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CASE 1 : B/O MRS.

NISANSALA

TERM BABY

SMALL FOR GESTATIONAL AGE

INVESTIGATED AND TREATED FOR


POSSIBLE SEPSIS

THE MOTHER

41 y/o primae, subfertility for 5years

POA 37 weeks

IM Betamethasone 2 doses given

Antenatal PIH on Methyldopa

MBG B +

THE BABY

Born by Elective LSCS Elderly primae,


subfertility at POA 37 weeks

DOB - 8 am on 28/09/2015

Birth weight 2 kg

OFC 31 cm Length 44 cm

APGAR at 1 min10 at 5 min-10

CBS at 20 min of life 79 mg/dl

SMALL FOR GESTATIONAL AGE (SGA)

Defined as a baby whose birth weight is


less than the 10 th percentile for
gestational age

For 37 weeks , 10th percentile is 2.5 kg

Anticipated problems:
-hypoglyceamia
- hypothermia
- polycytheamia
- jaundice

30 min of life groaning when put to


mothers breast, not sucking, colour pink,
no respiratory distress noticed
Kept warm, abdomen slight distention
NG aspirate amniotic fluid +, washout
given
Still not sucking from mother, mild nasal
flaring
Admitted to NICU

AT NICU

Incubator care--> Kept warm


Incubator Oxygen 3 l /min
CBS 49 mg/dl IVF 10% Dextrose 80
ml/kg over 24 hours started
Kept under observation
At 18 hours, no nasal flaring Oxygen
omitted
At 6 hours EBM feeds small amounts
started
Vomitting +

INVESTIGATIONS

FBC Hb -20.5 g/dl

WBC 12.61

PCV 57.2 % N 58% L 25%


Plt 236

CRP 0.7 mg/l


CBS monitored 4 6 hourly within
normal limits

DAY 2

NG aspirate 3 cc + clear fluid with particles

Sy domperidone stat dose given

Since no respiratory distress breast feeds


attempted
Poor sucking, tone good, but less active
Blood culture taken and broad spectrum IV
antibiotics commenced

INVESTIGATIONS

FBC Hb 19.7 mg/dl WBC 12.61


PCV 54.2 %

N 42% L 46%

Plt 232

SE Na 135 K 3.81 Cl 100

Blood culture no growth

IVF gradually reduced while increasing


EBM feeds via syringe after attempting
breast feeds

DAY 3

Mild icterus noted


SBR T 9.46 mg/dl just below PT
level single intermittent PT given for
18 hrs

IVF omitted, mother trained cup feeds

Taking cup feeds well

Transferred to ward and discharged the


next day