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NEWBORN CASE PRESENTATION (2).pptx
- 2. B/O Jaya4 days old female neonate 1st born of non consanguinous parents Informant –mother ,reliability –good Date of birth-22.1.18 at 5.15 a.m Date of examination – 25.1.18 Admitted on day 1 for low birth weight care and found to have yellowish discolouration since day 2 of life
- 3. h/o yellowishdiscoluration since day 2 of life initially noted in eyes progressively seen in abdomen and thighs No h/o fever or hypothermia No h/o lethargy, irritability, poor feeding, seizures. No h/o swelling over scalp No h/o any bleeding manifestations No h/o birth injuries No h/o abdominal distension
- 4. No h/ohigh coloured urine
- 5. Age atmenarche – 15 yrs No h/o irregular menstrual cycles Age at marriage-21 yrs Conceived soon after marriage. Pregnancy detected by UPT at 40 days of amenorrhea , confirmed by USG at 2 months Registered at nearby phc at 2 months LMP-not known EDD- not known Prepregnancy weight-39kg, ht-140 cms
- 6. h/o hyperemesisgravidarum No h/o fever / rash / post auricular swelling No h/o drug intake, radiation exposure No h/o bleeding pv Not taken folic acid tablets Usg done at 2 month, said to be normal
- 7. Quickenning feltat 5th month. Able to percieve fetal movements thereafter Not taken oral supplements regularly h/o 1 dose of iron sucrose infusions was given No h/o bleeding pv No h/o PIH/GDM, hypothyroid complicating pregnancy or any other medical illness. Inj TT 2 doses given at 5th and 7th month usg done at 5th month,said to be normal
- 8. NO h/oPIH/GDM/UTI h/o anemia (Hb8 gms) for which 4 doses of iron sucrose injections were given Continued to perceive fetal movements well USG done at 7th month. Said to be normal. At 8th month of gestation, mother had lower abdominal pain and admitted on 21.1.18 in RMMCH said to have labour pain. No h/o premature rupture of membranes One dose of IM injection was given before delivery.
- 9. Delivered a femalebaby of weight 1.7 kg by normal vaginal delivery on 22.1.18 at 5.15 am. Cephalic presentation. Cried immediately after birth. Clear liquor, not foul smelling. routine care was given. No h/o birth asphyxia, respiratory distress, Cyanosis, obvious congenital anomalies at birth. Admitted in nicu for preterm, low birth weight care.
- 10. Started onEBM on day 1 of life and direct feeds since day 3 of life Urine and meconium passed on day 1. No h/o seizures, respiratory distress, cyanosis. No h/o jaundice on day 1
- 11. Non consanguinousparents Mother 22 yrs, house wife, blood group A positive Father 32yrs, working as driver, blood group not known No h/o preterm delivery in family No h/o jaundice , anemia in family No h/o surgeries among family members
- 12. Thatched house 4 members in family Use gas stove for cooking Use bore water for drinking Toilet facility available Monthly income rs :15000 Lower middle class
- 13. 4 days oldpreterm female neonate(32-34 wks) born to non consanguinous parents, primi high risk mother with anemia with no intrapartum complications with low birth weight and neonatal hyperbilirubinemia.
- 14. Cry &activity –good Colour- Icterus upto thighs Krammer’s index – 12mg/dl Posture-arms slightly flexed, legs flexed &abducted Breathing- abdominothoracic Iv cannula in lt hand
- 15. normothermic Allperipheral pulses felt equally on both sides. HR-130/min, regular. RR-48/min CRT <2sec Spo2-96% in room air
- 16. Weight -1.7Kg, AGA, between 50th and 90th percentile. Length - 43cms, 50th percentile. Head circumference-30.5cms, between 10th and 50th percentile Chest circumference-21cms Abd girth 25cms
- 17. SKIN smooth, visibleVeins Abundant lanugo hairs Icterus upto thighs no pallor/cyanosis / mottling HEAD&SKULL scalp hair fussy AF –open 1*1 cm flat, PF- admits tip of the little finger No cephalhematoma, cranio tabes sutures normal EYES: open, icterus +, no discharge, no hypertelorism NOSE: normal
- 18. ORAL CAVITY :normal. EARS-Slightlycurved pinna, soft , slow recoil NECK :Normal Chest-breast bud, 1-2mm, areola stippled, nipple flushed with surface. Abdomen- no distension , umbilical cord healthy BACK –normal Genitalia - enlarged clitoris, labia minora equally prominent Anus - patent
- 19. Lower limb normal,faint red marks seen on plantar surface. Hip- Ortolani, Barlow negative Neuromuscular maturity tests: Heel to ear-140 degree Popliteal angle-140 degree Scarf sign-elbow crosses the midline Square window – 30 degree Gestational age assessment: Physical maturity- 8 Neuromuscular maturity - 14 New ballord score – 22 (32-34 weeks)
- 20. CVS Apex notseen. Apex felt at left 4th ICS, lateral to mid clavicular line s1,s2 heard. No murmur Pulses well felt in all vessels on both sides RS- B/L chest movement equal, B/l air entry equal No added sounds
- 21. Abdomen – soft nodistension liver felt 2cm below the right costal margin liver span 5.5 cm umbilical cord - healthy
- 22. Cry good Spontaneous eye opening + Upper limb flexed at elbow, lower limbs semiflexed at both hip and knee No abnormal postures
- 23. Blinks on showinglight, B/L Pupils equally reacting to light, not follows light Dolls eye movement(+) Rooting (+) Sucking fair No facial asymmetry Good cry volume, swallowing(+)
- 24. 180 degree fliptest: pull to sit-head lag(+),rounded back Axillary suspension- does not slip from hands, mild flexion at hip and knee Ventral suspension- all 4 limbs extended ,neck flexed Power > 3/5 in all 4 limbs
- 25. Rooting present Sucking fair Grasp reflex present Stepping, placing present ATNR(+) Moro reflex present, incomplete. Galant reflex+
- 26. 4 days oldLBW PRETERM (32-34weeks), female neonate, Appropriate for gestational age, admitted for preterm care and neonatal hyperbilirubinemia probably physiological hyperbilirubinemia without complications
- 27.