- This document describes the case presentation of a 3 day old male newborn born via C-section to a 32 year old mother. The newborn was a twin, with twin 1 delivered first and crying immediately, while twin 2 was delivered with meconium staining and weak cry requiring resuscitation. Twin 1 was admitted for respiratory distress which resolved within 24 hours of treatment, while twin 2 unfortunately expired after developing respiratory distress and birth asphyxia. The newborn examined was twin 1, who presented with respiratory distress but was otherwise healthy on examination.

1. CASE PRESENTATION

2. Case presentation
• Baby of SELVARANI, 3 days old 2nd born male child
born to non consanguinous parents admitted in view of
respiratory distress
• The child was born on 2.9.15 at 11.45 am in RMMCH

3. Antenatal history
• Birth order : Gravida-2 ,Para-1,Live-1
• Maternal age : 32
• Age at conception : 31
• LMP: 14.12.2014
• EDD : 21.9.2015

4. Antenatal history
• Mode of conception : spontaneous
• Pregnancy confirmed by UPT at kammapuram GH at 45
days of LMP
• Booked and immunised
• Blood group : B positive

5. First trimester
• No h/o fever with rash
• No h/o bleeding per vagina
• No h/o radiation
• No h/o any drug intake
• USG scan not done IN FIRST TIRMESTER

6. Second trimester
• Quickening felt at 5 month
• No h/o GDM
H/o PIH-anti-hypertensive tab taken from 6th month
• No h/o bleeding per vagina
• TT injection taken at 5th & 7th month
• Usg revealed twin gestation – at 5 months
• Anomaly scan – done at 6 month. No anomalies
detected in both babies.
• Iron ,folic and calcium tablets taken from 4 th month..

7. Third trimester
• H/o PIH -Anti-hypertensive tab taken
• No h/o GDM
• No h/o UTI
• USG scan done found to be normal
• No bleeding pv
• No h/o any fever with rashes

8. Natal history
• EDD :21.9.2015
• Mode of delivery : LSCS
• Indication : previous LSCS with immenent eclampsia

9. Natal history
TWIN-1 TWIN-2
• Delivered a male baby of
birth weight 2.6 kg through
clear liquor with cephalic
presentation at 11.45 am on
2-8-15
APGAR 1ST min : 5
5 min : 7
• Baby cried immediately
after birth
• Delivered a male baby of
birth weight 2.5kg through
meconium stained liquor
with cephalic presentation
at 11.55 am on 2-8-15
• APGAR 1st min: 3
• 5 min : 5
• Baby didnot cry after birth;
established weak cry after
tube and bag ventilation
given for 20 min

10. neonatal history TWIN-1
• Baby [twin-1] is admitted in NICU in v/o respiratory
distress
• Passed meconium and urine at 1st day of life
• Baby was treated with nasal oxygen, IV fluids and
respiratory distress settled with in 24 hours of treatment

11. TWIN-2
• Baby was admitted in RNB in view of respiratory distress
and birth asphyxia
• Baby was treated with IV fluid ,iv antibiotic,and
mechanical ventilation were given, in spite of all the
measures baby expired at 2 am on 3-9-15

12. 40 yrs
32
yrs
4yrs

13. Family history
• History of twins in the fathers family
• No h/o any neonatal death / neonatal seizures /
developmental delay in the family

14. Socioeconomic history
• House : thatched
• No.of persons in the family 4
• Father 12th std , daily wages ,12,000 per month
• Mother 8th std. house wife
• According to modified kuppusamy scale upper middle
class

15. • Summary.
• 3 days old b/o selvarani.twin 1 delivered via lscs at
rmmch…cried imm after birth admitted in view of
respiratory distress and distress settled with in 24 hours
of admission

16. GENERAL EXAMINATION
• Age at examination:3rd day
• Posture :flexed
• Color : Pink
• Cry, Activity : GOOD
• Vital Signs
Heart Rate : 148 Beats/min
Resp. Rate : 44 /min
spo2 : 96% @ RA
CRT : < 2 secs

17. Anthropometry
• Weight : 2.5 kg
• length : 47 cm
• Head circumference : 36 cm
• Chest circumference : 33 cm

18. Head to Toe examination
• Head – normal
anterior fontanalle 3 X 3 cm
• Eyes : No discharge,no squint,no hypertelorism
• no sub-conj-hemorrhages
• Ears : no preauricular tag,no abnormal shape,external
auditory canal [patent]
• Nose : no bleeding,no flaring,patent

19. • Mouth : no cleft lip ,no cleft palate, no natal teeth,
• Neck : no swelling.
• Skin : pink
• Umblical cord : dried
• Genitals : testis descended
• Anus : patent
• Spine : normal
• Upper limb & lower limbs : normal

20. Systemic examination
• CVS
apical impulse at 4th ICS lateral to MCL
S1 & S2 normal
no murmurs
• RS
B/L air entry present
no added sounds
• Abdomen
umblicus-normal position , all quadrants moves with
respiration , no visible mass
no organomegaly

21. • CNS
AF at level pulsatile
Tone : normal
neonatal reflexes
ORAL REFLEXES:
• sucking
• Rooting
EYE REFLEXES
• Glabellar tap
• Mc Carthys reflex
• Light reflex

22. SPINE REFLEX
• Gallant’s reflex
• Perez reflex
LIMB REFLEXES
• Stepping
• Placing
• Moro’s
• Plantar and palmar grasp
• Magnet reflex

23. • 3 days old male newborn born to para -2, live-2 mother
whose gestational age is 37 weeks and 2 days/ AGA/
with respiratory distress most probable disgnosis
TRANSIENT TACHYPNEA OF NEWBORN

24. THANK YOU