RHI

1. Dr. T. M. Fahad Nasif
Assistant Registrar,
Dept of Paediatrics
ICMH, Dhaka.
Date: 15/07/13

2. Name - B/O of Amena
Age -28 Hours
Weight -2.5kg.
Sex -Female.
Address -Bondor,Narayanganj
DOB - 14/06/13 at 1.00PM
DOA &DOE - 15/06/13 at 5.00PM

3. Yellowish coloration of whole body for last
10 hours

4. According to the statement of patient’s
attendant the newborn was delivered at
39wks of gestation at home 28hours back by
NVD. Baby cried just after delivery. Mother
noticed yellowish coloration of whole body
for last 10 hours starting from face and which
was increasing with time. There is no history
of bluish colouration, poor feeding, fever,
convulsion or meconium stained liquor. With
this complain the baby got admitted to ICMH
for better management.

5. Antenatal-
 Mother 30years,non-diabetic,non-
hypertensive.
 No history of fever with rash.
 No previous history of heart or lung disease.
 She was on irregular ante-natal check-up
(only 2 visits at 28 and 36 weeks).
 Blood group- O-negative
 Antibody titre- not done
 She had no history of PROM, foul smelling per
veginal discharge or abdominal pain
 No history of drug ingestion except multi
vitamin

6. Natal History-
 The baby was born by NVD at home at 39 wks
of gestational age.
 The baby cried just after birth.
 APGAR score- Not known.
 Baby was active, sucking well.
Postnatal history-
 Passed urine 1 hour and stool 6hours after
birth.
 Noticed yellowish coloration of face and body
at 18-20hours of age
Birth History cont’d….

7.  Exclusive breast feeding.
 No prelacteal feeding was given.

8.  3rd issue of non consanguineous
parents.
 Previous 2 siblings are in good health.
They have no history of neonatal
jaundice.
 Father’s blood group- O(+ve)
Family History

9. Father - Shopkeeper
Mother - house wife
housing - Tinshed house
Drinks tube well water.
Uses sanitary latrine.

10. Appearance- Sick-looking, Icteric, pale.
Colour- Yellowish
Anaemia- Moderate.
Jaundice- present upto thigh.
Cyanosis- absent
Temp- 99˚F.
RR- 42/Min.
HR- 140/Min.
Fontanel- Open & normal.
Skin survey- Normal, no bleeding spot.

11. Scalp-
Face- Normal.
Eyes-
Neck-
Genitalia- Normal.
Extremities- Normal.
Spine- Normal.
Umbilicus- Healthy.
Tone- Normal.
Primitive reflexes- Moderate.

12. Anthropometry-
 Weight-2.5kg(In between 10th to 50th
centile)
 Height-46.7cm(50th centile)
 OFC-34cm(In between 50th to 90th centile)

13.  Mouth & Oral cavity-normal.
 Abdomen proper
Inspection-
Shape-normal.
Umbilicus centrally placed & healthy.
Palpation-
Liver & spleen- just palpable.
Auscultation-
Bowel Sound- present.

14.  Inspection:
R/R: 42/min
No chest Indrawing.
Movement of chest: Bilaterally
symmetrical.
 Palpation:
Trachea: Centrally placed.
Apex beat: Lt 5th intercostal space just
medial to midclavicular line.
 Auscultation:
Air entry good & equal in both side. Breath
sound vesicular in both lung field.

15. Inspection-
Precordium- Normal.
HR-140/Min.
No visible pulsation.
Palpation-
Apex beat in left 5th ICS medial to MCL.
Normal in character.
Auscultation-
S1 & S2 audible in all cardiac area.
A soft systolic murmur present

16. B/O Amena, 28hours old female child, 3rd
issue of non consanguinous parents, weight
2.5kg delivered at home by NVD at 39wks of
gestation was admitted to ICMH with the
complaint of yellowish coloration of whole
body which started from face since18-20
hours of life. The baby cried just after birth.
There is no history of bluish coloration, poor
feeding, fever or convulsion. Mother didn’t
take regular ANC & had no history of PROM,
prolonged labour or obstructed labour.

17. Mother’s blood group O(-ve), antibody titre
not done. Father’s blood group O(+ve).
Previous 2 siblings were normal and no
history of neonatal jaundice. On examination,
baby is ill-looking, pale, icteric upto the
thigh, Vital signs are normal, Frontanel-
normal, normotonic, primitive reflexes-
moderate. Liver and spleen just palpable.
Other system reveals no abnormalities.

18. Term AGA with Neonatal Jaundice
(Most probably Rh incompatibility )

19.  Minor blood group incompatibility
 G6PD deficiency

20. Blood group: O positive
Serum Billirubin(At 46 HOL)
Total: 20.9mg/dl
Direct:3.2mg/dl
Indirect:17.7mg/dl
Hb: 9.6 gm/dl
TC: 11,530/cumm
DC: N-69%, L-26%,M-3%,B-2%
Platelets count-2,57000/cumm
PBF- Features of hemolysis.

21.  Coomb’s Test (direct): Negative
 CRP: <6mg/dl
 RBS- 5.7mmol/L
 Blood culture-No growth

22. Neonatal jaundice due to
Rh incompatibility

23.  Exclusive breast feeding
 Extensive Phototherapy (double blue)
 Inf.10% Baby saline(80ml/kg for 24hr).
 Antibiotic-Inj.Ampicillin(100mg/kg/day) &
Inj.Gentamicin(5mg/kg/day)
Umbilical catheterization done
 Plan-
Double volume exchange blood transfusion
Requisition given for O(-ve) blood

24.  Baby develope convulsion
 Temp 1000F
 Inj.Phenobarbitone(20mg/kg loading &
5mg/kg/day maintenance)
 Antibiotic changed-
Inj.Ceftazidime(150mg/kg/day)
Inj.Amikacin(15mg/kg/day)
Inj.Metronidazole(1.5ml/kg/dose)

25. On day 3 (59 HOL)

27. Hb- 6.9g/dl
Serum Billirubin-
Total- 22.0mg/dl
Direct-2.9mg/dl
Indirect-19.0mg/dl
Serum Electrolytes
Na-140mmol/L
K-3.6mmol/l
Cl-96.9mmol/l
Serum Calcium-8.9mg/dl
Serum creatinine-0.9mg/dl

28.  Baby develope high grade fever
 Temp 1040F
 Antibiotic Changed
Inj. Meropenam(40mg/kg/dose)

29. On day 4 (80HOL)

30.  Hb- 9.0gm/dl
 Serum Billirubin-
Total-7.8mg/dl
Direct-0.8mg/dl
Indirect-7.0mg/dl
 Serum Electrolytes-
Na-140.2mg/dl,
K-3.8mg/dl,
Cl-96.9mg/dl
 Serum calcium-8.2mg/dl
 Serum creatinine-0.8mg/dl

31. Day C/C Temp Anaemia Jaundice Reflexes Manage
ment
Day5 Fever 102° F Pale Upto
abdomen
Moderate Continue
photo
therapy
Day6 Fever 100° F Pale Face Good Transfusi
on O-ve
blood
Day7 None 99°F Absent Face Good Medicati
on
as before

32. Baby was discharged on day-9…
Well alert
Colour-pink.
RR-42/min.
HR-130/min.
Mildly icteric.
Hypertonic
Sucking breast milk properly
Medication-Tab.phenobarbitone(5mg/kg BD)
Advice-Follow up after 7days
Immunization.
Exclusive breast feeding.

33.  Baby active
 Tone normal
 Anaemia- absent
 Jaundice- absent
 Reflexes good