clinical meeting

1. Dr. KANTA HALDER
Resident (MD;Phase A)
BICH

2. Particulars of the patient
 Name: Baby of Asma.
 Age: 17 days.
 Sex: Male.
 Address: Demra, Dhaka.
 Date of Admission: 28.09.2015.
 Date of Examination: 30.09.2015.

3. Chief Complaints
 Reluctant to feed since birth.
 Convulsion for 1 time.
 Delayed crying after birth.

4. History of present illness
According to the statement of mother, baby was
born by vaginal delivery at term at hospital with
average birth weight and cried 20 minutes after
birth following resuscitation. The baby was
reluctant to feed since birth. With these
complaints, he was admitted in Dhaka Shishu
Hospital for further evaluation and better
management. On query, mother told that her
baby had an episode of convulsion after
admission which was tonic in nature and lasted
for about 5 minutes.

5. Birth History
Antenatal : Mother, Asma, a 18 years old lady,
gravida – 2nd, para – 2, was on irregular
antenatal check up and was normotensive &
nondiabetic. She had history of prolong labour
with frequent per vaginal examination. There
was no history of premature rupture of
membrane, fever with rash or taking any
offending drug during her pregnancy period
and she was immunized against tetanus.

6. Birth History (cont..)
Postnatal : Baby cried 20 minutes after birth
following resuscitation.
Natal : Baby was delivered normally at 37th weeks
of gestation on 14.09.2015 at 02.00 PM with
average birth weight.

7. Family History
He is the 2nd issue of his non-consanguineous
parents.
Socio-economic History
He came from a low socio-economic family.
Feeding History
Baby was given expressed breast milk from
1st day of life by dropper feeding.

8. Physical Examination
o Baby was lathergic, pale, acyanotic, anicteric.
o Weight : 2000 gm( falls below 10th centile ).
o Length : 46 cm ( falls below 10th centile ).
o OFC : 32 cm ( falls below 10th centile ).
o Temperature : 98° F.
o CRT ˂ 3 seconds.
o SaO₂ (Pulse oximeter) : 94% in room air.

9. Cont..
o Frontanelle : Normal, not bulged.
o Face : No dysmorphysm.
o Eye : Pupil size was normal, light reflex was
present.
o Nose : No choanal atresia.
o Ear : Formed pinna, firm and instant recoil.
o Oral cavity : Normal.
o Neck : Normal.

10. Cont..
o No chest deformity, chest movement was
symmetrical on both side.
o Air entry was good and symmetrical in both
side, no added sound.
o Respiratory rate : 48/min.
o Apex beat was palpable in left 4th intercostal
space just medial to the mid clavicular line, 1st
and 2nd heart sound was audible in all 4 areas,
no murmur.
o Heart rate : 140/min.

11. Cont..
o Abdomen : Soft, not distended.
o Umbillicus : Dry, healthy.
o Liver : Not palpable.
o Spleen : Not palpable.
o Kidneys : Not ballotable.
o Bowel sound : Present.
o Genitalia : Both testes are in scrotum.

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

13. Salient feature
Baby of Asma, 17 days old male neonate was
born by vaginal delivery at 37 weeks of
gestational age with average birth weight and
cried after 20 minutes following
resuscitation. He was reluctant to feed since
birth and had h/o convulsion after admission.
Mother had history of prolong labour with
frequent per vaginal examination. Baby was
lathergic, pale, hypotonic with poor reflex
activities. Vitals were within normal limit.

14. Provisional Diagnosis
Neonatal Sepsis in a Term (37 weeks) Small
for Gestational Age baby.

15. Differential Diagnosis
Neonatal Meningitis with in a Term (37 weeks)
Small for Gestational Age baby.

16. Investigations
Complete Blood Count :
• Hb%: 7.8 gm/dl
• WBC: Total count: 8,300/cumm
Differential count:
o Neutrophil: 80%
o Lymphocyte: 18%
o Monocyte: 01%
o Eosinophil: 01%
o Basophil : 00%

17. Cont..
o RBC: Anisochromic with anisocytic.
o WBC: Shows neutrophil
predominane.
o Platelet: Normal.
Comment : Neutrophillia.
• Platelet : 3,38,000/cumm
• PBF:

18. Cont..
Blood grouping and Rh typing : B (+ve).
RBS : 6.0 mmol/L.
S. Electrolyte : Na⁺ - 148.6 mmol/L
K⁺ - 5.3 mmol/L
Cl⁻ - 110.6 mmol/L.
S. Calcium : 2.1 mmol/L.
CRP : 59.5 mg/L.
Blood C/S : No growth of any bacteria.
USG f brain : Findings in favour of obstructive
hydrocephalus. .

19. Cont..
CSF Study :
Appearance – Clear.
Total leukocyte count – 04/mm³.
Polymorph – 00%
Lymphocyte – 100%
RBC – 00/mm³
Protein – 150 mg/dl.
Sugar – 52 mg/dl.
Gram stain – Bacteria not found.
Ziehl Neelsen stain – AFB not found.

20. Final Diagnosis
Neonatal Sepsis with Hydrocephalus in a Term
(37 weeks) Small for Gestational Age baby.

21. Management
A.Counseling.
B.Supportive:
 Maintenance of temperature.
 Airway clearance by O-P & N-P suction.
 Maintenance of breathing.
 Maintenance of circulation.
 Maintenance of hydration and nutrition : Inf.
10% dextrose in 0.225% NaCl along with EBM
by NG tube feeding (150ml/kg).

22. Cont..
 Blood transfusion (10 ml/kg).
C.Specific:
 Inj. Ceftazidime 100 mg/kg/day in 2 divided
doses.
 Inj. Amikacin 15 mg/kg/day in 2 divided
doses.
C.Surgical consultation.
D.Follow up.

23. Thank you