S2 +, normal, no murmurs.
RS : Severe respiratory distress +, ICR, SCR, Nasal flaring +, Tachypnea +,
Bilateral air entry equal, NVBS heard, no adventitious sounds, SpO2 : 84%
without O2 P/A : Soft, no organomegaly, CNS : NNR sluggish. Features of
encephalopathy +. Baby was immediately intubated and connected to mechanical
ventilator. On investigation Total WBC count was elevated 42,400/mm3. Hb was
normal. Serum creatinine was 1.2 but improved to 0.6mg% with treatment CRP
was negative. Baby was managed with Iv. Fluid, Iv. Antibiotics, anticonvulsant,
mechanical ventilator and other symptomatic and supportive therapeutic measures.
Baby’s general condition improved. Baby was weaned from the ventilator and
feeds introduced gradually. Baby was discharged in stable condition with
following advice.
INVESTIGATIONGlucometer
GLUCOMETER SUGAR
1AM 136 mg/dl 11-08-2010 / 14:40
4AM 169 mg/dl 11-08-2010 / 14:41
7AM 156 mg/dl 11-08-2010 / 14:41
1PM 130 mg/dl 11-08-2010 / 14:42
7PM 110 mg/dl 11-08-2010 / 14:44
2AM 145 mg/dl 11-08-2010 / 14:44
8AM 127 mg/dl 11-08-2010 / 14:45
4PM 125 mg/dl 11-08-2010 / 14:45
10PM 136 mg/dl 11-08-2010 / 14:46
4AM 164 mg/dl 11-08-2010 / 14:46
12PM 108 mg/dl 11-08-2010 / 14:47
8PM 112mg/dl 11-08-2010 / 14:47
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 06-08-2010 / 10:07
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 17.0 13.6 to 19.6 g/dL 06-08-2010 / 18:30
TOTAL WBC COUNT (Coulter Principle) 42400 10000 to 25000 Cells/cumm 06-08-2010 / 18:30
PLATELET COUNT (Plt Histogram) 15000
0
150000 to 450000 Cells/
cumm 06-08-2010 / 18:30
PCV (Hct) (Calculated) 52 44 to 62 % 06-08-2010 / 18:30
TOTAL RBC COUNT (Coulter Principle) 4.4 4.9 to 5.6 Mill/Cumm 06-08-2010 / 18:30
MCV (RBC Histogram) 115 76 to 96 Fl 06-08-2010 / 18:30
MCH (Calculated) 37 27 to 32 pg/cell 06-08-2010 / 18:30
MCHC (Calculated) 32 32 to 36 % 06-08-2010 / 18:30
RDW (RBC Histogram) 18.7 11 to 15 % 06-08-2010 / 18:30
MPV (Plt Histogram) 6.8 6 to 10.2 Fl 06-08-2010 / 18:30
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 1.2 0.4 to 1.4 mg/dL 07-08-2010 / 10:52
Plasma Creatinine (Jaffe Kinetic) 0.6 0.4 to 1.4 mg/dL 09-08-2010 / 16:03
POTASSIUM (ISE) 4.1 3.5 to 5 mEq/L 06-08-2010 / 10:08
POTASSIUM (ISE) 3.0 3.5 to 5 mEq/L 08-08-2010 / 07:55
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 07-08-2010 / 12:27
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes
and macrocytes.NRBCs 15/100 WBCs.
No nucleated RBCs or hemoparasites.
WBC count neutrophilic leukocytosis
with shift to left.
06-08-2010 / 18:30
No atypical or immature cells.
DIFFERENTIAL COUNT : Myelocytes :02%
NeutroPhils :70%
Stab :04%
Eosinophils :00%
Monocytes :03%
Lymphocytes :21%
06-08-2010 / 18:30
Platelets Count normal in Number and
morphology
06-08-2010 / 18:30
IMPRESSION : LEUKOERTHROBLASTIC BLOOD
PICTURE.
06-08-2010 / 18:30
ADVICE ON DISCHARGE
Inj. Ronem 100mg IV BD x 5 days
Domstal drops 6 drops TID x 1 week
Tab. Gardenal 15mg HS x 3 months
Name : B/o. Benazir Begam Age/Sex : NB/ F Dept : NeonatologyHos.No: 472663 Mrd.No : 349954 Ward: IL.NB. NICUD.O.A : 06.08.10 D.O.D : 20.08.10 ************************************************************************REF.BY.DR.PEER MOHAMED., PLACE : MADURAI
DIAGNOSIS: BIRTH ASPHYXIA WITH NEONATAL SEIZURE HIE STAGE 2 MECONIUM ASPIRATION SYNDROME
COURSE:
This Pre term (34-36 weeks) / AGA / female baby deliverd by LSCS (Ind :
fetal distress) was referred to MMHRC for respiratory distress since birth. Mother
is 23 years / primi / on fertility treatment for 5 years. No H/o. PIH, GDM, Fever
with rash, hypothyroidism during antenatal period. EDD was 15.09.10. Amniotic
fluid was thick meconium stained and blood stained. Placenta was unhealthy. No
H/o. cord around the neck. Baby was delivered at 4.30am on 06.08.10. Baby cried
soon after birth but then developed respiratory distress. No H/o. cyanosis or
convulsion. O/E : Baby cry and activity were moderate. Trunk was pink,
acrocyanosis +, CFT < 3 sec, HR : 110/min, regular. Mean arterial pressure : 65
mm/of/Hg. RR : 60/min, regular, Spo2 : 80% without oxygen and 90% with
5lit/min oxygen via hood. No pallor, icterus, edema. No external congenital
anomalies. No signs of dehydration. CVS : S1 S2 +, normal, no murmurs, RS :
Mild distress + (sub costal indrawing and nasal flaring +), Bilateral air entry equal,
NVBS heard over both lung fields, Bilateral firn crepts +. P/A : soft, no
organomegaly. CNS : Moving all four limbs. AF normal. NNR sluggish. On
investigation: Complete blood count and serum creatinine were normal. CRP was
negative and blood culture revealed no growth of organisms. Baby developed
convulsion during course of stay in hospital. Baby was managed with bubble
CPAP, Iv. Antibiotics, Iv. Fluids, anticonvulsants and other symptomatic &
supportive treatment measures. With this baby’s respiratory distress subsided and
general condition improved. Feeds were gradually introduced which was well
tolerated by baby. Hence baby was discharged with following advice.
INVESTIGATION
Glucometer
GLUCOMETER SUGAR
1PM 112 mg/dl 11-08-2010 / 09:31
7PM 80mg/dl 11-08-2010 / 09:32
2pm 173 mg/dl 11-08-2010 / 09:40
10PM 95 mg/dl 11-08-2010 / 12:30
4AM 158 mg/dl 11-08-2010 / 12:58
10AM 117 mg/dl 11-08-2010 / 12:59
4PM 113 mg/dl 11-08-2010 / 12:59
10PM 129 mg/dl 11-08-2010 / 13:00
BLOOD BANK
BLOOD GROUPING & Rh TYPING
B POSITIVE 06-08-2010 / 10:28
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 11.9 13.6 to 19.6 g/dL 06-08-2010 / 18:20
TOTAL WBC COUNT (Coulter Principle) 7300 10000 to 25000 Cells/cumm 06-08-2010 / 18:20
PLATELET COUNT (Plt Histogram) 27200
0
150000 to 450000 Cells/
cumm 06-08-2010 / 18:20
PCV (Hct) (Calculated) 35 44 to 62 % 06-08-2010 / 18:20
TOTAL RBC COUNT (Coulter Principle) 3.1 4.9 to 5.6 Mill/Cumm 06-08-2010 / 18:20
MCV (RBC Histogram) 114 76 to 96 Fl 06-08-2010 / 18:20
MCH (Calculated) 37 27 to 32 pg/cell 06-08-2010 / 18:20
MCHC (Calculated) 33 32 to 36 % 06-08-2010 / 18:20
RDW (RBC Histogram) 17.5 11 to 15 % 06-08-2010 / 18:20
MPV (Plt Histogram) 7.4 6 to 10.2 Fl 06-08-2010 / 18:20
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 0.7 0.4 to 1.4 mg/dL 08-08-2010 / 07:19
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 08-08-2010 / 07:09
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic normocytes
and macrocytes.NRBCs 2/100 WBC.
No nucleated RBCs or hemoparasites.
WBC count normal .
No atypical or immature cells.
06-08-2010 / 18:20
DIFFERENTIAL COUNT : NeutroPhils :62%
Eosinophils :02%
Monocytes :02%
Lymphocytes :34%
06-08-2010 / 18:20
Platelets Count normal in Number and
morphology
06-08-2010 / 18:20
IMPRESSION : -- 06-08-2010 / 18:20
ADVICE ON DISCHARGE
Tab. Gardenal 15mg HS x 3 months
Syp. Eptoin 1.5ml BD x 3 months
Syp. Deriphylline 8 drops TID x 1 month
Tab. Cavetra 25mg 1/5 th BD x 1 month
Tab. Aldactone 25mg 1/5th OD x 1 month
Domstal drops 6 drops TID x 1 week
Name : B/o. Punitha devi Age/Sex : NB/ M Dept : NeonatologyHos.No: 475966 Mrd.No : 352040 Ward: IL.NB. NICUD.O.A : 28.08.10 D.O.D : 30.08.10 ************************************************************************REF.BY.DR. MUTHUARASAN., PLACE : PARAMAKUDI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERINATAL ASPHYXIA PPHN COURSE:
This term / AGA / male baby was born at private hospital by LSCS (Ind : Failed
induction) on 28.08.10 @ 1.40pm. Baby was deeply asphyxiated, cried after, tracheal toileting
bag and mask ventilation. H/o. Thick meconium stained liquor +. Since baby had severe distress
baby was referred to MMHRC on 28.08.10 for further management. No H/o. cord around the
neck. Maternal history : G2 A1. No Maternal H/o. PIH, PROM, GDM & fever with rash. O/E :
baby’s activity & cry : nil, cyanosed, dyspnoeic +, tachypnoeic +, not icteric, no birth injury &
no obvious external anamoly, CVS : S1 S2 heard, RS : ICR +, SCR +, RR@80/mnt, Bilateral air
entry +, bilateral crepts +, P/A : Soft, CNS : NNR absent. Baby was investigated peripheral
smear showed Hb : 15gms%, TC : 16,200 cells/mm3 & platelet count : 2.8 lakhs, PCV : 45.
CRP : Positive, serum creatinine : 1.3mg/dl (30.08.10). Baby was managed with mechanical
ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inotropic
support. ABG showed PH : 7.182, Pco2 : 80.9, Po2 : 20.7 with HCo3 : 29. ventilator settings
were changed accordingly. Now baby is on mechanical ventilator support, with high frequency
mode with Fio2 100%, maintaining Spo2 : 98%. Condition & prognosis of the baby were well
explained to the parents, since parents were not willing for further management, baby is
discharged AGAINST MEDICAL ADVICE on 30.08.10 @ 8.30pm.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
A POSITIVE 29-08-2010 / 13:25
HAEMOGLOBIN (Photometric
Measurement) 15.0 13.6 to 19.6 g/dL 30-08-2010 / 11:53
TOTAL WBC COUNT (Coulter Principle) 16200 10000 to 25000 Cells/cumm 30-08-2010 / 11:53
PLATELET COUNT (Plt Histogram) 28500
0
150000 to 450000 Cells/
cumm 30-08-2010 / 11:53
PCV (Hct) (Calculated) 45 44 to 62 % 30-08-2010 / 11:53
TOTAL RBC COUNT (Coulter Principle) 5.0 4.9 to 5.6 Mill/Cumm 30-08-2010 / 11:53
MCV (RBC Histogram) 110 76 to 96 Fl 30-08-2010 / 11:53
MCH (Calculated) 35 27 to 32 pg/cell 30-08-2010 / 11:53
MCHC (Calculated) 31 32 to 36 % 30-08-2010 / 11:53
RDW (RBC Histogram) 17.3 11 to 15 % 30-08-2010 / 11:53
MPV (Plt Histogram) 6.7 6 to 10.2 Fl 30-08-2010 / 11:53
Plasma Creatinine (Jaffe Kinetic) 1.3 0.4 to 1.4 mg/dL 30-08-2010 / 18:53
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 48 ul/ml 30-08-2010 / 18:49
RBCs show macrocytic normochromic.
No nucleated RBCs or hemoparasites.
WBC count neutrophilia with toxic
changes.
No atypical or immature cells.
30-08-2010 / 11:53
DIFFERENTIAL COUNT : NeutroPhils :81%
Eosinophils :01%
Monocytes :02%
Lymphocytes :16%
30-08-2010 / 11:53
Platelets Count normal in Number and
morphology
30-08-2010 / 11:53
IMPRESSION : -- 30-08-2010 / 11:53
Name : B/o. Bhuvaneswari Age/Sex : NB/ F Dept : NeonatologyHos.No: 475533 Mrd.No : 351772 Ward: IL.NB. NICUD.O.A : 26.08.2010 D.O.D : 03.09.2010 ************************************************************************DIAGNOSIS: PRETERM (30 – 32 WEEKS) / AGA RESPIRATORY DISTRESS SYNDROME SURFACTANT 1 DOSE GIVEN NEC / RH INCOMPATIBILITY
SEP 10Name : B/o. Abirami Age/Sex : NB/ M Dept : NeonatologyHos.No: 476819 Mrd.No : 352616 Ward: IL.NB. NICUD.O.A :04.09.2010 D.O.D :06.09.2010************************************************************************
DIAGNOSIS: PRETERM (28-30 WEEKS) / VLBW / RESPIRATORY DISTRESS SYNDROME ( 1 DOSE OF SURFACTANT GIVEN ON 04.09.10 ) / SHOCK
Name : B/o. Vidhya Age/Sex : NB/ M Dept : NeonatologyHos.No: 472603 Mrd.No : 349870 Ward: IL.NB. NICUD.O.A : 05.08.10 D.O.D : 02.09.10 ************************************************************************REF.BY.DR. SABARI RAJA., PLACE : SIVAGANGAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME HYPOXIC ISCHEMIC ENCEPHALOPATHY STAGE I CHRONIC LUNG DISEASE COURSE:
This term / AGA / male baby was delivered via LSCS on 04.08.10 at
6.30pm was admitted on the first day of life with H/o. Respiratory distress since
birth. Mother is 25 years old, primi with H/o. GDM and PIH during antenatal
period. No H/o. fever with rash, hypothyroidism, recurrent UTI during antenatal
period. H/o. Meconium staining of amniotic fluid. No H/o. PROM or cord around
the neck. Baby cried soon after birth, H/o. Respiratory within 2 hours after birth.
No H/o. Convulsion or cyanosis. Baby was managed with in a private hospital
with O2, Iv. Fluids, Iv. Antibioitcs and since distress didn’t subside, baby was
referred here for further management. O/E : baby had moderate cry and activity,
colour : pink, CFT < 3 sec, no pallor, icterus, cyanosis, edema, no external
congenital anamolies. No signs of dehydration. RS Tachypnoea + with RR of
80/min, regular, Spo2 : 85% (in room air), nasal flaring, sub costal and intercostals
indrawing +, bilateral NVBS +, crepts heard over both lung fields. CVS : S1 S2 +,
normal. No murmur, P/A : Soft, no organomegaly, CNS : Moving all four limbs,
NNR sluggish, AF : Normal. On investigation : complete blood count, blood sugar
and serum creatinine were normal. CRP was positive (48mg/dl). Chest x – ray
showed bilateral infiltrates. Blood culture showed no growth of organisms. Baby
was intubated and connected to mechanical ventilator support. During the course
of stay in hospital baby recived blood transfusion thrice (whole fresh blood once
and packed cell twice). Baby was on ventilator for 14 days. Baby was managed
with Iv. Fluids, Iv. Antibiotics, inotropes, vaso pressors and pulmonary
vasodilators (cavetra). Baby was also started on diuretics as weaning from the
ventilator was difficult and CLD was suspected. Other symptomatic and supportive
treatment measures were instituted. Enteral feeds was introduced but baby
developed abdominal distension, NEC was suspected and managed conservatively
with Nil per oral, then gradually feeds wre gradually introduced. With these above
management baby’s general condition improved, respiratory distress subsided, now
taking feeds well, hence baby was discharged with following advice.
INVESTIGATIONGlucometer
GLUCOMETER SUGAR
2AM 95 mg/dl 11-08-2010 / 13:03
10AM 73 mg/dl 11-08-2010 / 13:04
6PM 79 mg/dl 11-08-2010 / 13:04
2AM 79 mg/dl 11-08-2010 / 13:05
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 06-08-2010 / 10:06
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 17.3 13.6 to 19.6 g/dL 06-08-2010 / 18:18
TOTAL WBC COUNT (Coulter Principle) 24100 10000 to 25000 Cells/
cumm 06-08-2010 / 18:18
PLATELET COUNT (Plt Histogram) 18100
0
150000 to 450000 Cells/
cumm 06-08-2010 / 18:18
PCV (Hct) (Calculated) 51 44 to 62 % 06-08-2010 / 18:18
TOTAL RBC COUNT (Coulter Principle) 5.8 4.9 to 5.6 Mill/Cumm 06-08-2010 / 18:18
MCV (RBC Histogram) 114 76 to 96 Fl 06-08-2010 / 18:18
MCH (Calculated) 37 27 to 32 pg/cell 06-08-2010 / 18:18
MCHC (Calculated) 32 32 to 36 % 06-08-2010 / 18:18
RDW (RBC Histogram) 20.3 11 to 15 % 06-08-2010 / 18:18
MPV (Plt Histogram) 8.1 6 to 10.2 Fl 06-08-2010 / 18:18
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 0.4 0.4 to 1.4 mg/dL 06-08-2010 / 21:12
POTASSIUM (ISE) 5.0 3.5 to 5 mEq/L 06-08-2010 / 14:22
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 48 MICROGRAM/ML 07-08-2010 / 15:34
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show normochromic
normocytes macrocytes.NRBCs +.
Hemoparasites nil.
WBC count neutrophilic leukocytosis
with shift to left.
No atypical or immature cells.
06-08-2010 / 18:18
DIFFERENTIAL COUNT : NeutroPhils :88%
Stab :03%
Eosinophils :00%
Monocytes :02%
Lymphocytes :07%
06-08-2010 / 18:18
Platelets Count normal in Number
and morphology
06-08-2010 / 18:18
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS WITH
SHIFT TO LEFT.
06-08-2010 / 18:18
ADVICE ON DISCHARGE
Tab. Aldactone 1/4th OD x 2 weeks
Tab. Cacerta 1/5th BD x 1 weeks
Syp. Deriphylline 80 TID x 2 weeks
Syp. Domstal drops 80 TID x 2 weeks
Syp. Silybon 100 TID x 1 weeks
Name : B/o. Kousalya Age/Sex : NB/ F Dept : NeonatologyHos.No: 477497 Mrd.No : 353032 Ward: IL.NB. NICUD.O.A : 09.09.10 D.O.D : 09.09.10 ************************************************************************
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME ? PPHN COURSE:
This 1 day old term female baby as referred to MMHRC on 08.09.10 as a
case of Meconium aspiration. Baby delivered by LSCS (Ind: Fetal distress with
meconium stained Liquor) on 08.09.10 at 10.44a.m. H/o. Baby didn’t cry after
birth. H/o. respiratory distress since birth. H/o. Meconium aspiration+. No H/o.
cyanosis, convulsion at birth. No significant maternal history. O/E: Baby’s cry and
activity weak, CFT > 3 sec, peripheral cyanosis+. No pallor / icterus / external
anomaly. CVS : S1 S2 +, RS: RR @ 78/min, SCR+, ICR+. Bilateral air entry +,
Bilateral crepts +, P/A : Soft, no organomegaly, CNS : NNR sluggish. Chest x –
ray suggestive of meconium aspiration. Baby was intubated and connected to
mechanical ventilator. Managed with mechanical ventilator support, Iv. Fluids, Iv.
Antibiotics, Inotropes and supportive measures. In spite of all above measures
baby went into sudden cardiac arrest, resuscitation measures done as per the
guidelines, but could not be revived and DECLARED DEAD on 09.09.10 @
7.a.m.
INVESTIGATION:BLOOD BANK
BLOOD GROUPING & Rh TYPING
A POSITIVE 09-09-2010 / 09:04
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 16.0 13.6 to 19.6 g/dL 09-09-2010 / 16:06
TOTAL WBC COUNT (Coulter Principle) 27400 10000 to 25000 Cells/cumm 09-09-2010 / 16:06
PLATELET COUNT (Plt Histogram) 25700
0
150000 to 450000 Cells/
cumm 09-09-2010 / 16:06
PCV (Hct) (Calculated) 50 44 to 62 % 09-09-2010 / 16:06
TOTAL RBC COUNT (Coulter Principle) 4.6 4.9 to 5.6 Mill/Cumm 09-09-2010 / 16:06
MCV (RBC Histogram) 107 76 to 96 Fl 09-09-2010 / 16:06
MCH (Calculated) 34 27 to 32 pg/cell 09-09-2010 / 16:06
MCHC (Calculated) 31 32 to 36 % 09-09-2010 / 16:06
RDW (RBC Histogram) 19.4 11 to 15 % 09-09-2010 / 16:06
MPV (Plt Histogram) 8.2 6 to 10.2 Fl 09-09-2010 / 16:06
PATHOLOGY
RBCs show normochromic normocytes
and macrocytes.
Nucleated RBCs 2/100WBCs.
WBC count shows neutrophilic
leukocytosis with shift to left.
No atypical or immature cells.
09-09-2010 / 16:06
DIFFERENTIAL COUNT : NeutroPhils :73%
Eosinophils :01%
Monocytes :05%
Lymphocytes :21%
09-09-2010 / 16:06
Platelets Count normal in Number and
morphology
09-09-2010 / 16:06
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS WITH
SHIFT TO LEFT.
09-09-2010 / 16:06
Name : B/o. Shanthi Age/Sex : NB/ M Dept : NeonatologyHos.No: 474075 Mrd.No : 350822 Ward: IL.NB. NICUD.O.A :16.08.2010 D.O.D :06.09.2010************************************************************************REF.BY.DR. JEYAM., PLACE : MELUR
DIAGNOSIS: MECONUM ASPIRATION WITH SEPTICEMIA HIE STAGE II – III WITH NEONATAL SEIZURES
COURSE:
This newborn male baby was referred to MMHRC on 16.08.10 as a case of
severe birth asphyxia. Baby was born by normal vaginal delivery on 15.08.10.
baby did not cry for about half an hour after birth and was resuscitated (details not
known). Baby was deeply cyanosed at birth. H/o. respiratory distress since birth.
H/o. Irritable cry since few hours after birth. No H/o. convulsion. No H/o. Cord
around the neck. H/o. Thick meconium stained liquor +. No H/o. PPROM II stage
of labour +. Maternal history : 27 years old P2 L1 A0, IIcm, conceived seven years
after first delivery, spontaneous conception. EDD : 15.08.10. No H/o. PIH, GDM,
Hypothyrodism, fever with rash. O/E : Irritable cry, moderate activity, colour :
pink, CRT < sec, HR : 130/mt, RR : 64/m right, Spo2 : 90% without O2 and 100%
with O2 via hood. MAP : 70 mmHg. No pallor, not icteric, no cyanosis, no edema,
no dehydration, no extneral congenital anamaly +, CVS : S1 S2 heard, no murmur,
RS : tachypnea +, SCR , ICR +, Nasal flaring +, Bilateral air entry equal, NVBS +,
no adventitious limbs, AF : normal. On investigations Hb : 18.8gm%, TC :
24,600cells, Platelet count : 1.8 lakhs, CRP : Negative (17.08.10), serum creatinine
: 1.0mg/dl (17.08.10), 0.5 (20.08.10). chest x-ray showed bilateral infiltrates. Baby
was managed with nasal C-PAP, O2, Iv. Fluids, Iv. Antibiotics, Inotrope support,
Iv. Anticonvulsant (developed convulsion after admission). During the hospital
course baby had abdominal distension developed icterus & respiratory distress
managed with phototherapy, and other supportive measures. Baby was gradually
weaned from nasal C-PAP, enteral feeding started, tolerating well. With these
above measures, baby’s cry and activity improved, on DBF, tolerating well, icterus
decreased, no further convulsion occurred. Hence discharged today to continue the
following advice.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
A POSITIVE 16-08-2010 / 09:42
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 18.8 13.6 to 19.6 g/dL 16-08-2010 / 11:35
TOTAL WBC COUNT (Coulter Principle) 24600 10000 to 25000 Cells/
cumm 16-08-2010 / 11:35
PLATELET COUNT (Plt Histogram) 18200
0
150000 to 450000 Cells/
cumm 16-08-2010 / 11:35
PCV (Hct) (Calculated) 58 44 to 62 % 16-08-2010 / 11:35
TOTAL RBC COUNT (Coulter Principle) 4.8 4.9 to 5.6 Mill/Cumm 16-08-2010 / 11:35
MCV (RBC Histogram) 121 76 to 96 Fl 16-08-2010 / 11:35
MCH (Calculated) 39 27 to 32 pg/cell 16-08-2010 / 11:35
MCHC (Calculated) 32 32 to 36 % 16-08-2010 / 11:35
RDW (RBC Histogram) 18.4 11 to 15 % 16-08-2010 / 11:35
MPV (Plt Histogram) 7.7 6 to 10.2 Fl 16-08-2010 / 11:35
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 1.0 0.4 to 1.4 mg/dL 17-08-2010 / 18:50
Plasma Creatinine (Jaffe Kinetic) 0.5 0.4 to 1.4 mg/dL 20-08-2010 / 14:24
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 17-08-2010 / 20:09
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBCs show macrocytic normochromic
.NRBCs+
Hemoparasites nil.
WBC count neutrophilic leukocytosis
with shift to left.
No atypical or immature cells.
16-08-2010 / 11:35
DIFFERENTIAL COUNT : NeutroPhils :79%
Eosinophils :00%
Monocytes :05%
Lymphocytes :16%
16-08-2010 / 11:35
Platelets Count Adequate 16-08-2010 / 11:35
IMPRESSION : -- 16-08-2010 / 11:35
INVESTIGATION
Inj. Ronem 125mg IV BD x 5 days
Tab. Gardenol 15mg HS x 3 months
Syp. Silybon 10 drops TID x 2 weeks
Domstal drops 8 drops TID x 2 weeks
Name : B/o.Ambujam Age/Sex : NB/ M Dept : NeonatologyHos.No: 477908 Mrd.No : 353277 Ward: IL.NB. NICUD.O.A :11.09.2010 D.O.D :12.09.2010************************************************************************REF.BY.DR. INDIRA RAJA., PLACE : MADURAI
DIAGNOSIS: PRETERM (28-30 WEEKS) / LBW RESPIRATORY DISTRESS SYNDROME SURFACTANT THERAPY GIVEN
Name : B/o. Karthika Age/Sex : NB/ F Dept : NeonatologyHos.No: 476724 Mrd.No : 352536 Ward: IL.NB. NICUD.O.A : 03.09.10 D.O.D : 06.09.10 ************************************************************************DIAGNOSIS: TERM / RESPIRATION DISTRESS THICK MECONIUM ASPIRATION SYNDORME PERINATAL ASPHYXIA COURSE:
This term / AGA / female baby was delivered by normal vaginal delivery on 03.09.10 at
MMHRC H/o. baby cried soon after birth developed respiratory distress since birth hence
admitted at NICU for further management. H/o. Thick meconium stained liquor +. No H/o.
cyanosis, convulsion at birth. Maternal history : 23 years, G4, P1, L1, A2, EDD : 09.09.10. No
H/o. PIH, GDM, fever with rash, UTI, Hypothyrodism . No H/o. Prolonged II stage of labour,
cord around the neck. O/E : baby’s cry : moderate, activity : good, HR : 140/m ®, RR : 52/min,
mean BP : 60 mmHg, Spo2 : 95% with O2. no pallor, not icteric, no cyanosis, no external
congenital anamoly, no birth injury. CVS : S1 S2 heard, RS : grunting +, SCR +, ICR +,
Bilateral air entry +, no added sounds, P/A : Soft, CNS : NNR +. On investigations Hb : 12.9gm
%, TC : 1, 58, 000cells (corrected count - 29000), platelet count : 2.8 lakhs, PCV : 38, serum
creatinine : 0.9mg/dl. CRP : Negative. Chest x-ray showed bilateral infiltrates. Peripheral smear
showed leukoerythroblastic picture with neutophilic leukocytosis. Baby was managed with
oxygen, Iv. Fluids, Iv. Antibiotics, Inj. Calcium glucaonte, Inj. Vitamin K. RTF started and
increased to full feeds, tolerating well. With these above measures baby’s respiratory distress
decreased, cry and activity improved, tolerating breast feeds and hence discharge today with the
advice to continue the following.
INVESTIGATION
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 12.9 13.6 to 19.6 g/dL 06-09-2010 / 10:20
TOTAL WBC COUNT (Coulter Principle) 15800
0 10000 to 25000 Cells/cumm 06-09-2010 / 10:20
PLATELET COUNT (Plt Histogram) 287000 150000 to 450000 Cells/
cumm 06-09-2010 / 10:20
PCV (Hct) (Calculated) 38 44 to 62 % 06-09-2010 / 10:20
TOTAL RBC COUNT (Coulter Principle) 5.2 4.9 to 5.6 Mill/Cumm 06-09-2010 / 10:20
MCV (RBC Histogram) 89 76 to 96 Fl 06-09-2010 / 10:20
MCH (Calculated) 24 27 to 32 pg/cell 06-09-2010 / 10:20
MCHC (Calculated) 27 32 to 36 % 06-09-2010 / 10:20
RDW (RBC Histogram) 32.3 11 to 15 % 06-09-2010 / 10:20
MPV (Plt Histogram) 9.8 6 to 10.2 Fl 06-09-2010 / 10:20
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 0.9 0.4 to 1.4 mg/dL 05-09-2010 / 11:42
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 05-09-2010 / 12:33
RBCs show normocytic
normochromic .Macrocytes +.NRBCs+ (
450/ 100 WBCs )
Hemoparasites nil.
WBC count - Corrected WBC count
29,000 cells / cumm.Neutrophilic
leukocytosis with shift to left.
No atypical or immature cells.
06-09-2010 / 10:20
DIFFERENTIAL COUNT : NeutroPhils :48%
Band form :08%
Myelocytes :04%
Lymphocytes :40%
06-09-2010 / 10:20
Platelets Count Adequate. 06-09-2010 / 10:20
IMPRESSION : SUGGGESTIVE OF
LEUKOERYTHROBLASTIC PICTURE.
CLINICAL CORRELATION AND REPEAT
SMEAR IS SUGGESTED IF CLINICALY
WARRANTED.
06-09-2010 / 10:20
Name : B/o. Sangeetha Age/Sex : NB/ M Dept : NeonatologyHos.No: 481193 Mrd.No : 355246 Ward: IL.NB. NICUD.O.A :04.10.2010 D.O.D :16.10.2010************************************************************************
DIAGNOSIS: MECONUM ASPIRATION SYNDROME HIE STAGE II NEONATAL SEIZURES ACUTE RENAL FAILURE SPONTANEOUS PNEUMOTHORAX ICD DONE ON 06.10.10
COURSE:
This Term / AGA / male baby was born at private hospital by vaccum
extraction on 04.10.10 @ 5.30a.m. H/o. Baby didn’t cry immediately after birth,
cried after resuscitation (details not known). H/o. Meconium aspiration +. H/o.
Baby developed respiratory distress since birth, hence brought to MMHRC on
04.10.10 for further management. Maternal history : H/o. PROM – 15 hrs+, No
Maternal H/o. PIH / GDM / PROM & fever with rash. O/E : Baby’s activity & cry
– Nil, CFT – prolonged, peripheral cyanosis +, dyspnoeic +, tachypnoeic +, not
anemic, not icteric, no cyanosis, no birth injury & no obvious external anamoly.
CVS: S1 & S2 heard, RS : RR @ 72/mt, SCR + / LCI +, Bilateral air entry +,
bilateral crepts +, P/A: soft, CNS: NNR sluggish encephalopathy +. Baby was
investigated peripheral smear showed Hb : 14.8gm%, TC : 30,400cells/mm3,
Platelet count : 2.6 lakhs, PCV: 45. Serum creatinine : 1.5mg/dl (06.10.10),
0.6mg/dl (08.10.10), CRP: Negative. Chest x-ray suggestive of MAS. Baby was
managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj.
Calcium gluconate, Inj. Vitramin K & Inotropic support.Baby had convulsions – 2
episodes, (outside) Inj. Gardenol was added. Baby had raised Renal parameters
with decreased urine output managed with Inj. Lasix. ABG’s were done
periodically & ventilator settings were adjusted according. As baby had
desaturation on 06.10.10, Chest x – ray was taken which showed Pneumothorax
(right side). Hence ICD done and air let out. Baby had GI Bleed, Inj. Rantac was
added & 1 FFP transfusion was given on 07.10.10. With these above measures,
baby’s activity improved, respiratory distress settled, convulsions controlled so
weaned from the ventilator on 11.10.10. Baby was started on small Ryles tube
feeds & gradually raised. Repeat Serum creatinine became normal. Urine output
improved. Baby was slowly weaned from the oxygen & oral feeds tried. As air
entry improved on right side and chest x – ray became normal – ICD was removed.
Now Baby’s activity improved had no further convulsions & taking feeds oral well
hence discharged today with the advice to continue the following.
INVESTIGATION:BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 04-10-2010 / 15:59
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 14.8 13.6 to 19.6 g/dL 04-10-2010 / 18:42
TOTAL WBC COUNT (Coulter Principle) 3040
0
10000 to 25000 Cells/
cumm 04-10-2010 / 18:42
PLATELET COUNT (Plt Histogram) 26500
0
150000 to 450000 Cells/
cumm 04-10-2010 / 18:42
PCV (Hct) (Calculated) 45 44 to 62 % 04-10-2010 / 18:42
TOTAL RBC COUNT (Coulter Principle) 3.9 4.9 to 5.6 Mill/Cumm 04-10-2010 / 18:42
MCV (RBC Histogram) 116 76 to 96 Fl 04-10-2010 / 18:42
MCH (Calculated) 38 27 to 32 pg/cell 04-10-2010 / 18:42
MCHC (Calculated) 32 32 to 36 % 04-10-2010 / 18:42
RDW (RBC Histogram) 16.2 11 to 15 % 04-10-2010 / 18:42
MPV (Plt Histogram) 6.3 6 to 10.2 Fl 04-10-2010 / 18:42
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 1.5 0.4 to 1.4 mg/dL 06-10-2010 / 10:23
Plasma Creatinine (Jaffe Kinetic) 0.6 0.4 to 1.4 mg/dL 08-10-2010 / 13:21
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 06-10-2010 / 08:34
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBCs show normochromic
normocytes and macrocytes.
Nucleated RBCs 2/100WBCs.
WBC count neutrophilic
leukocytosis.
No atypical or immature cells.
04-10-2010 / 18:42
DIFFERENTIAL COUNT : NeutroPhils :75%
Eosinophils :01%
Monocytes :05%
Lymphocytes :19%
04-10-2010 / 18:42
Platelets Count normal in Number
and morphology
04-10-2010 / 18:42
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 04-10-2010 / 18:42
ADVICE ON DISCHARGE
Tab. Gardenol 15mg HS x Till further advice
Domstal drops 80 drops TID x 2 weeks
OCT 10Name : B/o.Devasudha Age/Sex : NB/ M Dept : NeonatologyHos.No: 481130 Mrd.No : 355194 Ward: IL.NB. NICUD.O.A : 03.10.10 D.O.D : 14.10.10 ************************************************************************REF.BY.DR. SURYA PRABHA., PLACE : PARAMAKUDI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME
COURSE:
This term / AGA / male baby was referred to MMHRC on 03.10.10 as a case
of Meconium aspiration syndrome with respiratory distress. Baby was delivered by
LSCS (Ind : Previous LSCS with fetal distress) on 02.10.10. H/o. Meconium
aspiration +, cried soon after birth and developed respiratory distress since birth.
H/o. Grunting +. No H/o. Cord around the neck, cyanosis, jaundice at birth.
Maternal history : 30 years, G2, P1, L1 NCM parents. No H/o. PIH, GDM,
Hypothyroidism, UTI, fever with rash. O/E : Baby’s cry and activity : weak.
Colour : cyanosis+, CFT > 3 sec, no pallor / external congenital anomaly. CVS: S1
S2 +, RS : RR @ 88/mt, SCR +, ICR +, Grunting +, Bilateral+, Bilateral crepts+,
P/A : Soft, CNS : NNR absent. On investigations, Hb : 14.6g%, TC : 12800cells,
Platelet count – 2.3 lakhs. Serum creatinine – 0.6mg%. CRP : Positive (12). Blood
culture no grew organisms. Chest x-ray showed bilateral infiltrations. ECHO
showed OS ASD (4mm) with IAS aneurysm, no pulmonary hypertension. Baby
was managed with mechanical ventilator support, inotropic support, Iv. Fluids, Iv.
Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K. ABG was periodically
recorded, which was showing metabolic acidosis, correction with NaHco3 given
and ventilator settings changed accordingly. Inspite of mechanical ventilation,
ABG showed hypoxia and baby could not be weaned from the ventilator. Need for
prolonged ventilator support and the condition of the baby were well explained to
the parent. As they were not willing for further management, baby discharged
“AGAINST MEDICAL ADVICE” on 14.10.10.
INVESTIGATIONBLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 03-10-2010 / 10:26
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 14.6 13.6 to 19.6 g/dL 04-10-2010 / 13:02
TOTAL WBC COUNT (Coulter Principle) 12800 10000 to 25000 Cells/
cumm 04-10-2010 / 13:02
PLATELET COUNT (Plt Histogram) 23000
0
150000 to 450000 Cells/
cumm 04-10-2010 / 13:02
PCV (Hct) (Calculated) 43 44 to 62 % 04-10-2010 / 13:02
TOTAL RBC COUNT (Coulter Principle) 3.6 4.9 to 5.6 Mill/Cumm 04-10-2010 / 13:02
MCV (RBC Histogram) 119 76 to 96 Fl 04-10-2010 / 13:02
MCH (Calculated) 40 27 to 32 pg/cell 04-10-2010 / 13:02
MCHC (Calculated) 33 32 to 36 % 04-10-2010 / 13:02
RDW (RBC Histogram) 18.3 11 to 15 % 04-10-2010 / 13:02
MPV (Plt Histogram) 7.1 6 to 10.2 Fl 04-10-2010 / 13:02
Plasma Creatinine (Jaffe Kinetic) 0.6 0.4 to 1.4 mg/dL 04-10-2010 / 21:58
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 12 MICRO GRAM /ML 04-10-2010 / 22:37
RBCs macrocytic normochromic.
No nucleated RBCs or
hemoparasites seen.
WBC count mild leukocytosis seen.
No atypical or immature cells seen.
04-10-2010 / 13:02
DIFFERENTIAL COUNT : NeutroPhils :59%
Eosinophils :00%
Monocytes :03%
Lymphocytes :38%
04-10-2010 / 13:02
Platelets Count Adequate on smear 04-10-2010 / 13:02
IMPRESSION : MILD LEUKOCYTOSIS NOTED. 04-10-2010 / 13:02
Name : B/o.Sathiya priya Age/Sex : NB/ F Dept : NeonatologyHos.No: 479565 Mrd.No : 354348 Ward: IL.NB. NICUD.O.A : 23.09.10 D.O.D : .10.10 ************************************************************************REF.BY.DR. MATHIAZHAKAN., PLACE : BODINAYAKANUR
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME NEONATAL SEIZURE PPHN ? BRONCHO PULMONARY DYSPLASIA COURSE:
This term / AGA / female baby was born by at private hospital normal
vaginal delivery on 22.09.10 @ 3.30pm. H/o. Baby cried soon after birth. H/o.
Baby developed respiratory distress since birth. H/o. Meconium aspiration +. H/o.
Baby developed cyanosis & irritable cry for which baby was treated at referral
doctor clinic with oxygen Iv. Antibiotics & referred to MMHRC on 23.09.10 for
further management. Maternal history : G2 P1 L1 A0, H/o. PROM – 4 hrs. No
MH/o. PIH, GDM, Fever with rash & Hypothyroidism. O/E : Baby’s activity –
weak, cry : irritable, CFT > 3 sec, peripheral cyanosis +, dyspnoeic +, Tachypnoeic
+, not icteric, no birth injury, no obvious external anamoly, CVS : S1 S2 heard, RS
: RR@72/mt, LCI +, SCR +, Bilateral air entry equal, bilateral crepts +, P/A :
Soft, CNS : NNR sluggish. Baby was investigated peripheral smear showed Hb :
13.7gms%, TC : 15,900cells/mm3 & platelet count : 2.7 lakhs, PCV : 38, CRP :
Negative. Serum creatinine was normal. Chest x-ray suggestive of meconium
aspiration syndrome. ECHO showed CHD, OS ASD (8mm) with L -> R shunt
mild PHT. Baby was managed with mechanical ventilator support, Iv. Fluids, Iv.
Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inotropic support. Baby had
convulsion, Inj. Gardenol was added. Baby was started on small ryles tube feeds &
gradeually raised. ABG’s was done periodically & ventilator settings were adjusted
according to that. With these above measures baby’s respiratory distress settled
convulsions controlled so weaned form the ventilator on 05.10.10. As baby had
increased respiratory distress with desaturation, connected to C-PAP. Baby was
weaned from the C-PAP on 09.10.10 & put on oxygen hood. As baby had
difficulty in weaning from the oxygen, bronchopulmonary dysplasia was
suspected, Tab. Aldactone & deriphylline drops were added. Baby was slowly
weaned from the oxygen therapy & oral feeds tried. Now baby’s respiration
became normal, had no further convulsions active & taking oral feeds. Baby is
discharged today with the advice to continue further follow-up with the referral
doctor.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
B POSITIVE 24-09-2010 / 09:54
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 13.7 13.6 to 19.6 g/dL 24-09-2010 / 11:32
TOTAL WBC COUNT (Coulter Principle) 15900 10000 to 25000 Cells/cumm 24-09-2010 / 11:32
PLATELET COUNT (Plt Histogram) 27900
0
150000 to 450000 Cells/
cumm 24-09-2010 / 11:32
PCV (Hct) (Calculated) 38 44 to 62 % 24-09-2010 / 11:32
TOTAL RBC COUNT (Coulter Principle) 4.5 4.9 to 5.6 Mill/Cumm 24-09-2010 / 11:32
MCV (RBC Histogram) 107 76 to 96 Fl 24-09-2010 / 11:32
MCH (Calculated) 38 27 to 32 pg/cell 24-09-2010 / 11:32
MCHC (Calculated) 35 32 to 36 % 24-09-2010 / 11:32
RDW (RBC Histogram) 19.3 11 to 15 % 24-09-2010 / 11:32
MPV (Plt Histogram) 7.9 6 to 10.2 Fl 24-09-2010 / 11:32
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 0.6 0.4 to 1.4 mg/dL 24-09-2010 / 08:18
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 24-09-2010 / 08:26
PERIPHERAL BLOOD SMEAR STUDY
RBCs show macrocytic normochromic.
No nucleated RBCs or hemoparasites.
WBC count neutrophilic leukocytosis
with shift to left.
No atypical or immature cells.
24-09-2010 / 11:32
DIFFERENTIAL COUNT : NeutroPhils :68%
Eosinophils :00%
Monocytes :05%
Lymphocytes :27%
24-09-2010 / 11:32
Platelets Count Adequate 24-09-2010 / 11:32
IMPRESSION : -- 24-09-2010 / 11:32
ADVICE ON DISCHARGE
Deriphylline drops 8 drops TID x 2 weeks
Tab. Aldactone 25mg 1/4th OD x 2 weeks
Name : B/o. Bharakath nisha Age/Sex : NB/ F Dept : NeonatologyHos.No: 482821 Mrd.No : 356281 Ward: IL.NB. NICUD.O.A :14.10.2010 D.O.D :18.10.2010************************************************************************
DIAGNOSIS: PRETERM (29-30 WEEKS) / ELBW / RESPIRATORY DISTRESS SYNDROME /
SURFACTANT THERAPY GIVEN
Name : B/o. Jaringursiyatha TwinII Age/Sex : NB/ F Dept : NeonatologyHos.No: 483021 Mrd.No : 356423 Ward: IL.NB. NICUD.O.A :16.10.2010 D.O.D :16.10.2010************************************************************************
DIAGNOSIS: PRETERM (32-33 WEEKS) WITH RESPIRATORY DISTRESS SYNDROME HIE WITH SHOCK SURFACTANT THERAPY GIVEN
Name : B/o. Uma Maheswari Age/Sex : NB/ F Dept : NeonatologyHos.No: 484469 Mrd.No : 357472 Ward: IL.NB. NICUD.O.A : 27.10.10 D.O.D : 27.10.10 ************************************************************************REF.BY.DR. JENITHA., PLACE : ODDANCHATRAM
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION OF NEWBORN COURSE:
This term / AGA / female baby was born at private hospital by LSCS (Ind :
Meconium stained liquor with fetal distress) on 27.10.10 @ 12.30am. H/o. Baby
had weak cry at birth, had developed respiratory distress soon after birth. Baby was
admitted at referral doctor hospital, had cyanosis & hypoglycemia+ on correction
given, inotropes were started, baby had convulsion managed with Inj.
Phenobarbitone (outside) and referred to MMHRC on 27.10.10 for further
management. Maternal history : No MH/o. PIH, GDM, Fever with rash & UTI.
O/E : Baby’s activity & cry – poor, peripheral cyanosis +, CFT > 3 sec, perfusion –
poor, BP not recordable, dyspnoeic +, tachypnoeic +, dehydration +, not anaemic,
not icteric, no obvious external anamoly, CVS : S1 & S2 heard, no murmur, RS –
RR@80/mt, SCR+, ICR+, bilateral air entry +, Bilateral crepts+, P/A : Soft, CNS :
NNR absent, encephalopathy +. Baby was investigated, peripheral smear showed
Hb : 23.5gms%, Tc : 33,900cells/mm3 & platelet count : 1.1 lakhs, PCV : 74. Baby
was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj.
Dopamine infusion, Inj. Calcium gluconate and Inj. Vitamin K. Baby had
persistent hypotension with peripheral cyanosis, Inj. Nor – adrenaline infusion was
started. ABG done showed PH – 7.059, PCo2 : 81.4 & PO2 : 11.7 with Hco3 :
22.5, ventilator settings were changed accordingly. Even with these above
measures baby had desaturation, pulmonary vasodilators were started. Planned for
ECHO. Now baby is on mechanical ventilator support with Fio2 100% maintaining
Spo2 96% & with inotropes support. Since parents were not willing for further
management, baby is discharged “AGAINST MEDICAL ADVICE” on 27.10.10
@ 7.30PM.
INVESTIGATIONBLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 27-10-2010 / 13:37
HAEMOGLOBIN (Photometric
Measurement) 23.5 13.6 to 19.6 g/dL 27-10-2010 / 16:39
TOTAL WBC COUNT (Coulter
Principle) 23900
10000 to 25000 Cells/
cumm 27-10-2010 / 16:39
PLATELET COUNT (Plt Histogram) 11500
0
150000 to 450000 Cells/
cumm 27-10-2010 / 16:39
PCV (Hct) (Calculated) 74 44 to 62 % 27-10-2010 / 16:39
TOTAL RBC COUNT (Coulter Principle) 6.7 4.9 to 5.6 Mill/Cumm 27-10-2010 / 16:39
MCV (RBC Histogram) 110 76 to 96 Fl 27-10-2010 / 16:39
MCH (Calculated) 35 27 to 32 pg/cell 27-10-2010 / 16:39
MCHC (Calculated) 31 32 to 36 % 27-10-2010 / 16:39
RDW (RBC Histogram) 17.7 11 to 15 % 27-10-2010 / 16:39
MPV (Plt Histogram) 8.6 6 to 10.2 Fl 27-10-2010 / 16:39
RBCs-Mild erythrocytosis seen.
Macrocytic normochromic
normocytes.
No nucleated RBCs or
hemoparasites.
WBC - Marked neutrophilic
leukocytosis noted with shift to left .
No atypical or immature cells.
27-10-2010 / 16:39
DIFFERENTIAL COUNT : NeutroPhils :72%
Eosinophils :01%
Monocytes :05%
Lymphocytes :22%
27-10-2010 / 16:39
Platelets Count Adequate. 27-10-2010 / 16:39
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 27-10-2010 / 16:39
NOV10Name : B/o. Madhubala Age/Sex : NB/ F Dept : NeonatologyHos.No: 485258 Mrd.No : 357987 Ward: IL.NB. NICUD.O.A :01.11.2010 D.O.D :07.11.2010************************************************************************
DIAGNOSIS: SEVERE BIRTH ASPHYXIA PRETERM (28-30 WEEKS)
RESPIRATORY DISTRESS SYNDROME / 2 DOSES OF SURFACTANT THERAPY GIVEN
Name : B/o. Siva sankari Age/Sex : NB/ M Dept : NeonatologyHos.No: 483091 Mrd.No : 356472 Ward: IL.NB. NICUD.O.A : 17.10.10 D.O.D : 31.10.10 ************************************************************************
DIAGNOSIS: TERM / MAS / BIRTH ASPHYXIA SEPTICEMIA ? BPD
COURSE:
This term / AGA / Twin II / male baby was born at MMHRC by normal
vaginal delivery on 17.10.10. H/o. Baby didn’t cry soon after birth. H/o.
Meconium stained liquor +. Baby was intuabted & tracheal toileting given, after
that baby developed spontaneous respiration. H/o. respiratory distress since birth.
Maternal history : H/o.PROM +, H/o. fever for 1 day before delivery+. No MH/o.
GDM, PIH, UTI. O/E : baby’s activity & cry : moderate, CFT < 3 sec, colur : pink,
dyspneic +, tachypneic, no pallor / icterus / birth injury / obvious external
congenital anomaly. CVS : S1 & S2 heard, RS : RR@60/mt, SCR +, ICR+,
Bilateral+, P/A : Soft, CNS : NNR sluggish. Baby was investigated which showed
Hb : 15.5gm%, TC : 22,300cells/mm3 & platelet count : 2.1 lakhs, peripheral smear
showed neutron philic leukocytosis with shift to left. PCV : 47, serum creatinine
was normal. Blood culture showed no growth. CRP : Negative. Chest x-ray
showed bilateral infiltrates. Baby was managed with C-PAP, Iv. Fluids, Iv..
Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inotropic support. With
these above measues respiratory distress settled hence weaned form the C-PAP &
put on O2 hood. Baby was started on small ryles tube feeds & gradually raised. As
baby had abdominal distension kept in NPO for 72 hrs then ryles tuibe feeds
restarted. As baby had difficulty in weaning from the oxygen bronchopulmonary
dysplasia was suspected & Tab. Aldactone was added. Baby was slowly weaned
form the oxygen & oral feeds tried. Now baby is active, respiration became normal
& taking oral feeds well hence the baby is discharged today with the advice to
continue the following.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
A POSITIVE 17-10-2010 / 14:46
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 15.5 13.6 to 19.6 g/dL 18-10-2010 / 11:15
TOTAL WBC COUNT (Coulter Principle) 22200 10000 to 25000 Cells/cumm 18-10-2010 / 11:15
PLATELET COUNT (Plt Histogram) 21700
0
150000 to 450000 Cells/
cumm 18-10-2010 / 11:15
PCV (Hct) (Calculated) 47 44 to 62 % 18-10-2010 / 11:15
TOTAL RBC COUNT (Coulter Principle) 4.3 4.9 to 5.6 Mill/Cumm 18-10-2010 / 11:15
MCV (RBC Histogram) 109 76 to 96 Fl 18-10-2010 / 11:15
MCH (Calculated) 35 27 to 32 pg/cell 18-10-2010 / 11:15
MCHC (Calculated) 32 32 to 36 % 18-10-2010 / 11:15
RDW (RBC Histogram) 18.2 11 to 15 % 18-10-2010 / 11:15
MPV (Plt Histogram) 8.5 6 to 10.2 Fl 18-10-2010 / 11:15
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 0.3 0.4 to 1.4 mg/dL 19-10-2010 / 03:05
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 19-10-2010 / 03:02
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
RBC macrocytic normochromic.
No hemoparasites seen.
WBC count neutrophilic leukocytosis
with shift to left.
No atypical or immature cells seen.
18-10-2010 / 11:15
DIFFERENTIAL COUNT : NeutroPhils :73%
Eosinophils :00%
Monocytes :05%
Lymphocytes :22%
18-10-2010 / 11:15
Platelets Count Adequate on smear. 18-10-2010 / 11:15
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 18-10-2010 / 11:15
ADVICE ON DISCHARGE
Inj. Ronem 125mg IV BD x 5 days
Syp. Domstal 5 drops TID x 2 weeks
Tab. Aldactone 25mg 1/6th OD x 2 weeksName : B/o.Yogeswari Age/Sex : NB/ M Dept : NeonatologyHos.No: 484879 Mrd.No : 357713 Ward: IL.NB. NICU
D.O.A : 29.10.10 D.O.D : 13.11.10 ************************************************************************REF.BY.DR. RAVISANKAR., PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH PPHN
COURSE:
This term / AGA / male baby was born at private hospital by normal vaginal
delivery on 29.10.10 @ 12.45pm. H/o. Baby had weak cry at birth. H/o. Meconium
aspiration + resuscitated at referral doctor clinic & refereed to MMHRC on
29.10.10 for further management. Maternal history : No MH/o. PIH, GDM, PROM
& fever with rash. O/E : Baby’s activity & cry – weak, had no spontaneous
respiration & cyanosed – immediately intuabted with ambu bag ventilation Spo2
picked up, not anemic, not icteric, no obvious external anamoly, CVS : S1 S2
heard, RS : Bilateral air entry equal with ET tube, P/A : Soft, no organomegaly,
CNS : NNR not elicitable. Baby was investigated peripheral smear showed Hb :
17.4gms%, TC : 6900cells/mm3 & platelet count : 1.9 lakhs, PCV : 52. CRP :
Positive. Serum creatinine was normal. Blood culture showed no growth. chest x-
ray suggestive of bilateral meconium infiltrations. Baby was managed with
mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate,
Inj. Vitamin K & Ionotrophic support. Series of ABG’s were done & ventilator
settings were adjusted according to that. Baby was started on small ryles tube feeds
on 01.11.10 & gradually raised. As baby had abdominal distension kept in NPO for
72 hrs. With these above measures baby’s abdominal distension reduced, so ryles
tube feeds restarted. As baby’s ABG’s showed raised Pco2, suspected PPHN &
managed with High frequency ventilation. Baby was slowly weaned from the
ventilator on 06.11.10 & Ionotropes were stopped. Baby was extubated on
09.11.10 & put on O2 hood. As baby’s respiratory distress settled gradually
weaned from the oxygen therapy & oral feeds tried. Now baby is active respiration
became normal & taking oral feeds. Baby is discharged today with the advice to
continue further follow-up with the referral doctor.
INVESTIGATIONBLOOD BANK
BLOOD GROUPING & Rh TYPING
A POSITIVE 30-10-2010 / 09:44
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric 17.4 13.6 to 19.6 g/dL 30-10-2010 / 12:01
Measurement)
TOTAL WBC COUNT (Coulter Principle) 6900 10000 to 25000 Cells/cumm 30-10-2010 / 12:01
PLATELET COUNT (Plt Histogram) 10900
0
150000 to 450000 Cells/
cumm 30-10-2010 / 12:01
PCV (Hct) (Calculated) 52 44 to 62 % 30-10-2010 / 12:01
TOTAL RBC COUNT (Coulter Principle) 4.8 4.9 to 5.6 Mill/Cumm 30-10-2010 / 12:01
MCV (RBC Histogram) 108 76 to 96 Fl 30-10-2010 / 12:01
MCH (Calculated) 35 27 to 32 pg/cell 30-10-2010 / 12:01
MCHC (Calculated) 33 32 to 36 % 30-10-2010 / 12:01
RDW (RBC Histogram) 18.8 11 to 15 % 30-10-2010 / 12:01
MPV (Plt Histogram) 8.1 6 to 10.2 Fl 30-10-2010 / 12:01
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 0.3 0.4 to 1.4 mg/dL 31-10-2010 / 17:57
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 24 MICROGRAM/ML 31-10-2010 / 17:09
PERIPHERAL BLOOD SMEAR STUDY
RBCs - macrocytic normochromic.
No nucleated RBCs or hemoparasites.
WBC count within normal range
neutrophilic prepondarence noted
No atypical or immature cells.
30-10-2010 / 12:01
DIFFERENTIAL COUNT : NeutroPhils :71%
Eosinophils :01%
Monocytes :05%
Lymphocytes :23%
30-10-2010 / 12:01
Platelet just adequate on smear 30-10-2010 / 12:01
IMPRESSION : NORMOCYTIC NORMOCHROMIC BIOOD
PICTURE
30-10-2010 / 12:01
Name : B/o. Siva sankari Age/Sex : NB/ M Dept : NeonatologyHos.No: 483090 Mrd.No : 356471 Ward: IL.NB. NICUD.O.A : 17.10.10 D.O.D : 22.11.10 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA MAS NEONATAL SEIZURE SEPTICEMIA WITH NEC
COURSE:
This term / AGA / male / Twin I / was born at MMHRC by normal vaginal delivery on
17.10.10 @ 125am. H/o. Baby did n’t cry soon after birth. H/o. Thick mecnoium aspiration +,
baby was immediately intubated, tracheal toileting given. Baby developed severe respiratory
distress since birth – shifted to NICU for further management. Maternal history : H/o. PROM – 5
hrs. No H/o. PIH, GDM, UTI & hypothyroidism. O/E : baby’s activity & cry – weak, peripheral
cyanosis, CFT > 3 sec, dyspnoeic +, tachypnoeic +, no birth injury & no obvious external
anamoly, CVS : S1 S2 heard, RS : RR@ 80/mt, LCI +, SCR, Bilateral crepts +, P/A : Soft,
CNS : NNR sluggish. Baby was investigated peripheral smear showed HB : 16.6gms%, TC :
7500cells/mm3 & platelet count : 2.4 lakhs, PCV : 50, serum creatinine : 0.9mg/dl (19.10.10).
Chest x-ray showed bilateral extensive infiltrates. CRP : positive. Blood culture showed no
growth. baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj.
Calcium gluconate, Inj. Vitamin K & Inotropic support. Baby had convulsions on 18.10.10,
managed with Inj. Gardenol. Baby was started on small tyles tube feeds & gradually raised. Baby
had decreased urine output, managed with Inj. Lasix on 24.10.10. baby had abdominal
distension. NEC was suspected hence kept NPO. Baby was odematous with serum creatinine :
1.3mg/dl ( 30.10.10). Fluid restriction was done & Inj. Lasix added. On 30.10.10, baby had
bleeding from the injection sites and became pale, (HB was 6.5gms%), managed with WFB
transfusion. Baby had petechial spots, repeat platelet count was 20,000 only – managed with
platelet concentrate transfusion. With these above measures baby’s abdominal distension
reduced, small ryles tube feeds was restarted. Baby’s urine output improved & repeat serum
creatinine became normal (1.11.10). As baby had GI bleed & pallor +, managed with 1 WFB &
platelet transfusion OD for 4 days. Baby was weaned form the ventilator on 06.11.10 &
extubated on 08.11.10. but baby had again developed distress hence connected to C-PAP on
09.11.10. Baby had desaturation with the C-PAP, so intubated and again connected to
mechanical ventilator support on 13.11.10. As baby had difficulty in weaning form the
ventilator, BPD was suspected and Tab. Aldactone added. Baby again developed abdominal
distension with vomiting of feeds, antibiotics were changed and kept NPO again. Now baby is on
mechanical ventilator support with Fio2 100%, maintaining Spo2 of 95% & in NPO. Condition
& prognosis of the baby & need for prolonged ventilator support were well explained to the
parents. Since parents want to continue further management at Government Hospital, baby is
discharged AGAINST MEDICAL ADVCIE on 22.11.10 at 1pm.
INVESTIGATIONHAEMATOLOGY & CLINICAL PATHOLOGY
HAEMOGLOBIN (Photometric
Measurement) 7.1 11.2 to 19.6 g/dL 22-11-2010 / 02:38
PLATELET COUNT (Plt Histogram) 20000 150000 to 450000 Cells/
cumm 31-10-2010 / 06:51
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 17-10-2010 / 14:48
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 16.6 13.6 to 19.6 g/dL 18-10-2010 / 11:12
TOTAL WBC COUNT (Coulter Principle) 17500 10000 to 25000 Cells/cumm 18-10-2010 / 11:12
PLATELET COUNT (Plt Histogram) 24900
0
150000 to 450000 Cells/
cumm 18-10-2010 / 11:12
PCV (Hct) (Calculated) 50 44 to 62 % 18-10-2010 / 11:12
TOTAL RBC COUNT (Coulter Principle) 4.6 4.9 to 5.6 Mill/Cumm 18-10-2010 / 11:12
MCV (RBC Histogram) 109 76 to 96 Fl 18-10-2010 / 11:12
MCH (Calculated) 35 27 to 32 pg/cell 18-10-2010 / 11:12
MCHC (Calculated) 32 32 to 36 % 18-10-2010 / 11:12
RDW (RBC Histogram) 18.3 11 to 15 % 18-10-2010 / 11:12
MPV (Plt Histogram) 7.9 6 to 10.2 Fl 18-10-2010 / 11:12
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 0.9 0.4 to 1.4 mg/dL 19-10-2010 / 03:05
Plasma Creatinine (Jaffe Kinetic) 0.6 0.4 to 1.4 mg/dL 23-10-2010 / 07:50
Plasma Creatinine (Jaffe Kinetic) 1.3 0.4 to 1.4 mg/dL 30-10-2010 / 17:14
Plasma Creatinine (Jaffe Kinetic) 0.9 0.4 to 1.4 mg/dL 01-11-2010 / 23:25
Plasma Creatinine (Jaffe Kinetic) 1.0 0.4 to 1.4 mg/dL 02-11-2010 / 14:26
POTASSIUM (ISE) 3.5 3.5 to 5.1 mEq/L 18-11-2010 / 17:34
POTASSIUM (ISE) 3.0 3.5 to 5.1 mEq/L 20-11-2010 / 15:07
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein POSITIVE 24microgram/ml 19-10-2010 / 03:02
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBC macrocytic normochromic .
No hemoparasites seen.
WBC count moderate neutrophilic
leukocytosis noted.
No atypical or immature cells seen.
18-10-2010 / 11:12
DIFFERENTIAL COUNT : NeutroPhils :66%
Eosinophils :00%
Monocytes :05%
Lymphocytes :29%
18-10-2010 / 11:12
Platelets Count Adequate on smear. 18-10-2010 / 11:12
IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS
NOTED.
18-10-2010 / 11:12
Name : B/o. Bhuvaneswari Age/Sex : NB/ F Dept : NeonatologyHos.No: 487000 Mrd.No : 359168 Ward: IL.NB. NICUD.O.A : 15.11.10 D.O.D : 24.11.10 ************************************************************************
DIAGNOSIS: PRETERM / VLBW / SEVERE BIRTH ASPHYXIA WITH SHOCK ACUTE RENAL FAILURE RESPIRATORY DISTRESS SYNDROME SURFACTANT THERAPY GIVEN
Name : B/o. Subathra Age / Sex: NB/F Dept : NeonatologyHos.No : 488871 Mrd.No : 360323 Ward : I NB NICUD.O.A : 27.11.10 D.O.D :28.11.10************************************************************************REF.BY.DR.PUSHPALATHA GOKULNATH., PLACE : MADURAI
DIAGNOSIS: PRETERM (28-30 WEEKS) / VLBW
RESPIRATORY DISTRESS SYNDROME
NEONATAL SEIZURE
SURFACTANT THERAPY GIVEN
DEC 10Name : B/o. Palaniammal Age / Sex: NB/F Dept : NeonatologyHos.No : 488534 Mrd.No : 360125 Ward : I NB NICUD.O.A : 24.11.10 D.O.D :01.12.10************************************************************************
DIAGNOSIS: PRETERM (28 - 30 WEEKS) / VLBW / RESPIRATORY DISTRESS SYNDROME CHD (SMALL PDA / SMALL ASD) ? SEPTICEMIA NEONATAL SEIZURE SURFACTANT THERAPHY GIVEN
Name : B/o. Manimegalai Age / Sex: NB/F Dept : NeonatologyHos.No : 490472 Mrd.No : 361429 Ward : I NB NICUD.O.A : 09.12.10 D.O.D :10.12.10************************************************************************
DIAGNOSIS: SEVERE BIRTH ASPHYXIA / MECONIUM ASPIRATION SYNDROME / IUGR / MULTI CYSTIC DYSPLASTIC KIDNEY
COURSE:
This term / IUGR / female baby delivered by LSCS (Ind : Severe
oligohydramnios AFI – 3) on 08.12.10 at 10.04pm at MMHRC. H/o. Baby was not
cried immediately after birth, (thick mecnoium stained liquor +). Baby cried after
tracheal toileting and bag and tube ventilation. Baby was shifted to NICU for
further management. Maternal history : 22 years, primi, conceived after infertility
treatment. Antenatal USG abdomen showed dysplastic left kidney + severe
oligohydramnios. Apgar score 1 mint 3/10, 5 mits 7/10. O/E : activity – weak, wt:
1.5kg, acrocyanosis +, no pallor. CVS : S1 S2 heard, murmur +, RS : NVBS, no
added sounds, no organomegaly, CNS : NNR absent. Child was investigated which
showed Hb : 14.5gms%, TC : 49,300cells/mm3, platelets – 80,000, PCV : 45%.
Blood culture sent, reports awaited. Chest x-ray showed cardiomegaly with
bilateral infiltrates. Child was managed with mechanical ventilator support, Iv.
Fluids, Iv. Antibiotics Inj. Calcium gluconate, Iv. Inotropes and Inj. Vitamin K.
ABG was done periodically and ventilator settings changed accordingly. USG
abdomen showed multi cytic dysplastic kidney. Urology opinion was obtained. As
baby had bleeding form injection site and platelet count was only 80,000, baby was
managed with platelet concentrate and FFP transfusion. Condition of the baby and
prognosis were explained to the parents. As they were not willing for further
management, baby was discharged “AGAINST MEDICAL ADVCIE” on
10.12.10.
INVESTIGATION :BLOOD BANK
BLOOD GROUPING & Rh TYPING
A POSITIVE 09-12-2010 / 09:28
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 14.5 13.6 to 19.6 g/dL 09-12-2010 / 10:30
TOTAL WBC COUNT (Coulter Principle) 4930
0 10000 to 25000 Cells/cumm 09-12-2010 / 10:30
PLATELET COUNT (Plt Histogram) 8000
0
150000 to 450000 Cells/
cumm 09-12-2010 / 10:30
PCV (Hct) (Calculated) 45 44 to 62 % 09-12-2010 / 10:30
TOTAL RBC COUNT (Coulter Principle) 3.3 4.9 to 5.6 Mill/Cumm 09-12-2010 / 10:30
MCV (RBC Histogram) 135 76 to 96 Fl 09-12-2010 / 10:30
MCH (Calculated) 42 27 to 32 pg/cell 09-12-2010 / 10:30
MCHC (Calculated) 31 32 to 36 % 09-12-2010 / 10:30
RDW (RBC Histogram) 22.5 11 to 15 % 09-12-2010 / 10:30
MPV (Plt Histogram) 7.2 6 to 10.2 Fl 09-12-2010 / 10:30
POTASSIUM (ISE) 3.5 3.5 to 5.1 mEq/L 09-12-2010 / 05:22
PERIPHERAL BLOOD SMEAR STUDY
RBC mild anisocytosis, predominantly
macrocytic normochromic. 33
NRBC/100 WBC.
No hemoparasites nil seen.
WBC count marked leukocytosis with
predominance of lymphocytes. Mild
shift to left in neutrophilic series noted.
No atypical or immature cells seen.
09-12-2010 / 10:30
DIFFERENTIAL COUNT : Metamyelocytes :06%
NeutroPhils :21%
Monocytes :04%
Lymphocytes :69%
09-12-2010 / 10:30
Platelets Count just Adequate on smear
(90,000 cells/cumm)
09-12-2010 / 10:30
IMPRESSION : MARKED LEUKOCYTOSIS.
Adv:
1) Please correlate with clinical details
2) Coombs test, Tetic count.
09-12-2010 / 10:30
Name : B/o. Sasi kala Age / Sex: NB/M Dept : NeonatologyHos.No : 491926 Mrd.No : 362361 Ward : I NB NICUD.O.A : 18.12.10 D.O.D :19.12.10************************************************************************
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH BA WITH PROFOUND SHOCK
COURSE:
This term / AGA / male baby was delivered by LSCS (Ind : CPD with Grade
III MSAF) on 18.12.10 11.05am. H/o. Baby did not cry after birth, intubated and
referred to Christian hospital, hence baby was connected to ventilator, chest x-ray
was taken, showed bilateral haziness and desaturation and hence referred here for
further management. H/o. cyanosis +. Mother had UTI 2 days before delivery and
treated with antibiotics. No H/o. GDM, PIH, Hypothyroidism, fever with rash. O/E
: ET tube in site, Spo2 : 65% with bag & mask ventilator, peripheries were
cyanosed, HR : 170/mt, RR : 60/mt, no pallor, not icteric, no external anamoly +,
umbilicus : unhealthy +, CVS : S1 S2 heard, RS : Bilateral crepts +, P/A : Soft,
CNS : NNR sluggish. Baby was investigated Hb : 13.4, TC : 23400, platelet count ;
1.37 lakhs, blood culture sent report awaited. Chest x-ray showed bilateral
infiltrates. Baby was managed with mechanical ventilator, inotrope support, Iv.
Antibiotics and other supportive measures. ABG taken after 1hr showed, severe
metabolic acidosis, correction with NaHco3 given. Ventilator settings changed
accordingly. Bleeding from UVC site +, managed with packed cell transfusion.
Baby had desaturation followed by bradycardia and went for cardio respiratory
arrest and could not revived and “DECLARED DEAD” on 19.12.10 at 6am.
INVESTIGATIONBLOOD BANK
BLOOD GROUPING & Rh TYPING
A POSITIVE 19-12-2010 / 09:42
HAEMOGLOBIN (Photometric
Measurement) 13.4 13.6 to 19.6 g/dL 20-12-2010 / 10:10
TOTAL WBC COUNT (Coulter Principle) 26400 10000 to 25000 Cells/cumm 20-12-2010 / 10:10
PLATELET COUNT (Plt Histogram) 13700
0
150000 to 450000 Cells/
cumm 20-12-2010 / 10:10
PCV (Hct) (Calculated) 41 44 to 62 % 20-12-2010 / 10:10
TOTAL RBC COUNT (Coulter Principle) 4.4 4.9 to 5.6 Mill/Cumm 20-12-2010 / 10:10
MCV (RBC Histogram) 118 76 to 96 Fl 20-12-2010 / 10:10
MCH (Calculated) 38 27 to 32 pg/cell 20-12-2010 / 10:10
MCHC (Calculated) 32 32 to 36 % 20-12-2010 / 10:10
RDW (RBC Histogram) 18.5 11 to 15 % 20-12-2010 / 10:10
MPV (Plt Histogram) 7.3 6 to 10.2 Fl 20-12-2010 / 10:10
RBC macrocytic normochromic .8
NRBC/100 WBC.
No nucleated RBCs or hemoparasites
seen.
WBC count marked leukocytosis with
lymphocytic prepondrance.Mild shift to
left noted.
No atypical or immature cells seen.
20-12-2010 / 10:10
DIFFERENTIAL COUNT : Metamyelocytes :06%
NeutroPhils :28%
Eosinophils :02%
Monocytes :07%
Lymphocytes :57%
20-12-2010 / 10:10
Platelets Count Adequate on smear 20-12-2010 / 10:10
IMPRESSION : MODERATE LEUKOCYTOSIS WITH
SHIFT TO LEFT.
20-12-2010 / 10:10
Name : B/o. Nandhini Age / Sex: NB/M Dept : NeonatologyHos.No : 491929 Mrd.No : 362369 Ward : I NB NICUD.O.A : 18.12.10 D.O.D :29.12.10************************************************************************
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH NEONATAL SEIZRUE WITH ACUTE RENAL FAILURE
COURSE:
This term / AGA / male baby was referred to MMHRC on 18.12.10 as a
case of MAS. H/o. Baby didn’t cry immediately afterbirth APGAR 4 and 6. baby
was resusciated and referred here for further management. Maternal history : 34
years, primi, k/c/o hypothyroidism on T- Eltroxin H/o. PIH +. No H/o. GDM, fever
with rash, UTI. Baby was delivered by LSCS ( Ind : fetal distress with mild PIH).
O/E : baby ET tube in situ tachypnoea +, dyspnoea +. CFT > 3 sec, RS : air entry
equal on both sides, bilateral crpts +, CVS : S1 S2 +, P/A : Soft, liver 1cm
palpable, CNS : NNR sluggish. Baby was investigated which showed Hb : 13, TC :
26900, platelet : 2.62 lakhs, CRP : Negative. PCV : 40, TSH : 3.12. Repeat Hb :
12.3 (28.12.10), serum creatinine : 1.5 (1.12.10), 1.4 (22.12), 1.4 (24.12), 1.6
(26.12), 1.6 (28.12). Blood culture showed no growth. ET tip culture sent awaited.
Serum K+ : 1.4. USG abdomen showed heterogenous echogenic cystic lesion in
right lobe of liver (26.12.10). Child was managed with mechanical ventilator
support, Iv. Fluids, Iv. Antibiotics, Inj. Ratnac, Inj. Calcium gluconate, Iv.
Inotropes and Vitamin K. As child had GI bleed, FFP was transfused on 22.12.10.
renal failure was managed with fluid restriction and Inj. Lasix. With these above
measues child respiratory distress settled, hence started weaning form ventilator
(23.12.10) and extubated on 27.12.10. Child developed respiratory distress on
28.12.10 and hence reintubated and connected to mechanical ventilator. Despite
this measures baby had persistent renal failure and had hypokalemia which was
corrected with KCL. Baby went in to sudden cardiac arrest at 12.30am (24.12.10).
Despite active resuscitation, could not be revived & DECLARED DEAD on
24.12.10 at 1am.
INVESTIGATIONHAEMATOLOGY & CLINICAL PATHOLOGY
HAEMOGLOBIN (Photometric
Measurement) 12.3 11.2 to 19.6 g/dL 28-12-2010 / 05:31
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE 19-12-2010 / 10:04
HAEMATOLOGY & CLINICAL PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric
Measurement) 13.0 13.6 to 19.6 g/dL 20-12-2010 / 10:14
TOTAL WBC COUNT (Coulter Principle) 2690
0
10000 to 25000 Cells/
cumm 20-12-2010 / 10:14
PLATELET COUNT (Plt Histogram) 26200
0
150000 to 450000 Cells/
cumm 20-12-2010 / 10:14
PCV (Hct) (Calculated) 40 44 to 62 % 20-12-2010 / 10:14
TOTAL RBC COUNT (Coulter Principle) 3.6 4.9 to 5.6 Mill/Cumm 20-12-2010 / 10:14
MCV (RBC Histogram) 113 76 to 96 Fl 20-12-2010 / 10:14
MCH (Calculated) 36 27 to 32 pg/cell 20-12-2010 / 10:14
MCHC (Calculated) 31 32 to 36 % 20-12-2010 / 10:14
RDW (RBC Histogram) 18.1 11 to 15 % 20-12-2010 / 10:14
MPV (Plt Histogram) 7.0 6 to 10.2 Fl 20-12-2010 / 10:14
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 1.5 0.4 to 1.4 mg/dL 20-12-2010 / 20:39
Plasma Creatinine (Jaffe Kinetic) 1.4 0.4 to 1.4 mg/dL 23-12-2010 / 00:16
Plasma Creatinine (Jaffe Kinetic) 1.4 0.4 to 1.4 mg/dL 24-12-2010 / 07:43
Plasma Creatinine (Jaffe Kinetic) 1.4 0.4 to 1.4 mg/dL 24-12-2010 / 10:17
Plasma Creatinine (Jaffe Kinetic) 1.5 0.4 to 1.4 mg/dL 26-12-2010 / 08:19
Plasma Creatinine (Jaffe Kinetic) 1.6 0.4 to 1.4 mg/dL 28-12-2010 / 06:17
Serum Thyroid Stimulating Hormone
(CLIA) 3.12 0.34 to 5.6 µIU/mL 19-12-2010 / 15:44
POTASSIUM (ISE) 1.4 3.5 to 5.1 mEq/L 28-12-2010 / 22:48
MICROBIOLOGY
CRP-C REACTIVE PROTEIN
C- Reactive Protein NEGATIVE 20-12-2010 / 21:07
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY
.
RBC macrocytic normochromic.3
NRBC/100WBC.
No hemoparasites nil.
WBC count marked leukocytosis with
mild shift to left.
No atypical or immature cells seen.
20-12-2010 / 10:14
DIFFERENTIAL COUNT : Metamyelocytes :05%
NeutroPhils :46%
Eosinophils :02%
Monocytes :08%
Lymphocytes :39%
20-12-2010 / 10:14
Platelets Count Adequate on smear 20-12-2010 / 10:14
IMPRESSION : MARKED LEUKOCYTOSIS. 20-12-2010 / 10:14
Name : B/o. Logeswari Age / Sex: NB/M Dept : NeonatologyHos.No : 482816 Mrd.No : Ward : I NB NICUD.O.A : 14.10.10 D.O.D :31.12.10************************************************************************
DIAGNOSIS: PRETERM WITH VLBW RESPIRATORY DISTRESS SYNDROME (SURFACTANT GIVEN ON 14.10.10) PDA ( SURGICAL CLOSURE DONE ON 16.11.10) NEONATAL SEIZURE BRONCHOPULMONARY DYSPLASIA