Clinical meeting Paediatrics

1. Welcome to
clinical meeting
Dr. KANTA HALDER
Resident (MD;Phase A),
General paediartics,
BICH.

2. Particulars of the patient
 Name: Sourov
 Age: 6 days.
 Sex: Male.
 Address: Kuralia, Chadpur.
 Date of Admission: 06.11.2015.
 Date of Examination: 06.11.2015.

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

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

5. Birth History
Antenatal : Mother, Rina, a 35 years old lady,
gravida – 5th, para – 5, was on irregular
antenatal check up and was normotensive &
nondiabetic. Her blood group was B (- ve), but
she did not take Inj. Anti D during her previous
pregnancies. There was no history of premature
rupture of membrane, fever with rash or taking
any offending drug during her pregnancy period
and she was immunized against tetanus.

6. Birth History (cont..)
Postnatal : Baby cried immediately after birth,
needed no resuscitation.
Natal : Baby was delivered normally at 39 weeks
of gestation at hospital on 31.10.2015 at 05.30
PM with average birth weight.

7. Family History
He is the 5th issue of his non-consanguineous
parents. Other sibs are in good health. There is
no h/o jaundice or sidling death. Their blood
group is not known.
Socio-economic History
He came from a low socio-economic family.
Feeding History
Baby was on exclusive breast feeding.

8. Physical Examination
o Baby was active, mildly pale, icteric up to palm
& sole.
o Weight : 3200 gm( falls above 10th centile ).
o Length : 48 cm ( falls above 10th centile ).
o OFC : 34 cm ( falls above 10th centile ).
o Temperature : 98° F.
o CRT ˂ 3 seconds.
o SPO₂ (Pulse oximeter) : 96% in room air.

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

10. Cont..
o Respiratory rate : 40/min.
o No chest deformity, chest movement was
symmetrical on both side.
o Air entry was good and symmetrical in both
side, no added sound.
o Heart rate : 120/min.
o Apex beat was palpable in left 4th intercostal
space just medial to the mid clavicular line, 1st
and 2nd heart sound was audible in all 4 areas,
no murmur.

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 : Normal.
o Primitive reflexes : Good.
o No visible congenital anomaly.

13. Salient feature
Sourov, 6 days old male neonate was
admitted with the complaints of jaundice
from 4th day of age and reluctant to feed for 1
day. Baby was born by vaginal delivery at 39
weeks of gestational age with average birth
weight and cried immediately after birth.
Mother’s blood group is B (- ve), but she had
no h/o taking Inj. Anti D. Baby was active,
mildly pale, icteric up to palm & sole, normal
primitive reflexes with good muscle tone.
Vitals were within normal limit.

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

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

16. Investigations
Complete Blood Count :
• Hb%: 16.6 gm/dl
• WBC: Total count: 12,000/cumm
Differential count:
o Neutrophil: 64%
o Lymphocyte: 28%
o Monocyte: 06%
o Eosinophil: 02%
o Basophil : 00%

17. Cont..
o RBC: Normocytic with
normochromic.
o WBC: As distribution.
o Platelet: Adequate.
• Platelet : 3,37,000/cumm.
• PBF:
• Reticulocyte count: 01%.

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

19. Final Diagnosis
Neonatal Jaundice in a Term (39 weeks)
Appropriate for Gestational Age baby of a Rh
(- ve) mother.

20. Management
A.Counseling.
B.Supportive:
 Maintenance of temperature.
 Maintenance of airway, breathing &
circulation.
 Maintenance of hydration and nutrition :
Breast feeding on demand along with Inf. 10%
dextrose in 0.225% NaCl (100ml/kg).
 Continuous phototherapy covering eyes and
genitalia.

21. Cont..
 Inj. Ceftazidime 100 mg/kg/day in 2 divided
doses.
C.Specific:
 Exchange transfusion was done with 0 (- ve)
blood on 07.11.2015.
D.Follow up.

22. Pre-exchange
S. Billirubin : Total – 25.48 mg/dl.
Direct – 1.00 mg/dl.
Indirect – 24.48 mg/dl.

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

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

25. Thank you