Thesis

APRIL 08 MARCH 09

MAS : 21

Jan 09

Name : B/o. MANGALAM Age / Sex: NB/M Dept : NeonatologyHos.No : 399420 Mrd.No :302313 Ward : I NB NICUD.O.A : 26.12.08 D.O.D : 03.01.09REF. BY. DR. MAHALINGAM PLACE: MADRUAI

DIAGNOSIS: MECONIUM ASPIRATION WITH RESPIRATORY DISTRESS CHD [MODERATE ASD WITH PPHN] THROMBOCYTOPENIACOURSE:

This Term / AGA / Male / born at private hospital by LSCS (Indication:

Meconium stained liquor) on 25.12.08. Baby cried soon after birth, H/o. Meconium

aspiration +, and developed respiratory distress since birth for that transferred to

MMHRC on 26.12.08 for further management. H/o. Cyanosis +. No Maternal H/o. PIH,

GDM & PROM. O/E. Baby activity & cry: Weak, Peripheral cyanosis +, CFT > 3 sec,

dyspnoeic +, tachypnoeic +, no birth injury, CVS: S1, S2 heard, murmur +. RS: RR:

>60/mt, Bilateral air entry equal, P/A: soft, CNS: NNR sluggish. External genitalia : Left

Undesended testis +. Baby was investigated – Peripheral smear showed

Thrombocytopenia (Platelet count – 20,000). Blood sugar & serum creatinine were

normal. Chest X ray showed Bilateral meconium infiltration. Echo showed moderate

sized ostium secundum type of ASD, L R shunt and Mild PHT. Baby was managed

with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate &

Syp. Digoxin. Baby had hypotension, perfusion was low Inj. Dopamine was started.

With the above measures baby respiratory distress reduced, so weaned form the ventilator

31.12.08 & started on tube feeds. Now baby is taking oral feeds and discharged today

with the advice to continue further follow up with the referral doctor.

INVESTIGATIONS:

Investigation Result Unit Date

HAEMOGLOBIN 15.2 gm/dl 26/12/2008

TOTAL COUNT 9100 cells/cumm 26/12/2008

PCV 43 % 26/12/2008

MCV 113 FL 26/12/2008

MCH 39 PG 26/12/2008

MCHC 34 % 26/12/2008

RDW 13 % 26/12/2008

RBC 3.8 MILL/Cumm 26/12/2008

MPV 7.9 FL 26/12/2008

NEUTROPHILS 60 % 26/12/2008

LYMPHOCYTE 38 % 26/12/2008

EOSINOPHIL 02 % 26/12/2008

PLATELET COUNT 20,000 CELLS Lakhs/Cumm 26/12/2008

CREATININE 0.7 mg /dl 27/12/2008

PERIPHERAL SMEAR SHOWED (26.12.08): RBCs show normochromic

normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No

atypical or immature cells. DC: Neutrophils: 54%, Eosinophils: 01%, Monocytes: 05%,

Lymphocytes: 40%. Platelets normal in number and morphology. IMPRESSION:

THROMBOCYTOPENIA.

ECHO REPORT SHOWED (27.12.08) : SITUS SOLITUS. LEVOCARDIA. AV, VA

CONCORDANCE. NORMAL RELATED GREAT VESSELS. MODERATE SIZED

OSTIUM SECUNDUM OF ASD. LEFT TO RIGHT SHUNT > 2:1. TR PEAK

GRADIENT = 30mm of hg. NO PDA / COARCTATION. MILD PHT. IMPRESSION : MODERATE SIZED OSTIUM SECUNDUM TYPE OF ASD, L R SHUNT AND MILD PHT.

ADVICE ON DISCHARGE :

Tab. Edigra 1/8th TID x 1 weekSyp. Digoxin 0.75ml OD x Till further advice

PLAN : REPEAT ECHO AFTER 1 WEEK

Admission weight : 3.690 KgDischarge Weight : 3.680 Kg

Name : B/o. Amarshanthi Age/Sex : NB/ M Dept : NeonatologyHos.No: 399328 Mrd.No : 302215 Ward : IL.NB. NICUD.O.A : 24/12/08 D.O.D : 25/12/08 ************************************************************************DIAGNOSIS: NEONATAL JAUNDICE / RH INCOMPATIBILITY WITH NEONATAL CONVULSION AND ? MECONIUM ASPIRATION

COURSE:

This 1 days old Term / Female / AGA born at private hospital by normal vaginal

delivery on 23.12.08 to RH negative mother. No H/o Birth asphyxia. H/o. respiratory

distress since birth, H/o. ? meconium aspiration +, H/o. refusal of feeds +, H/o convulsion

– 1 episode. No maternal H/o PIG, GDM & PROM, O/E. Baby’s activity & cry were

weak, Tachypnoeic +, dyspnoeic +, grunting +, cyanosis +, no birth injury, no obvious

external anomaly. CVS: S1, S2 heard, RS: RR > 60/min, sub costal indrawing +, P/A:

distension +, CNS: NNR sluggish. Baby was investigated peripheral smear showed

leukoerythroblastic blood picture (HB : 13.3m%, TC – 2 lakhs, Platelet count : 70000)

DCT : positive, Serum bilirubin : 18.8mg%, Serum Creatinine : 1.1 mg%, Reticulocyte

count : 3.6%. Baby was managed with mechanical ventilator support, Iv fluids, Iv

antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inj. Gardenol, Baby had severe

jaundice, treated with triple sided phototherapy & exchange blood transfusion. Post

exchange serum bilirubin was 16.1mg%. On 25.12.08 ABG showed respiratory acidosis

& hyperkalemia, Asthalin nebulization & Inj. Insulin infusion started. Baby’s blood

sugar hourly monitored. Baby developed Hypotension, ionotropes started. Baby had

desaturation, persistent cyanosis & bradycardia, CPR carried out, Inj. Adrenaline, Inj.

Atropine given. Even with above measures baby could not be revived, DECLARED

DEAD on 25.12.08 at 9.30pm

INVESTIGATION :


CREATININE 1.1 mg /dl 25/12/2008 BILIRUBIN TOTAL 18.8 mg/dl 25/12/2008 BILIRUBIN DIRECT 3.4 mg/dl 25/12/2008 DIRECT ANTI HUMAN GLOBULIN TEST (COOMBS)

POSITIVE 25/12/2008

HAEMOGLOBIN 13.3 gm/dl 25/12/2008 TOTAL COUNT 2.0 LAKHS cells/cumm 25/12/2008 HAEMOGLOBIN 13.3 gm/dl 25/12/2008 TOTAL COUNT 2.0 LAKSH {TWICE RPT} cells/cumm 25/12/2008 PCV 44 % 25/12/2008 PCV 44 % 25/12/2008 MCV 158 FL 25/12/2008 MCV 158 FL 25/12/2008 MCH 47 PG 25/12/2008 MCH 47 PG 25/12/2008 MCHC 30 % 25/12/2008 MCHC 30 % 25/12/2008 RDW 31 % 25/12/2008 RDW 31.0 % 25/12/2008 RBC 2.8 MILL/Cumm 25/12/2008 RBC 2.8 MILL/Cumm 25/12/2008 MPV 8.8 FL 25/12/2008 MPV 8.8 FL 25/12/2008 NEUTROPHILS 30 % 25/12/2008 LYMPHOCYTE 68 % 25/12/2008 EOSINOPHIL 02 % 25/12/2008 NEUTROPHILS 30 % 25/12/2008 LYMPHOCYTE 68 % 25/12/2008 EOSINOPHIL 02 % 25/12/2008 PLATELET COUNT 70,000 CELLS Lakhs/Cumm 25/12/2008 PLATELET COUNT 70,000 CELLS Lakhs/Cumm 25/12/2008 RETICULOCYTE COUNT (Children)

3.6 % 25/12/2008

BILIRUBIN TOTAL 16.1 mg/dl 25/12/2008 BILIRUBIN DIRECT 3.8{TWICE RPT} mg/dl 25/12/2008

PERIPHERAL SMEAR (25.12.08): RBCs show normocytes and macrocytes. Nucleated RBCs 120 /100 WBCs. WBC count shows leukocytosis with shift to left. No atypical or immature cells. DC: Neutrophils: 25%, Eosinophils: 00%, Monocytes: 02%,

Lymphocytes: 73%. Platelets count diminished. IMPRESSION: LEUKOERYTHROBLASTIC BLOOD PICTURE

FEB 09

Name : B/o. SOORATH EMINA Age/Sex : NB/ F Dept : NeonatologyHos.No: 403566 Mrd.No : 305105 Ward : IL.NB. NICUD.O.A : 02/02/09 D.O.D : 05/02/09 ************************************************************************REF.BY.DR.KYRDUDYN PLACE : RAMNAD

DIAGNOSIS: PNEUMONITIS (EARLY ONSET OF SEPSIS)

COURSE:

This 5 days old Term / AGA/ female born at private hospital by LSCS

(Indication : Previous LSCS with PROM) on 28.01.09. H/o. Baby cried immediately

after birth and developed respiratory distress since birth, for that referred to MMHRC on

02.02.09 for further management. Maternal H/o. PROM – 8 hours +, H/o. Meconium

aspiration +, H/o. vomiting – 2 episodes +, H/o PIH & GDM. O/E. activity & cry were

weak, dyspnoeic +, tachypnoeic +, colour : icteric, CFT < 3 sec, no birth injury, no

obvious external anomaly. CVS: S1, S2 heard, RS: Bilateral crepitation +, P/A:

distended +, CNS : NNR sluggish. Baby was investigated – Peripheral smear, Blood

sugar & Serum creatinine were normal. Serum bilirubin T : 14.9mg%, D : 0.5mg%.

Chest X-ray suggestive of Pneumonitis. Echo was normal. Baby was managed with

oxygen, Iv fluids, Iv antibiotics, Inj. calcium gluconate, Inj. Rantac & Phototherapy.

With the above measures baby’s respiration became normal, activity improved and

started on small tube feeds. Now baby is taking oral feeds and discharged today with the

advice to continue the further follow-up with the referral doctor.

INVESTIGATION :

Investigation Result Unit DateCREATININE 0.3 mg /dl 02/02/2009 BILIRUBIN TOTAL

14.9 mg/dl 02/02/2009

BILIRUBIN DIRECT

0.5 mg/dl 02/02/2009

HAEMOGLOBIN gm/dl 02/02/2009 TOTAL COUNT cells/cumm 02/02/2009 HAEMOGLOBIN 17.1 gm/dl 02/02/2009 TOTAL COUNT 7200 cells/cumm 02/02/2009 PCV % 02/02/2009 PCV 51 % 02/02/2009 MCV FL 02/02/2009 MCV 101 FL 02/02/2009 MCH PG 02/02/2009 MCH 34 PG 02/02/2009 MCHC % 02/02/2009 MCHC 33 % 02/02/2009 RDW % 02/02/2009 RDW 18 % 02/02/2009 RBC MILL/Cumm 02/02/2009 RBC 4.9 MILL/Cumm 02/02/2009 MPV FL 02/02/2009 MPV 6.7 FL 02/02/2009 LYMPHOCYTE % 02/02/2009 EOSINOPHIL % 02/02/2009 MONOCYTES % 02/02/2009 NEUTROPHILS 58 % 02/02/2009 LYMPHOCYTE 40 % 02/02/2009 EOSINOPHIL 02 % 02/02/2009 PLATELET COUNT

Lakhs/Cumm 02/02/2009

PLATELET COUNT

2.4 Lakhs/Cumm 02/02/2009

PERIPHERAL SMEAR (02.02.09): RBCs shows normochromic normocytes and

macrocytes . Nucleated RBCs 2/100 WBCs. WBC count normal. No atypical or

immature cells. DC: Neutrophils: 42%, Eosinophils: 02%, Monocytes: 05%,

Lymphocytes: 51%. Platelets count normal in number and morphology. IMPRESSION:

NORMAL SMEAR STUDY

ECHO REPORT SHOWED (02.02.09) : SITUS SOLITUS. LEVOCARDIA.

NORMAL VALVES, IAS, IVS INTACT, GREAT VESSELS NORML, NO PDA /

COARCTATION, NO PHT, NORMAL LV AND RV FUNCTION.

IMPRESSION : NORMAL STUDY.


Inj. Magnex 125mg IV BD x 5 daysInj.Amikacin. 40mg IVOD x 5 days

Admission weight : 2.715 KgDischarge weight : 2.975 Kg

Name : B/o. KALAIARASI Age / Sex: NB/ M Dept : NeonatologyHos.No : 403698 Mrd.No : 305199 Ward : I NB NICU

D.O.A :02.02.09 D.O.D : 20.02.09************************************************************************REF. BY. DR. SABARI RAJA., PLACE : SIVAGANGAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME COURSE:

This Term / AGA / Male / born at private hospital by LSCS (Indication : Fetal

Bradycardia with thick meconium stained liquor) on 02.02.09. H/o. Baby cried

immediately after birth and developed respiratory distress and convulsion since birth for

that referred to MMHRC on 02.02.09 for further management. Maternal H/o. PROM 6

hours +, UTI +. No Maternal H/o PIH & GDM. O/E. Baby activity : Sluggish & cry:

Irritable, peripheral cyanosis +, convulsion +, dyspnoeic +, tachypnoeic +, Pallor +, no

birth injury, no obvious external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower

chest indrawing+, P/A: soft, CNS: Irritable, Convulsion +. Baby was investigated –

Peripheral smear showed neutrophilic leukocytosis. Blood sugar & Serum creatinine

were normal. Echo within normal limits. Chest X ray showed meconium aspiration

syndrome. Baby was managed with Mechanical ventilator support, Iv fluids, Iv

antibiotics, Inj. Dopamine infusion, Inj. Gardenol, Inj. Calcium gluconate, Inj. Surfactant

& Domstal drops. With the above measures baby’s respiratory distress reduced so

weaned from the ventilator on 12.02.09 & started on small tube feeds. On 12.02.09 as

baby had lower chest indrawing, suspected as CLD hence started on Tab. Aldactone and

mucolite drops. Now baby’s respiration became normal and is taking breast-feeds and

discharged today with advice to continue further fellow up with the referral doctor.

INVESTIGATION :


BLOOD GROUP RH TYPING "AB" POSITIVE 03/02/2009

HAEMOGLOBIN 18.2 [ TWICE RPT ] gm/dl 03/02/2009 TOTAL COUNT 33900 cells/cumm 03/02/2009 PCV 54 % 03/02/2009 MCV 114 FL 03/02/2009 MCH 38 PG 03/02/2009 MCHC 33 % 03/02/2009 RDW 19 % 03/02/2009 RBC 4.7 MILL/Cumm 03/02/2009 MPV 7.3 FL 03/02/2009 NEUTROPHILS 80 % 03/02/2009 LYMPHOCYTE 19 % 03/02/2009 EOSINOPHIL 01 % 03/02/2009 PLATELET COUNT 1.9 Lakhs/Cumm 03/02/2009 CREATININE 0.8 mg /dl 05/02/2009

PERIPHERAL SMEAR SHOWED (03.02.09): RBCs shows normochromic

normocytes and macrocytes . Nucleated RBCs 6/100 WBCs. WBC count shows

neutrophilic leukocytosis. No atypical or immature cells. DC: Neutrophils: 82%,

Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 12%. Platelets count normal in

number and morphology.

IMPRESSION: NEUTROPHILIC LEUKOCYTOSIS.

ECHO CARDIOGRAPHY REPORT (07.02.09) : SITUS SOLITUS. LEVOCARDIA.

NORMAL VALVES. GREAT VESSELS NORMAL. IAS, IVS INTACT. NO PDA/

COARCTATION. NO PULMONARY HYPERTENSION. NORMAL LV AND RV

FUNCITON. IMPRESSION : NORMAL STUDY.

Admission Weight : 3.250 KgDischarge Weight : 3.320 Kg

Name : B/o. PUSHPALATHA Age / Sex: NB/ M Dept : NeonatologyHos.No : 404046 Mrd.No : 305407 Ward : I NB NICUD.O.A :05.02.09 D.O.D : 20.02.09************************************************************************REF. BY. DR. SABARI RAJA., PLACE : SIVAGANGAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH THROMBOCYTOPENIA

COURSE:

This Term / AGA / Male baby born at private hospital by LSCS : (Indication :

Previous LSCS) on 05.02.09. H/o. Baby cried immediately after birth and developed

respiratory distress and convulsion since birth, for that referred to MMHRC on 05.02.09

for further management. Maternal H/o. Pervious LSCS, H/o. Consanguinous marriage.

No Maternal H/o PIH, GDM & PROM. O/E. Baby activity & cry: Weak, peripheral

cyanosis +, convulsion +, dyspnoeic +, tachypnoeic +, no birth injury, no obvious

external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest indrawing+, P/A:

soft, CNS: NNR sluggish, Convulsion +. Baby was investigated – Peripheral smear

showed Thrombocytopenia. Blood sugar was normal. Serum creatinine : 1.1 (07.02.09),

1.2 (10.02.09), 0.8 (13.02.09). Platelet counts : 20,000 (05.02.09), 60,000 (10.02.09).

Chest X ray showed meconium aspiration syndrome. Baby was managed with

Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Dopamine infusion, Inj. Nor –

adrenalin, Inj. Pavlon, Inj. Calcium gluconate, Inj. Gardenol, Inj. Rantac & Domstal

drops. With the above measures baby’s respiratory distress reduced so weaned from the

ventilator on 16.02.09 & started on small tube feeds. On 16.02.09 as baby had features

suggestive of CLD started on Tab. Aldactone. Now baby’s respiration became normal

and is taking oral feeds hence discharged today with advice to continue further fellow up

with the referral doctor.

INVESTIGATION :


BLOOD GROUP RH TYPING

" AB " POSITIVE 05/02/2009


" AB " POSITIVE 06/02/2009

HAEMOGLOBIN 15.5 gm/dl 05/02/2009 TOTAL COUNT 18700 cells/cumm 05/02/2009

HAEMOGLOBIN 15.5 gm/dl 06/02/2009 TOTAL COUNT 18700 cells/cumm 06/02/2009 PCV 44 % 05/02/2009 PCV 44 % 06/02/2009 MCV 107 FL 05/02/2009 MCV 109 FL 06/02/2009 MCH 37 PG 05/02/2009 MCH 37 PG 06/02/2009 MCHC 34 % 05/02/2009 MCHC 34 % 06/02/2009 RDW 17 % 05/02/2009 RDW 17.0 % 06/02/2009 RBC 4.0 MILL/Cumm 05/02/2009 RBC 4.0 MILL/Cumm 06/02/2009 MPV 10.4 FL 05/02/2009 MPV 10.4 FL 06/02/2009

P/S

RBCs: NORMOCHROMIC NORMOCYTIC. NO HAEMOPARASITES ARE SEEN. WBCs: COUNT IS NORMAL. NO IMMATURE CELLS ARE SEEN. PLATELET COUNT IS DECREASED.

06/02/2009

NEUTROPHILS 80 % 05/02/2009 LYMPHOCYTE 19 % 05/02/2009 EOSINOPHIL 01 % 05/02/2009 NEUTROPHILS 80 % 06/02/2009 LYMPHOCYTE 19 % 06/02/2009 EOSINOPHIL 01 % 06/02/2009 PLATELET COUNT

20,000 CELLS Lakhs/Cumm 05/02/2009

PLATELET COUNT


IMPRESSION THROMBOCYTOPENIA 06/02/2009 CREATININE 1.1 mg /dl 07/02/2009 CREATININE 1.2 mg /dl 10/02/2009 PLATELET COUNT









Admission Weight : 3.420 KgDischarge Weight : 3.265 Kg

Name : B/o. Ushnara {Twin – I} Age/Sex : NB/ M Dept : Neonatology

Hos.No: 406170 Mrd.No : 306825 Ward : IL.NB. NICUD.O.A : 25.02.09 D.O.D : 26.02.09 ************************************************************************DIAGNOSIS: PRE TERM (26 WEEKS) / ELBW

RESPIRATORY DISTRES SYNDROME

COURSE:

This Pre Term (26 weeks) / ELBW / male / Twin – I born at MMHRC by Normal

vaginal delivery (Breech presentation) on 25.02.09. H/o. Baby had weak cry after birth

and developed grunting and respiratory distress for that baby shifted to NICU for further

management. No Maternal H/o PIH, GDM & PROM. O/E. Activity & cry were weak,

grunting +, Peripheral cyanosis +, dyspnoeic +, tachypnoeic +, CFT > 3 sec, no birth

injury, no obvious external anomaly. CVS: S1, S2 heard, hypotension +, RS: RR :

>60/mt, Lower chest indrawing +, P/A: soft, CNS : NNR sluggish. Baby was

investigated – HB : 16.1 gm%, TC – 18,400 cells, Platelet count 2.7 lakhs. Blood sugar

was normal. Baby was managed in incubator with Mechanical ventilator support,

Surfactant [2 doses], Iv fluids, Iv antibiotics, Inj. calcium gluconate, Inj. Vitamin K, Inj.

Aminophylline & Ionotropes. With the above measures now baby is maintaining oxygen

saturation of 97% with mechanical ventilator support of FIO2 – 30%. Since parents were

not willing for further management, Baby is discharged Against Medical Advice on

26.02.09

INVESTIGATION :


BLOOD GROUP RH TYPING "O" POSITIVE 25/02/2009

HAEMOGLOBIN 16.1 gm/dl 26/02/2009 TOTAL COUNT 18,400 cells/cumm 26/02/2009 PCV 49 % 26/02/2009 MCV 106 FL 26/02/2009 MCH 35 PG 26/02/2009 MCHC 32 % 26/02/2009 RDW 17.1 % 26/02/2009 RBC 4.6 MILL/Cumm 26/02/2009

MPV 7.8 FL 26/02/2009 NEUTROPHILS 61 % 26/02/2009LYMPHOCYTE 38 % 26/02/2009 EOSINOPHIL 01 % 26/02/2009 PLATELET COUNT 2.7 Lakhs/Cumm 26/02/2009

Name : B/o. Ushnara {Twin – II} Age/Sex : NB/ M Dept : Neonatology

Hos.No: 406171 Mrd.No : 306826 Ward : IL.NB. NICUD.O.A : 25.02.09 D.O.D : 26.02.09 ************************************************************************DIAGNOSIS: PRE TERM (26 WEEKS) / ELBW

RESPIRATORY DISTRES SYNDROME

COURSE:

This Pre Term (26 weeks) / ELBW / male / Twin – II born at MMHRC by Normal

vaginal delivery (Breech presentation) on 25.02.09. H/o. Baby had weak cry after birth

and developed grunting and respiratory distress for that baby shifted to NICU for further

management. No Maternal H/o PIH, GDM & PROM. O/E. Activity & cry were weak,

grunting +, Peripheral cyanosis +, dyspnoeic +, tachypnoeic +, CFT > 3 sec, no birth

injury, no obvious external anomaly. CVS: S1, S2 heard, hypotension +, RS: RR :

>60/mt, Lower chest indrawing +, P/A: soft, CNS : NNR sluggish. Baby was

investigated – HB : 19.7 gm%, TC – 11,200 cells, Platelet count 2 lakhs. Blood sugar

was normal. Baby was managed with Mechanical ventilator support, Surfactant [3

doses], Iv fluids, Iv antibiotics, Inj. calcium gluconate, Inj. Vitamin K, Inj.

Aminophylline & Ionotropes. With the above measures now baby is maintaining oxygen

saturation of 92% with mechanical ventilator support of FIO2 – 85%. Since parents were

not willing for further management, Baby is discharged Against Medical Advice on

26.02.09

INVESTIGATION :


BLOOD GROUP RH TYPING "A" NEGATIVE 25/02/2009

HAEMOGLOBIN 19.7 gm/dl 26/02/2009 TOTAL COUNT 11,200 cells/cumm 26/02/2009 PCV 60 % 26/02/2009 MCV 103 FL 26/02/2009 MCH 33 PG 26/02/2009 MCHC 32 % 26/02/2009 RDW 17.5 % 26/02/2009 RBC 5.8 MILL/Cumm 26/02/2009

MPV 8.2 FL 26/02/2009 NEUTROPHILS 24 % 26/02/2009 LYMPHOCYTE 75 % 26/02/2009 EOSINOPHIL 01 % 26/02/2009 PLATELET COUNT 2.0 Lakhs/Cumm 26/02/2009

Name : B/o. ANITHA BEGAM Age/Sex : NB/ M Dept : NeonatologyHos.No: 404311 Mrd.No : 305573 Ward : IL.NB. NICUD.O.A : 09/02/09 D.O.D : 28/02/09 ************************************************************************

REF. BY: DR.PREMA PRABHAKAR., PLACE: MELUR

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME CHD (SMALL MID MUSCULAR VSD, SMALL ASD, TINY

PDA)COURSE:

This new born Term / AGA/ male baby born at private hospital by LSCS

(Indication : PROM with failure to induction ) on 08.02.09, H/o. Baby cried immediately

after birth, then developed respiratory distress, H/o. Meconium aspiration +, H/o. cord

around the neck +, for that referred to MMHRC on 09.02.09. Maternal H/o. PROM +

with failure to induction. No Maternal H/o PIH & GDM. O/E. Baby activity & cry were

weak, dyspnoeic +, Tachypnoeic +, no cyanosis, CVS: S1, S2 heard, RS: RR > 60/mt.

lower chest indrawing +, Bilateral crepitation +, P/A: soft, CNS : NNR sluggish. Baby

was investigated – Peripheral smear showed neutrophilic leukocytosis, Blood sugar &

Serum creatinine were normal. Serum magnesium : 6.6. Chest X-ray suggestive of

meconium aspiration syndrome. ECHO showed small mid, muscular VSD, Small ASD,

Tiny PDA. Baby was managed with mechanical ventilator, Iv fluids, Iv antibiotics, Inj.

Nor – adrenaline infusion, Inj. Dopamine infusion, Inj. calcium gluconate, Inj. Rantac,

Tab. Edigra & Syp. Digoxin. With the above measures baby’s respiratory distress

reduced and weaned from mechanical ventilator on 18.02.09 and started on small tube

feeds. On 18.02.09 Tab. Aldactone was started since respiratory features were suggestive

of CLD. Now baby is on breast feeds and discharged today with the advice to continue

further follow up with the referral doctor.

INVESTIGATION :


BLOOD GROUP RH TYPING "A" POSITIVE 09/02/2009

HAEMOGLOBIN 13.8 gm/dl 09/02/2009 TOTAL COUNT 17200 cells/cumm 09/02/2009 PCV 42 % 09/02/2009 MCV 94 FL 09/02/2009 MCH 30 PG 09/02/2009 MCHC 32 % 09/02/2009 RDW 16 % 09/02/2009 RBC 4.4 MILL/Cumm 09/02/2009 MPV 6.6 FL 09/02/2009 NEUTROPHILS 80 % 09/02/2009 LYMPHOCYTE 19 % 09/02/2009 EOSINOPHIL 01 % 09/02/2009 PLATELET COUNT 3.0 Lakhs/Cumm 09/02/2009 CREATININE 0.9 mg /dl 11/02/2009 MAGNESIUM 6.6 mg/dl 14/02/2009

PERIPHERAL SMEAR SHOWED (09.02.09): RBCs show normochromic normocytes

and few macrocytes. No nucleated RBCs or hemoparasites. WBC count shows

neutrophilic leukocytosis. No atypical or immature cells.

IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS.

ECHO REPORT SHOWED (09.02.09) : SITUS SOLITUS. LEVOCARDIA. SMALL

MID MUSCULAR VSD, TINY PDA, SMALL OSTIUM SECUNDUM TYPE OF ASD,

L -> R SHUNT, NO PAH, GOOD LV AND RV FUNCTION.

IMPRESSION : CHD. SMALL MID MUSCULAR VSD, TINY PDA, SMALL ASD.

NO PAH.

APRIL 09Hos.No : 409759 Mrd.No : 309279 Ward : I NB NICUD.O.A : 28.03.09 D.O.D : 08.04.09************************************************************************REF. BY. DR. VIGNESHRAJ PLACE: DINDIGUL

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH THROMBOCYTOPENIA ? EARLY ONSET SEPSISCOURSE:

This pre term 36 weeks / AGA / Male / born at private hospital by LSCS (Indication:

Oligohydraminios) on 28.03.08. H/o. Baby cried soon after birth, H/o. Meconium aspiration

+, resuscitated at referral doctor clinic and developed respiratory distress since birth for that

referred to MMHRC on 28.03.09 for further management. Maternal H/o. PROM – 6hours +.

No Maternal H/o. PIH & GDM. O/E. Baby activity & cry: Weak, colour : Pink, CFT < 3

sec, dysphonic +, tachypnoeic +, no birth injury, CVS: S1, S2 heard, RS: RR: >60/mt, low

chest indrowing, Bilateral air entry equal, P/A: soft, CNS: NNR sluggish. Baby was

investigated – Peripheral smear showed leukocytosis & Thrombocytopenia (HB :

20.6%mg/dl, TC : 22,800, Platelet count – 20,000). Blood sugar was normal. serum

creatinine 1.1mg/dl (30.03.09), 0.7mg/dl (31.03.09). Chest X ray showed Bilateral

meconium infiltration. Baby was managed with C-PAP, Iv fluids, Iv antibiotics, Inj. Calcium

gluconate & Ionodrops. Baby had persistent respiratory distress, Inj. Midazolam infusion

started on 30.03.09. With the above measures baby respiratory distress reduced, so weaned

form the C-PAP on 03.04.09 & started on tube feeds. Now baby is taking oral feeds and

discharged today with the advice to continue further follow up with the referral doctor.

INVESTIGATION :

Investigation Result Unit DateHAEMOGLOBIN 20.6 [ TWICE RPT ] gm/dl 29/03/2009 TOTAL COUNT 22800 cells/cumm 29/03/2009 PCV 57 % 29/03/2009 MCV 109 FL 29/03/2009 MCH 38 PG 29/03/2009 MCHC 35 % 29/03/2009 RDW 12.7 % 29/03/2009 RBC 5.3 MILL/Cumm 29/03/2009 MPV 7.8 FL 29/03/2009 NEUTROPHILS 59 % 29/03/2009 LYMPHOCYTE 40 % 29/03/2009 EOSINOPHIL 01 % 29/03/2009 PLATELET COUNT 20,000 CELLS Lakhs/Cumm 29/03/2009 CREATININE 1.1 mg /dl 31/03/2009 CREATININE 0.7 mg /dl 31/03/2009

PERIPHERAL SMEAR SHOWED (30.03.09) : RBCs show normochromic

normocytes and macrocytes. Nucleated RBCs 5/100 WBCs. WBC count shows

leukocytosis. No atypical or immature cells. DC: Neutrophils: 49%, Eosinophils: 01%,

Monocytes: 05%, Lymphocytes: 45%. Platelet count diminished. IMPRESSION:

LEUKOCYTOSIS. THROMBOCYTOPENIA.

Name : B/o. Poomari Age / Sex: NB/F Dept : NeonatologyHos.No : 408068 Mrd.No : 308130 Ward : I NB NICUD.O.A : 13.03.09 D.O.D : 08.04.09************************************************************************REF. BY. DR. MUTHUPANDIAN PLACE: MANAMADURAI DIAGNOSIS: MECONIUM ASPIRATION SYNDROME CHD [SMALL ASD WITH MILD PAH] ACUTE RENAL FAILURE (RECOVERED)

COURSE:

This Term / AGA / Female / born at private hospital by LSCS (Indication: Failure

to Progress) on 13.03.09. Baby cried soon after birth, H/o. Meconium aspiration +, and

developed respiratory distress since birth for that referred to MMHRC on 13.03.09 for

further management. No Maternal H/o. PIH, GDM & PROM. O/E. Baby activity :

Weak, cry: Irritable, Colour : Pink, CFT > 3 sec, dyspnoeic +, tachypnoeic +, no birth

injury, CVS: S1, S2 heard, murmur +, RS: RR: >60/mt, lower chest indrowing +,

P/A: soft, CNS: NNR sluggish. Baby was investigated – Peripheral smear & Blood sugar

were normal. Serum creatinine : 1.2mg/dl (14.03.09), 1.4mg/dl (17.03.09), 0.9mg/dl

(19.03.09). Chest X ray showed bilateral meconium infiltration. Echo showed

congenital heart disease, Small sized ostium secundum type of ASD (4 – 5mm), L R

shunt and Mild PAH. Baby was managed with Mechanical ventilator support, Iv fluids,

Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Inj. Midazolam Infusion &

Ionotropes. Child had ET bleed, FFB transfusion given. On 14.03.09 baby’s oxygen

saturation not maintained & surfactant 1dose given, on 23.03.09 baby was pale, packed

cell transfusion given. With the above measures baby respiratory distress reduced, so

weaned form the ventilator 03.04.09 & started on tube feeds. Now baby is taking breast

feeds and discharged today with the advice to continue further follow up with the referral

doctor.

INVESTIGATION :


BLOOD GROUP RH TYPING "B" POSITIVE 14/03/2009

HAEMOGLOBIN 12.9 gm/dl 13/03/2009 TOTAL COUNT 13900 cells/cumm 13/03/2009 PCV 37 % 13/03/2009 MCV 103 FL 13/03/2009 MCH 35 PG 13/03/2009 MCHC 34 % 13/03/2009 RDW 17.1 % 13/03/2009 RBC 3.6 MILL/Cumm 13/03/2009 MPV 6.6 FL 13/03/2009 NEUTROPHILS 85 % 13/03/2009 LYMPHOCYTE 14 % 13/03/2009 EOSINOPHIL 01 % 13/03/2009 PLATELET COUNT 2.5 Lakhs/Cumm 13/03/2009 CREATININE 1.2 mg /dl 15/03/2009 CREATININE 1.4 mg /dl 17/03/2009 CREATININE 0.9 mg /dl 19/03/2009


normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No


Lymphocytes: 06%. Platelet count normal in number and morphology.

IMPRESSION: NORMAL SMEAR STUDY.

ECHO REPORT (16.03.09) : SITUS SOLITUS, LEVOCARDIA, SMALL OSTIUM

SECUNDUM TYPE OF ASD SEEN ( 4 – 5mm) L -> R SHUNT, IVS INTACT, RVSP ~

35mm of HG, MV,AV,PV NORMAL, GREAT VESSELS NORMALLY ARISING, NO

PERICARDIAL EFFUSION, NO PDA / COARCTATION, NORMAL LV AND RV

FUNCTION. IMPRESSION : CONGENITAL HEART DISEASE. SMALL PDA.

MILD PAH

ADVICE ON DISCHAGRE :

Syp. Deriphyllin 8 drops TID x 2 weeks

Domstal drops 5 drops TID x 2 weeks

Zincovit drops 10 drops OD x Till further advice

Evion drops 5 drops OD x Till further advice

Name : B/o. Thanga radhika Age / Sex: NB/ F Dept : NeonatologyHos.No : 410141 Mrd.No : 309586 Ward : I NB NICUD.O.A :02.04.09 D.O.D : 16.04.09************************************************************************REF. BY. DR.ANBURAJAN., PLACE : THENI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME COURSE:

This Term / AGA / female / born at private hospital by LSCS (Indication : Primi

with CPD) on 01.04.09. H/o. Baby did not cry immediately after birth, resuscitation was

done at referral doctor clinic. Baby developed respiratory distress since birth, for that

referred to MMHRC on 02.04.09, for further management. H/o. Meconium stained

liquor +. No Maternal H/o PIH, PROM & GDM. O/E. Baby activity & cry were weak,

Peripheral cyanosis +, poor perfusion +, grunting +, dyspnoeic +, tachypnoeic +, no birth

injury, no obvious external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest

indrawing+, Bilateral crepitations +, P/A: soft, CNS:NNR sluggish. Baby was

investigated – Peripheral smear showed neutrophilic leukocytosis. Blood sugar was :

34mg/dl (Corrected with dextrose). Serum creatinine was normal. Chest X-ray showed

bilateral infiltration. Baby was managed with Mechanical ventilator support, Ionotropes,

Iv fluids, Iv antibiotics, Inj. Gardenol, Inj. Calcium gluconate and Inj. Vitamin K. With

the above measures baby’s respiratory distress reduced so weaned from the ventilator on

08.04.09 & started on small tube feeds. Now baby’s respiration became normal and is

taking Oral feeds and discharged today with advice to continue further fellow up with the

referral doctor.

INVESTIGATION :



HAEMOGLOBIN 17.8 gm/dl 02/04/2009 TOTAL COUNT 26,800 cells/cumm 02/04/2009 PCV 53 % 02/04/2009 MCV 105 FL 02/04/2009 MCH 35 PG 02/04/2009 MCHC 33 % 02/04/2009 RDW 11.9 % 02/04/2009 RBC 5.0 MILL/Cumm 02/04/2009 MPV 8.2 FL 02/04/2009 NEUTROPHILS 58 % 02/04/2009 LYMPHOCYTE 40 % 02/04/2009 EOSINOPHIL 02 % 02/04/2009 PLATELET COUNT 2.0 Lakhs/Cumm 02/04/2009 CREATININE 0.7 mg /dl 03/04/2009

PERIPHERAL SMEAR SHOWED (02.04.09): RBCs shows normochromic normocytes

and macrocytes . Nucleated RBCs 2/100 WBCs. WBC count shows neutrophilic


Monocytes: 05%, Lymphocytes: 38%. Platelets count normal in number and morphology.


Admission Weight : 2.825 KgDischarge Weight : 2.72

MAY 09

Name : B/o. Kavitha Age/Sex : NB/ F Dept : NeonatologyHos.No: 414605 Mrd.No : 312433 Ward : IL.NB. NICUD.O.A : 09.05.09 D.O.D : 09.05.09 ************************************************************************

DIAGNOSIS: BIRTH ASPHYXIA MECONIUM ASPIRATION BILATERAL PNEUMOTHORAX COURSE:

This Term / AGA/ Female born at private hospital by Normal vaginal delivery on

09.05.09. H/o. Baby had weak cry immediately after birth resuscitated at referral doctor

clinic, H/o. Thick meconium stained liquor +, H/o. Respiratory distress since birth for

that referred to MMHRC on 09.05.09 for further management. No Maternal H/o PIH,

GDM & PROM. O/E. On admission baby had no spontaneous respiration, HR : 60/mt,

cyanosis +, CFT > 3 sec, BP not recordable, intubated and connected to Mechanical

ventilator support. CVS: S1, S2 heard, BP not recordable, RS: Bilateral air entry

diminished, P/A: soft, CNS : NNR not elicitable. Baby was investigated – Peripheral

smear showed neutrophilic leukocytosis. Chest X-ray showed Bilateral Pneumothorax.

ICD done bilaterally. Baby was managed with Mechanical ventilator support,

Ionotropes, Iv fluids, Iv antibiotics, Inj. NaHco3, Inj. calcium gluconate & Inj. Vitamin K.

Even with the above measures baby’s O2 Saturation not maintained, had persistent

bradycardia followed by cardiac arrest. CPR was carried out, Inj. Adrenaline & Atropin

were given. Baby could not be revived, “Declared Dead” on 09.05.09 at 9.10 PM.

INVESTIGATION :

Investigation Result Unit DateHAEMOGLOBIN 12.7 gm/dl 10/05/2009 TOTAL COUNT 38,700 [TWICE RPT] cells/cumm 10/05/2009 PCV 39 % 10/05/2009 MCV 111 FL 10/05/2009 MCH 35 PG 10/05/2009 MCHC 32 % 10/05/2009 RDW 19.7 % 10/05/2009 RBC 3.5 MILL/Cumm 10/05/2009 MPV 7.2 FL 10/05/2009 NEUTROPHILS 74 % 10/05/2009 LYMPHOCYTE 25 % 10/05/2009 EOSINOPHIL 01 % 10/05/2009 PLATELET COUNT

3.7 Lakhs/Cumm 10/05/2009

PERIPHERAL SMEAR (21.01.09): RBCs shows normochromic normocytes and

macrocytes. Nucleated RBCs 5/100 WBCs. WBC count shows neutrophilic



IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS

Name : B/o. Regina Age / Sex: NB/F Dept : NeonatologyHos.No : 415649 Mrd.No :313091 Ward : I NB NICUD.O.A :18.05.09 D.O.D : 29.05.09************************************************************************

DIAGNOSIS: PRETERM (32 WEEKS) / LBW RESPIRATORY DISTRESS SYNDROME SURFACTANT THREAPY GIVEN

COURSE:

This Preterm (32 weeks) / LBW / male born at MMHRC by LSCS (Indication :

premature labour with transverse lie) on 18.05.09. H/o. Baby cried immediately after

birth, then developed respiratory distress and grunting since birth, for that admitted in

NICU, for further management. Maternal H/o. PCOD +, conception after PCOD

puncturing. No Maternal H/o. PIH, GDM & PROM. O/E. Activity & cry were weak,

Peripheral cyanosis +, grunting +, CFT prolonged, dyspnoeic +, tachypnoeic +, no birth

injury, no obvious external anomaly. CVS : S1 & S2 heard, RS : RR > 60/mt, subcostal

retraction +, Bilateral air entry equal. P/A : Soft, CNS : NNR sluggish. Baby was

investigated : Peripheral smear, Blood sugar were normal. Serum creatinine : 1.0 mg/dl.

Chest x-ray showed respiratory distress syndrome. Baby was managed with mechanical

ventilator support, Ionotropes, surfactant (2doses), Iv fluids, Iv antibiotics, Inj.

Aminophylline, Inj. calcium gluconate, Inj. Vitamin K, FFP transfusion & Single side

Phototherapy. With the above measures baby’s activity improved, respiration became

normal & started on small tube feeds. Now baby is taking oral feeding and discharged

today with the advice to continue the following.

INVESTIGATION :Investigation Result Unit Date


"A" POSITIVE 19/05/2009

HAEMOGLOBIN 17.0 (TWICE RPT) gm/dl 19/05/2009

TOTAL COUNT 6700 cells/cumm 19/05/2009

PCV 51 % 19/05/2009

MCV 109 FL 19/05/2009

MCH 36 PG 19/05/2009

MCHC 33 % 19/05/2009

RDW 17.2 % 19/05/2009

RBC 4.6 MILL/Cumm 19/05/2009

MPV 7.9 FL 19/05/2009


LYMPHOCYTE 49 % 19/05/2009

EOSINOPHIL 01 % 19/05/2009

PLATELET COUNT 2.5 Lakhs/Cumm 19/05/2009



normocytes, macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No atypical

or immature cells. DC: Neutrophils: 49%, Eosinophils: 01%, Monocytes: 01%,

Lymphocytes: 49%. Platelet count normal in number and morphology.

IMPRESSION: NORMAL SMEAR STUDY.

Name : B/o. Bobby Age / Sex: NB/F Dept : NeonatologyHos.No : 415669 Mrd.No :313127 Ward : I NB NICUD.O.A :18.05.09 D.O.D : 29.05.09************************************************************************REF.BY.DR. RAJA GOPAL – BOOMA NURSING HOME PLACE : MADURAI

DIAGNOSIS: MECONIUM ASPIRATION PNEUMOTHORAX (RIGHT SIDE) ACUTE RENAL FAILURE (RECOVERED) ASD WITH PDA

COURSE:

This 2 days old Term / AGA / female / born at private hospital by LSCS

(Indication : Meconium stained liquor) on 17.05.09. H/o. Baby cried immediately after

birth and developed respiratory distress since birth. H/o. Meconium aspiration +, for that

referred to MMHRC on 18.05.09 for further management. No Maternal H/o PIH, PROM

& GDM. O/E. Baby’s activity & cry were weak, dyspnoeic +, tachypnoeic +, no birth

injury, no obvious external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest

indrawing+, P/A: soft, CNS: NNR sluggish, Baby was investigated – HB:18gm%, TC :

4,700, Platelet count 80,000 (19.5.09) 70,000 (21.05.09), Blood sugar was normal.

Serum creatinine : 1.5mg/dl(19.05.09), 1.7mg/dl(21.05.09). 1.2mg/dl( 22.05.09),

0.9mg/dl(23.05.09), Blood urea : 60mg/dl(21.05.09). 53mg/dl ( 22.05.09),

56mg/dl(23.05.09). Serum LDH was elevated. Urine routine showed albumin 2+, Urine

PCR : Protein - 45, Creatinine : 13, ratio - 3.6 : 1.0. Echo showed congenital heart

disease- Moderate sized ASD with PDA, Mild PAH. USG abdomen showed bilateral

medical renal disease. Chest X ray showed right side pneumothorax (18.05.09). Repeat

X-ray was normal (19.05.09). Nephrologist opinion was obtained. Baby was managed

with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Midazolam infusion, Inj.

Lasix, Inj. Calcium gluconate & Inj. Vitamin K. With the above measures baby’s

respiratory distress reduced, weaned from the ventilator on 24.05.09 & started on small

tube feeds. Now baby’s respiration became normal, activity improved, serum creatinine

became 0.9mg/dl(23.05.09) and taking breast-feeds. Baby is discharged today with

advice to continue further follow up with the referral doctor.

INVESTIGATION :



CREATININE 1.5 mg /dl 19/05/2009 HAEMOGLOBIN 18.0 (TWICE RPT) gm/dl 19/05/2009 TOTAL COUNT 4700 cells/cumm 19/05/2009 PCV 54 % 19/05/2009 MCV 119 FL 19/05/2009 MCH 39 PG 19/05/2009 MCHC 32 % 19/05/2009 RDW 21 % 19/05/2009 RBC 4.5 MILL/Cumm 19/05/2009 MPV 7.2 FL 19/05/2009 NEUTROPHILS 67 % 19/05/2009 LYMPHOCYTE 32 % 19/05/2009 EOSINOPHIL 01 % 19/05/2009 PLATELET COUNT 80,000 CELLS Lakhs/Cumm 19/05/2009 CREATININE 1.7 mg /dl 21/05/2009 UREA 60 mg/dl 21/05/2009 CREATININE 1.2 mg /dl 22/05/2009 PLATELET COUNT 70,000 CELLS Lakhs/Cumm 21/05/2009 POTASSIUM 2.0 mEq / L 21/05/2009 SODIUM 128 mEq / L 21/05/2009 UREA 53 mg/dl 22/05/2009 LDH 730 Iu/l 21/05/2009

COLOUR YELLOW 22/05/2009

TRANSPARENCY CLEAR 22/05/2009

REACTION ACIDIC 22/05/2009

ALBUMIN [++] 22/05/2009

SUGAR NIL 22/05/2009

EPI CELLS 2-3 / HPF 22/05/2009 PUS CELLS 2-3 / HPF 22/05/2009 URINE SPOT PROTEIN 45 mg/dl 22/05/2009 URINE SPOT CREATININE 13 mg/dl 22/05/2009 URINE FOR PROTEIN CREATININE RATIO

3.6 : 1.0 22/05/2009

CREATININE 0.9 mg /dl 23/05/2009 POTASSIUM 2.1 mEq / L 23/05/2009 SODIUM 135 mEq / L 23/05/2009 UREA 56 mg/dl 23/05/2009


normocytes, macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No


Lymphocytes: 32%. Platelet count adequate.

ECHO SHOWED ON 21.05.09 : SITUS SOLITUS, LEVOCARDIA, 3MM OSTIUM

SECUNDUM TYPE OF ASD SEEN, L -> R SHUNT, IVS INTACT, 1mm PDA SEEN,

L -> R SHUNT, MV, AV, PV NORMAL, RVSP – 30mm of hg, CHAMBERS

NORMAL SIZE, NORMAL LV FUNCTION, GREAT VESSELS NORMALLY

ARISING, NO COARCTATION. IMPRESSION : CONGENITAL HEART

DISEASE, MODERATE SIZED ASD WITH PDA, MILD PAH.

USG ABDOMEN PELVIS REPORT ON 21.05.09 : Bilateral medical renal disease.


Syp. Domstal drops 8 drops TID x 2 weeks

Admission weight : 2.290kgDischarge weight : 2.195kg

JUNE 09

Name : B/o. Jothi Lakshmi Age / Sex: NB/ F Dept : NeonatologyHos.No : 415923 Mrd.No : 313278 Ward : I NB NICUD.O.A : 20.05.09 D.O.D : 01.06.09******************************************************************REF. BY. DR.ARAVIND BABU., PLACE : VIRUDHUNAGAR

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERINATAL ASPHYXIA PERSISTENT PULMONARY HYPERTENSION

COURSE:

This Term / AGA / female born at private hospital by forceps delivery on 20.05.09 to

RH negative mother. H/o. Baby cried immediately after birth and developed respiratory

distress since 2 hours of life, for that referred to MMHRC on 20.05.09, for further

management. H/o. Meconium Aspiration +. No H/o. Cord around the neck, convulsion. No

Maternal H/o PIH, GDM & PROM. O/E. Baby activity & cry were weak, Peripheral

cyanosis +, dyspnoeic +, tachypnoeic +, left club foot +, cephalhematoma +, no obvious

external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest indrawing+, Grunting

+, Bilateral air entry equal, P/A: soft, CNS:NNR Absent. Baby was investigated –

Peripheral smear showed neutrophilic leukocytosis. Blood sugar & Serum creatinine were

normal. Serum Bilirubin : T – 3.2, D – 0.6. DCT was negative. Echo showed Congenital

Heart disease, Tiny PDA with PFO, mild PAH (? Newborn PAH). Baby was managed with

Mechanical ventilator support, Ionotropes, 1 dose of surfactant, Iv fluids, Iv antibiotics,

Inj. Calcium gluconate, Inj. Rantac, Inj. Vitamin K, Tab. Edigra, Mucolite drops, Domstal

Drops, & FFB transfusion. With the above measures baby’s Respiratory distress came

down, hence weaned from ventilator on 27.05.09, then started on small tube feeds. Baby

tolerated feed well and increased slowly. Now baby is on sufficient oral feeds and

discharged today with advice to continue the following.



BILIRUBIN TOTAL 3.2 mg/dl 20/05/2009 BILIRUBIN DIRECT 0.6 mg/dl 20/05/2009 DIRECT ANTI HUMAN GLOBULIN TEST (COOMBS)

"NEGATIVE" 21/05/2009

HAEMOGLOBIN 20.5 gm/dl 20/05/2009 TOTAL COUNT 15,500 cells/cumm 20/05/2009 PCV 63 % 20/05/2009 MCV 105 FL 20/05/2009 MCH 34 PG 20/05/2009 MCHC 32 % 20/05/2009 RDW 19.9 % 20/05/2009 RBC 6.0 MILL/Cumm 20/05/2009 MPV 7.4 FL 20/05/2009 NEUTROPHILS 69 % 20/05/2009 LYMPHOCYTE 30 % 20/05/2009 EOSINOPHIL 01 % 20/05/2009 PLATELET COUNT 2.1 Lakhs/Cumm 20/05/2009 CREATININE 0.9 mg /dl 21/05/2009









SMALL PFO +. L R SHUNT. TINY PDA + (<1mm). L R SHUNT. ALL CHAMBERS

NORMAL SIZE. NORMAL LV AND RV FUNCTIN. IVS INTACT. GREAT VESSELS

NORMALLY ARISING. MV, RV, PV NORMAL. RVSP 35 mm of hg. NO

COARCTATION.

IMPRESSION. CONGENITAL HEART DISEASE. TINY PDA WITH PFO MILD PAH

(? NEWBORN PAH)


Tab. Edigra 50mg 1/10th BD x 2 weeks

Name : B/o. Seema Age / Sex: NB/ M Dept : NeonatologyHos.No : 418760 Mrd.No : 315274 Ward : I NB NICUD.O.A : 13.06.09 D.O.D : 17.06.09******************************************************************REF. BY. DR.SARAVANAN., PLACE: PARAMAKUDI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME THROMBOCYTOPENIA

COURSE:

This Term / AGA / male born at private hospital by LSCS (Indication : Meconium

Stained Liquor and Failure to thrive) on 12.06.09, with H/o. Respiratory difficulty after 3

hours of life, hence referred to MMHRC on 13.06.9. No Maternal H/o PIH, GDM &

PROM. O/E. Baby activity & cry : Moderate, Colour : Pink, CFT < 2sec, no birth injury,

no obvious external anomaly, CVS: S1, S2 heard, RS: Bilateral air entry equal, P/A: soft,

CNS:NNR +. Baby was investigated – Peripheral smear showed neutrophilic leukocytosis

with thrombocytopenia. Blood sugar & Serum creatinine were normal. Baby was

managed with CPAP, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K.

With the above measures baby’s activity & cry : Fair, respiration became normal. Now

baby is on sufficient oral, hence discharged today with advice to continue further follow up

with the referral doctor.



HAEMOGLOBIN 14.9 gm/dl 13/06/2009 TOTAL COUNT 18700 cells/cumm 13/06/2009 PCV 44 % 13/06/2009 MCV 103 FL 13/06/2009 MCH 34 PG 13/06/2009 MCHC 33 % 13/06/2009 RDW 19.2 % 13/06/2009 RBC 4.2 MILL/Cumm 13/06/2009 MPV 9.9 FL 13/06/2009 NEUTROPHILS 85 % 13/06/2009 LYMPHOCYTE 14 % 13/06/2009 EOSINOPHIL 01 % 13/06/2009 PLATELET COUNT 30,000 CELLS Lakhs/Cumm 13/06/2009 PLATELET COUNT 1.1 Lakhs/Cumm 13/06/2009 CREATININE 0.7 mg /dl 14/06/2009




Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 13%. Platelets count diminished.



NORMAL VALVES. IAS, IVS INTACT. GREAT CESSELS NORMAL. NO PDA /

COARCTATION. NO PULMONARY HYPERTENSTION. GOOD LV AND RV

FUNCTION. IMPRESSION : NORMAL STUDY


Inj. Ceftocin 150mg IV BD x 4 days

Name : B/o. Rupavathy Age / Sex: NB/ M Dept : NeonatologyHos.No : 418894 Mrd.No : 315337 Ward : I NB NICUD.O.A : 14.06.09 D.O.D : 18.06.09******************************************************************REF. BY. DR. LAKSHMI GANESH., PLACE : MADURAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROMEPERSISTENT PULMONARY HYPERTENSION (RECOVERED)

COURSE:

This Term / AGA / male born by LSCS at private hospital on 14.06.09 with H/o.

Baby cried immediately after birth. H/o Respiratory distress since birth, hence referred to

MMHRC for further management. No H/o. Convulsion & Cord around the neck.

Maternal H/o. LSCS (Indication : Failure the progress and meconium stained liquor). No

Maternal H/o PIH, GDM, UTI, Fever, skin raches and hypothyroidism. O/E. Baby

activity & cry were weak, Colour : Pink, Peripheral cyanosis +, no birth injury and no

obvious external anomaly, CVS: S1, S2 heard, RS: Bilateral crepitatin +, P/A: soft,

CNS:NNR Absent. Local exmination left side undescended tests +. Baby was

investigated – Peripheral smear showed normal smear study. Blood sugar – 177mg/dl,

serum creatinine – 1.2. chest x-ray suggestive of meconium aspiration syndrome. Baby

was managed with Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Dopamine

infusion, Inj. Gardenol surfaced – 2 dose given, mechanical ventilator support and Inj.

Rantac 12th hourly. ABG was done. With above measures baby’s activity improved but

had persistent fall in oxygen saturation. 12th hourly ABG was done, PO2 & PCO2 showed

improvement but baby’s parents want to continue the further management in government

hospital, hence discharged AT REQUEST on 12.06.09.

INVESITGATION

Investigation Result Unit DateHAEMOGLOBIN 18.0{TWICE RPT} gm/dl 14/06/2009 TOTAL COUNT 8600 cells/cumm 14/06/2009 PCV 53 % 14/06/2009 MCV 111 FL 14/06/2009 MCH 37 PG 14/06/2009 MCHC 33 % 14/06/2009 RDW 16.5 % 14/06/2009 RBC 4.8 MILL/Cumm 14/06/2009 MPV 6.6 FL 14/06/2009 NEUTROPHILS 84 % 14/06/2009 LYMPHOCYTE 15 % 14/06/2009 EOSINOPHIL 01 % 14/06/2009 PLATELET COUNT 1.8 Lakhs/Cumm 14/06/2009 CREATININE 1.0 mg /dl 16/06/2009

PERIPHERAL SMEAR SHOWED (15.06.09): RBCs show normochromic normocytes

and microcytes. No nucleated RBCs or hemoparasites. WBC count normal. No atypical

or immature cells. DC: Neutrophils: 86%, Eosinophils: 01%, Monocytes: 01%,

Lymphocytes: 12%. Platelets count normal in number and morphology.

Name : B/o. Rathina Age / Sex: NB/ M Dept : NeonatologyHos.No : 418921 Mrd.No : 315361 Ward : I NB NICUD.O.A : 14.06.09 D.O.D : 22.06.09******************************************************************REF. BY : DR. ANBUCHELIYAN., PLACE : BODINAYAKANURREF. BY : DR. MAHALINGAM., PLACE : MADURAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH NEONATAL SEIZURE

CLINICAL SEPSIS

COURSE:

This Term / AGA / male born at private hospital by LSCS (Indication : meconium

stained liquor, Fetal distress, Failure to Progress, PIH) on 14.06.09. H/o. Baby cried

immediately after birth and developed respiratory distress since birth, H/o. Meconium

Aspiration +, for that referred to MMHRC on 14.06.09 for further management. Baby

received with only spo2 - 40% O2 saturation, hence baby was intubated and put on

mechanical ventilator support at NICU. No H/o. Cyanosis & cord around the neck.

Maternal H/o. PIH, Fever, and Bleeding PV at 3rd month of gestation. No Maternal H/o

GDM, PROM & Hypothyroidism. O/E. Baby activity & cry were weak, Colour :

Peripheral cyanosis +, CFT – Prolonged, dyspnoeic +, tachypnoeic +, no birth injury, no

obvious external anomaly, CVS: S1, S2 heard, RS: Bilateral air entry + RR: >70/mt, sub

costal retraction +, P/A: soft, CNS:NNR sluggish. Baby was investigated – Peripheral

smear showed normal smear study. TC : 3,200, Blood sugar was normal. Serum creatinine

1.2mg/dl (15.06.09), 1.0mg/dl (18.06.09), 0.6mg/dl (20.06.09) CRP was positive. Blood

culture no growth. Chest x-ray suggestive of meconium aspiration syndrome. Baby was

managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium

gluconate, Inj. Dopamine infusion, Inj. Gardenol, Inj. Rantac, Mucolite drops & oxygen

therapy. With the above measures baby’s Respiration became normal, hence weaned from

ventilator on 16.06.09, and started on small tube feeds. Now baby is on sufficient oral feeds

and discharged today with advice to continue the following.

INVESTIGATION :

Investigation Result Unit DateHAEMOGLOBIN 12.3 gm/dl 15/06/2009 TOTAL COUNT 3200 (TWICE RPT) cells/cumm 15/06/2009 PCV 35 % 15/06/2009 MCV 111 FL 15/06/2009 MCH 38 PG 15/06/2009 MCHC 34 % 15/06/2009 RDW 18.4 % 15/06/2009 RBC 3.2 MILL/Cumm 15/06/2009 MPV 8.7 FL 15/06/2009 NEUTROPHILS 70 % 15/06/2009 LYMPHOCYTE 29 % 15/06/2009 EOSINOPHIL 01 % 15/06/2009 PLATELET COUNT 1.5 Lakhs/Cumm 15/06/2009 CREATININE 1.2 mg /dl 15/06/2009 CREATININE 1.0 mg /dl 18/06/2009 CREATININE 0.6 mg /dl 20/06/2009

Name : B/o. Santha kumari Age / Sex: NB/ M Dept : NeonatologyHos.No : 420108 Mrd.No : 316129 Ward : I NB NICUD.O.A : 23.06.09 D.O.D : 24.06.09******************************************************************REF. BY. DR.MAHALINGAM., PLACE: MADURAI

DIAGNOSIS: MECONIUM ASPIRATION WITH RAISED RENAL PARAMETERS COURSE:

This 1 day old post dated / AGA / male born at private hospital by LSCS (Indication

: post dated pregnancy) on 22.06.09. H/o. Baby cried immediately after birth and developed

respiratory distress since birth. H/o. Meconium aspiration +, for that referred to MMHRC

on 23.06.09 for further management. No Maternal H/o PIH, GDM & PROM. O/E. Baby’s

activity & cry were weak. Colour : peripheral cyanosis +, CFT > 3sec, dyspnoeic +,

tachypnoeic +, no birth injury, no obvious external anomaly, CVS: S1, S2 heard, RS :

RR:60/mt, Bilateral air entry equal, P/A: soft, CNS:NNR sluggish. Baby was investigated –

HB : 14.6gm%, TC : 21,600, Platelet count : 3.3lakhs, serum Creatinine : 1.9mg/dl. Chest

x-ray showed Bilateral minimal meconium infiltration. CRP was negative. Baby was

managed with CPAP, Iv fluids, Inotropes, Iv antibiotics, Inj. Gardenol, Inj. Lasix, Inj.

Calcium gluconate & Inj. Vitamin K. Now baby is maintaining SPO2 100% with CPAP -

Fio2 of 30%, since parents want to continue further management at Government Hospital,

discharged AT REQUEST on 24.06.09.

INVESTIGATION :



C-REACTIVE PROTEIN(CRP) LATEX NEGATIVE 24/06/2009

CREATININE 1.9 mg /dl 24/06/2009 HAEMOGLOBIN 14.6 gm/dl 24/06/2009 TOTAL COUNT 21,600 cells/cumm 24/06/2009 PCV 42 % 24/06/2009 MCV 106 FL 24/06/2009 MCH 36 PG 24/06/2009 MCHC 34 % 24/06/2009 RDW 17.1 % 24/06/2009 RBC 4.0 MILL/Cumm 24/06/2009 MPV 6.6 FL 24/06/2009 NEUTROPHILS 84 % 24/06/2009 LYMPHOCYTE 15 % 24/06/2009 EOSINOPHIL 01 % 24/06/2009 PLATELET COUNT 3.3 Lakhs/Cumm 24/06/2009

JULY 09

Name : B/o. Sankareswari Age / Sex: NB/ F Dept : NeonatologyHos.No : 420515 Mrd.No : 316382 Ward : I NB NICUD.O.A :26.06.09 D.O.D :03.07.09************************************************************************REF. BY: DR. DEEPAN., PLACE: VIRUDHUNAGAR

DIAGNOSIS: NEONATAL ENCEPHALOPATHY,

MECONIUM ASPIRATION SYNDROME

COURSE:

This term / AGA / female / born at private hospital by LSCS (Indication : CPD &

Cord around the neck) on 26.06.09, H/o. Baby did not cry immediately after birth, H/o.

Thick meconium stained liquor, H/o. Baby had weak cry after ambu bag & mask

ventilation for 40 sec. H/o. Baby had respiratory distress with grunting since birth, hence

referred to MMHRC on 26.06.09, for further management. H/o cord around the neck +.

No Maternal H/o. PIH, GDM, PROM, fever and hypothyroidism. O/E. Baby’s activity &

cry were weak, Colour : Pink, CFT : > 3sec, dyspnoeic +, no birth injury and no obvious

external anamolies, CVS: S1, S2 heard, RS: Bilateral air entry +, Sub costal retraction

and lower chest indrawing +, P/A: soft, CNS: NNR sluggish, Encephalopathy +. Baby

was investigated peripheral smear showed neutrophilic leukocytosis. Blood sugar and

serum Creatinine were normal. Chest x-ray showed meconium aspiration syndrome.

Baby was managed with oxygen therapy, Iv fluids, Iv. Antibiotics, Inj. calcium

gluconate, Inj. Dopamine infusion, Inj. Eptoin and Inj. Rantac. With above measures

baby’s activity & cry : fair, respiration became normal and baby is now on breast feed,

hence discharged today.

INVESTIGATION


BLOOD GROUP RH TYPING "O" NEGATIVE 27/06/2009

HAEMOGLOBIN 15.4 gm/dl 26/06/2009 TOTAL COUNT 34,900 cells/cumm 26/06/2009 PCV 47 % 26/06/2009 MCV 98 FL 26/06/2009 MCH 31 PG 26/06/2009 MCHC 32 % 26/06/2009 RDW 11.2 % 26/06/2009 RBC 4.8 MILL/Cumm 26/06/2009 MPV 7.4 FL 26/06/2009 LYMPHOCYTE 01 % 26/06/2009 PLATELET COUNT 2.4 Lakhs/Cumm 26/06/2009 CREATININE 1.0 mg /dl 28/06/2009

PERIPHERAL SMEAR SHOWED ON (27.06.09): RBCs shows normochromic normocytes

and macrocytes. Nucleated RBCs 25/100 WBCs. WBC count shows neutrophilic leukocytosis.

No atypical or immature cells. DC: Neutrophils: 70%, Eosinophils: 01%, Monocytes: 05%,

Lymphocytes: 24%. Platelets count normal in number and morphology. IMPRESSION :

NEUTROPHILIC LEUKOCYTOSIS

Name : B/o. Vimala devi Age / Sex: NB/ F Dept : NeonatologyHos.No : 420145 Mrd.No : 316144 Ward : I NB NICUD.O.A :24.06.09 D.O.D :03.07.09************************************************************************REF. BY: DR. CAPT. AUGUSTUS SAMVEL DODD., PLACE: MADURAI

REF. BY : DR. THUTHESAN PAVA PLACE : MADURAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME NEONATAL SEIZURE COURSE:

This Term / AGA / female / born at private hospital by normal vaginal delivery on

23.06.09 with H/o. Baby cried immediately after birth, H/o. respiratory distress since

birth, H/o. Thick meconium stained liquor and aspiration +, hence referred to MMHRC

on 24.06.09 for further management. H/o. convulsion + after admission. No H/o. Cord

around the neck and cyanosis. Maternal H/o : No Maternal H/o. PIH, GDM, PROM,

Fever, UTI and hypothyroidism. O/E. Baby’s activity & cry were weak, dyspnoeic +,

tachypnoeic +, no birth injury and no obvious external anamolies, CVS: S1, S2 heard,

RS: Bilateral air entry +, lower chest indrawing & respiratory distress +, P/A: distended,

CNS: NNR sluggish. Baby was investigated peripheral smear showed neutrophilic

leukocytosis. Blood sugar and serum Creatinine were normal. CRP – Negative, Blood

culture – no growth, Chest x-ray suggestive of meconium aspiration syndrome. Baby

was managed with mechanical ventilator support, Iv fluids, Iv. Antibiotics, Inj. calcium

gluconate, Inj. Gardenol, Inj. Dopamine infusion, Mucolite drops & Domstal drops. With

above measures baby’s respiration became normal, hence weaned from ventilator support

on 27.06.09 and started on small tube feeds. Now baby is on direct breast feeds and no

further convulsion seen, hence discharged today with advice to continue the follow-up

with referral doctor.

INVESTIGATION



C-REACTIVE PROTEIN(CRP) LATEX

NEGATIVE 24/06/2009

CREATININE 0.9 mg /dl 24/06/2009 HAEMOGLOBIN 20.3{TWICE RPT} gm/dl 24/06/2009 TOTAL COUNT 17000 cells/cumm 24/06/2009 PCV 60 % 24/06/2009 MCV 108 FL 24/06/2009 MCH 36 PG 24/06/2009 MCHC 33 % 24/06/2009 RDW 19.4 % 24/06/2009 RBC 5.5 MILL/Cumm 24/06/2009 MPV 7.3 FL 24/06/2009 NEUTROPHILS 89 % 24/06/2009 LYMPHOCYTE 10 % 24/06/2009 EOSINOPHIL 01 % 24/06/2009 PLATELET COUNT 2.0 Lakhs/Cumm 24/06/2009

Name : B/o. Geetha Age / Sex: NB/M Dept : NeonatologyHos.No : 421462 Mrd.No : 316971 Ward : I NB NICUD.O.A :04.07.09 D.O.D :17.07.09************************************************************************REF. BY: DR. PARATHASARATHY., PLACE: PARAMAKUDI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME SEPTICEMIA COURSE:

This term / AGA / male / born at private hospital by LSCS (Indication : Post

dated with oligohydramnios / meconium stained liquor ) on 04.07.09. H/o. Baby cried

soon after birth and developed respiratory distress since birth for that referred to

MMHRC on 04.07.09 for further management. Maternal H/o. Oligohydrmnios +. No

Maternal H/o. PIH, GDM & PROM. O/E. Baby’s activity & cry were weak, Peripheral

cyanosis +, CFT : > 3sec, dyspnoeic+, tachypnoeic +, not anemic, not icteric, no birth

injury and no obvious external anomaly, CVS: S1, S2 heard, RS: RR > 60/mt, lower

chest indrawing +, P/A: soft, CNS: NNR sluggish. Baby was investigated peripheral

smear showed neutrophilic leukocytosis. Blood sugar and serum Creatinine were normal.

Chest x-ray showed left upper lobe infiltration. Baby was managed with CPAP, Iv fluids,

Iv. Antibiotics, Inj. calcium gluconate, Inj. Aminophylline & Inj. Dopamine. On

08.07.09 baby had brown coloured vomitus, Inj. Rantac was added. On 10.07.09, baby

had abdominal distension, ryles tube feeding was with held. On 16.07.09. Baby had

convulsion Inj. Gardenol was added. On 17.07.09 baby had desaturation with the C-PAP,

so intubated and connected to mechanical ventilator support. As baby had low perfusion

with hypotension, Ionotrophes were restarted. Now baby is on mechanical ventilator

support and maintaining O2 saturation 98% with Fio2 of 100%. Since parents were not

willing for further management, baby is discharged AGAINST MEDICAL ADVICE on

17.07.09.

INVESTIGATION :



HAEMOGLOBIN 17.6 gm/dl 04/07/2009 TOTAL COUNT 23,000 [ TWICE RPT ] cells/cumm 04/07/2009 PCV 53 % 04/07/2009 MCV 105 FL 04/07/2009 MCH 34 PG 04/07/2009 MCHC 32 % 04/07/2009 RDW 13.5 % 04/07/2009 RBC 5.1 MILL/Cumm 04/07/2009 MPV 8.1 FL 04/07/2009 NEUTROPHILS 67 % 04/07/2009 LYMPHOCYTE 31 % 04/07/2009 EOSINOPHIL 02 % 04/07/2009 PLATELET COUNT 2.5 Lakhs/Cumm 04/07/2009 CREATININE 1.0 mg /dl 05/07/2009 CREATININE 0.7 mg /dl 09/07/2009

PERIPHERAL SMEAR SHOWED (06.07.09) : RBCs shows normochromic

normocytes and macrocytes. No nucleated RBCs 2/100 WBCs. WBC count shows

neutrophillic leukocytosis. No atypical or immature cells. DC: Neutrophils: 60%,

Eosinophils: 02%, Monocytes: 05%, Lymphocytes: 33%. Platelet count normal in

number and morphology. IMPRESSION: NETROPHILIC LEUKOCYTOSIS.

Name : B/o. Aruna Rani Age / Sex: NB/ M Dept : Neonatology

Hos.No : 422643 Mrd.No : 317756 Ward : I NB NICUD.O.A : 15.07.09 D.O.D : 20.07.09************************************************************************REF. BY: DR.K.K RAVISANKAR., PLACE: MADURAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION OF NEWBORN ACUTE RENAL FAILURE

COURSE:

This Term / LBW / male baby born at private hospital by LSCS (Indication :

severe oligohydramnios with fetal distress) on 14.07.09 with baby cried immediately

after birth, H/o. Baby had respiratory distress since birth. Hence referred to MMHRC on

15.07.09, for further management. No H/o. cyanosis and convulsion. H/o. meconium

aspiration +. Maternal H/o. white discharge +, H/o. maternal fever +, H/o. sever

oligohydramnios and cord around the neck shown in the antenatal USG abdomen. O/E.

Baby’s activity & cry were weak, respiratory distress +, colour : pink, CFT > 3 sec,

CVS : S1 S2 heard, RS : sub costal and intercostal retraction +, bilateral air entry +, P/A:

soft, CNS: NNR sluggish. Baby was investigated peripheral smear showed mild

leukocytosis. Blood sugar – 104mg/dl, serum Creatinine – 1.1(15.07.09), 1.8(20.07.09)

CRP was negative. Blood culture – no growth. Chest x-ray suggestive of meconium

aspiration syndrome. Baby was managed with mechanical ventilator support, Iv fluids,

Iv. Antibiotics, Inj. Dopamine infusion, Inj. Nor aderenaline infusion, Inj.calcium

gluconate, Inj. Rantac and Inj. Aminophylline. With above management baby’s oxygen

saturation was maintained activity & cry were weak. Since baby’s parents were not

willing for further management, baby was discharged today “AGAINST MEDICAL

ADVICE” on 20.07.09

INVESTIGATION :



C-REACTIVE PROTEIN(CRP) LATEX NEGATIVE 15/07/2009

HAEMOGLOBIN 19.9 (TWUCE RPT) gm/dl 15/07/2009 TOTAL COUNT 15800 cells/cumm 15/07/2009 PCV 59 % 15/07/2009 MCV 107 FL 15/07/2009 MCH 35 PG 15/07/2009 MCHC 33 % 15/07/2009 RDW 12.9 % 15/07/2009 RBC 5.5 MILL/Cumm 15/07/2009 MPV 8.4 FL 15/07/2009 NEUTROPHILS 59 % 15/07/2009 LYMPHOCYTE 40 % 15/07/2009 EOSINOPHIL 01 % 15/07/2009 PLATELET COUNT 2.0 Lakhs/Cumm 15/07/2009 CREATININE 1.1 mg /dl 15/07/2009 CREATININE 0.8 mg /dl 18/07/2009 CREATININE 1.8 mg /dl 20/07/2009

Name : B/o. Haria Devi Age/Sex : NB/ F Dept : NeonatologyHos.No: 423288 Mrd.No : 318219 Ward : IL.NB. NICUD.O.A : 20.07.09 D.O.D : 21.07.09

************************************************************************

DIAGNOSIS: BIRTH ASPHYXIA THICK MECONIUM ASPIRATION

COURSE:

This Pre term (35 weeks) / AGA / female born at MMHRC by normal vaginal

delivery on 20.07.09 with H/o. Baby did not cry immediately after birth, H/o. Thick

meconium stained liquor, hence immediately intubated with 3 size ET tube and

resuscitated with ambu bag ventilator, then baby’s activity & cry regained and shifted to

NICU for further management. No H/o. convulsion and cord around the neck. Maternal

H/o. draining PV – 3 days, H/o. Hepatitis E Positive, Maternal H/o. Jaundice with

elevated LFT. O/E. Baby activity & cry – weak. Colour : Pink, CFT < 3 sec, Mild

respiratory distress +, no birth injury, no obvious external anomaly. Baby was

extubated on the same day of birth and was on oxygen therapy. CVS : S1 S2 heard, RS :

Bilateral air entry equal, mild lower chest indrawing +, P/A soft, CNS : NNR sluggish.

Baby was investigated : Peripheral smear showed Neutrophilic leukocytosis. Blood sugar

– normal. CRP – Negative, Blood culture report awaited. Baby was managed with

oxygen therapy, Iv fluids, Inj. Calcium gluconate and Inj. Vitamin K. With above

measures baby’s activity & cry - fair, no respiratory distress and baby is on sufficient

oral feeds hence discharged today with advice to continue.

INVESTIGATION :



HAEMOGLOBIN 12.5 gm/dl 20/07/2009 TOTAL COUNT 23600 cells/cumm 20/07/2009 PCV 37 % 20/07/2009 MCV 111 FL 20/07/2009 MCH 37 PG 20/07/2009 MCHC 33 % 20/07/2009 RDW 13.5 % 20/07/2009 RBC 3.3 MILL/Cumm 20/07/2009 MPV 9.0 FL 20/07/2009 NEUTROPHILS 65 % 20/07/2009 LYMPHOCYTE 32 % 20/07/2009 EOSINOPHIL 03 % 20/07/2009 PLATELET COUNT 3.3 Lakhs/Cumm 20/07/2009

PERIPHERAL SMEAR (20.07.09): RBCs show normochromic normocytes and

macrocytes. Nucleated RBCs 2/100 WBCs. WBC count shows neutrophilic



IMPRESSION : NEUTROPHILIC LEUKOCYTOSISName : B/o. Saritha Rani Age / Sex: NB/M Dept : NeonatologyHos.No : 423715 Mrd.No : 318497 Ward : I NB NICUD.O.A : 23.07.09 D.O.D : 27.07.09************************************************************************REF. BY: DR.S.N SURESH KUMAR., PLACE: MADURAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PULMONARY HYPERTENSION ACUTE SEPTAL DEFECT

COURSE:

This Term / AGA / male baby born at private hospital by LSCS (Indication : Non

progression of labour) on 21.07.09 with H/o. baby cried immediately after birth and had

respiratory distress since birth, hence child was referred to MMHRC on 23.07.09 for

further management. H/o. Meconium stained liquor +, H/o. Aspiration +. No H/o.

cyanosis and cord around the neck. No Maternal H/o. PIH, GDM, UTI, fever and

hypothyroidism. O/E. Baby’s activity & cry were weak, respiratory distress +, colour :

Icteric, CFT < 3 sec, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external

anomaly, CVS : S1 S2 heard, RS : Bilateral air entry equal, P/A: soft, CNS: NNR

sluggish. Baby was investigated peripheral smear, Blood sugar & serum Creatinine were

normal. DCT was negative. Reticulocyte count – 2.6%. Serum Bilirubin : T – 13.3

mg/dl, D- 0.4mg/dl (23.07.09), T - 12.9mg/dl, D – 0.5 mg/dl (27.07.09). Echo showed

congenital heart disease, moderate sized ASD, mild PAH. Baby was managed with

Oxygen, Iv fluids, Iv. Antibiotics, Inj.calcium gluconate, Inj. Vitamin K and Double side

phototheraphy. With these above measures baby’s activity & cry – moderate, ictures and

respiratory distress reduced, hence started on oral feeds. Since baby’s parents were not

willing for further management, was discharged “AGAINST MEDICAL ADVICE” on

27.07.09

INVESTIGATION :

Investigation Result Unit DateCREATININE 0.9 mg /dl 24/07/2009 BILIRUBIN TOTAL

13.3 mg/dl 24/07/2009

BILIRUBIN DIRECT

0.4 mg/dl 24/07/2009

DIRECT ANTI HUMAN GLOBULIN TEST (COOMBS)

"NEGATIVE" 25/07/2009

HAEMOGLOBIN 18.0 gm/dl 24/07/2009 TOTAL COUNT 7100 cells/cumm 24/07/2009 HAEMOGLOBIN 18.0 gm/dl 24/07/2009 TOTAL COUNT 7100 cells/cumm 24/07/2009 HAEMOGLOBIN 18.0 gm/dl 24/07/2009 TOTAL COUNT 7100 cells/cumm 24/07/2009 PCV 55 % 24/07/2009 PCV 55 % 24/07/2009 PCV 55 % 24/07/2009 MCV 94 FL 24/07/2009 MCV 94 FL 24/07/2009 MCV 94 FL 24/07/2009 MCH 30 PG 24/07/2009 MCH 30 PG 24/07/2009 MCH 30 PG 24/07/2009 MCHC 32 % 24/07/2009 RDW 14.1 % 24/07/2009 RBC 5.8 MILL/Cumm 24/07/2009 MPV 8.2 FL 24/07/2009 P/S RBC'S: ARE NORMOCHROMIC

NORMOCYTIC. NO HAEMOPARASITES ARE 24/07/2009

SEEN. WBC'S: COUNTS ARE NORMAL. NO IMMATURE CELLS ARE SEEN. PLATELETS ARE NORMAL IN COUNT AND MORPHOLOGY.

NEUTROPHILS 61 % 24/07/2009 LYMPHOCYTE 38 % 24/07/2009 EOSINOPHIL 01 % 24/07/2009 PLATELET COUNT

2.9 Lakhs/Cumm 24/07/2009

IMPRESSION NORMAL STUDY. 24/07/2009 RETICULOCYTE COUNT (Children)

2.6 % 24/07/2009

BILIRUBIN TOTAL

12.8 mg/dl 27/07/2009

BILIRUBIN DIRECT

0.5 mg/dl 27/07/2009



SMALL OSTIUM SECUNDUM TYPE OF ASD SEEN (5mm). LR SHUNT. IVS

INTACT. RVSP 40mm of hg. OTHER VALVES NORMAL. GREAT VESSELS

NORMALLY ARISING. NO PDA / COARCTATION. NORMAL LV FUNCTION.

IMPRESSION : CONGENITAL HEART DISEASE. MODERATE SIZED ASD.

MILD PAH.

Name : B/o. Kamala Age / Sex: NB/M Dept : NeonatologyHos.No : 423815 Mrd.No :318543 Ward : I NB NICUD.O.A : 24.07.09 D.O.D : 28.07.09************************************************************************

REF. BY : DR. KARTHIKEYINI., PLACE : DEVAKOTTAI

DIAGNOSIS: PRETERM (32 – 34 WEEKS)

RESPIRATORY DISTRESS SYNDROME

PERIPHERAL CIRCULATORY FAILURE

HIGH RISK FOR SEPSIS [PROM > 7 DAYS]

SURFACTANT THERAPY GIVEN ON 25.07.09

COURSE :

This Pre term (32 - 34 weeks) / AGA / male born at Private hospital by Normal

vaginal delivery on 24.07.09. H/o. Baby cried immediately after birth and developed

respiratory distress since birth for that referred to MMHRC on 24.07.09 for further

management. Maternal H/o. PROM – 7 days, UTI +. No Maternal H/o. GDM and PIH.

O/E. Activity & cry : weak, Peripheral cyanosis +, CFT > 3 sec, dyspnoeic +,

tachypnoeic +, no obvious external anomaly. CVS : S1 & S2 heard, Hypertension +,

RS : RR > 60/mt, Lower chest indrawing +. P/A : Soft, CNS : NNR sluggish. Baby was

investigated : Peripheral smear was normal smear study. CRP was negative. Chest x-ray

suggestive of respiratory distress syndrome. Echo showed IAS aneurysm. Baby was

managed with Mechanical ventilator support, Ionotropes, Iv fluids, Iv antibiotics, Inj.

calcium gluconate, Inj. Vitamin K and 2 doses of surfactant given. On 27.07.09 baby had

persistent cyanosis with hypotension, Inj. Nor adrenaline infusion was started. Baby had

decreased urine output and raised renal parameters of Blood urea – 81mg/dl and Serum

creatinine was - 1.3mg/dl, Inj. Lasix infusion was added on 28.07.09. Now baby is in

mechanical ventilator support, maintaining oxygen saturation 94% with the FIO2 of

100%. Since parents were not willing for further management, baby is discharged

“Against Medical Advice” on 28.07.09 at 12.00 no

INVESTIGATION :

Investigation Result Unit DateBLOOD GROUP RH TYPING

"A" POSITIVE 24/07/2009


NEGATIVE 24/07/2009


NEGATIVE 25/07/2009

HAEMOGLOBIN 14.5 gm/dl 24/07/2009 TOTAL COUNT 8500 cells/cumm 24/07/2009 HAEMOGLOBIN 14.5 gm/dl 25/07/2009 TOTAL COUNT 8500 cells/cumm 25/07/2009 PCV 41 % 24/07/2009 PCV 41 % 25/07/2009 MCV 104 FL 24/07/2009 MCV 104 FL 25/07/2009 MCH 36 PG 24/07/2009 MCH 36 PG 25/07/2009 MCHC 34 % 24/07/2009 MCHC 34 % 25/07/2009 RDW 17.3 % 24/07/2009 RDW 17.3 % 25/07/2009 RBC 4.0 MILL/Cumm 24/07/2009 RBC 4.0 MILL/Cumm 25/07/2009 MPV 7.6 FL 24/07/2009 MPV 7.6 FL 25/07/2009 P/S RBC'S: NORMOCHROMIC NORMOCYTIC. 25/07/2009

NO HAEMOPARASITES ARE SEEN. WBC'S: COUNTS ARE NORMAL. NO IMMATURE CELLS ARE SEEN. PLATELETS ARE NORMAL IN COUNT AND MORPHOLGY.

NEUTROPHILS 65 % 24/07/2009 LYMPHOCYTE 34 % 24/07/2009 EOSINOPHIL 01 % 24/07/2009 NEUTROPHILS 65 % 25/07/2009 LYMPHOCYTE 34 % 25/07/2009 EOSINOPHIL 01 % 25/07/2009 PLATELET COUNT

2.8 Lakhs/Cumm 24/07/2009

PLATELET COUNT

2.8 Lakhs/Cumm 25/07/2009

IMPRESSION NORMAL STUDY. 25/07/2009 CREATININE 1.0 mg /dl 27/07/2009


AV, VA CONCORDANCE. NORMAL RELATED GREAT VESSELS. NORMAL

VALVES. CHAMBERS NORMAL. IAS, IVS INTACT. IAS ANEURYSM +. NO

SHUNT. NO PDA / COARCTATION. NO PULMONARY HYPERTENSION.

IMPRESSION : IAS ANEURYSM. NO SHUNT.

AUG 09

Name : B/o. Jothi Age / Sex: NB/M Dept : NeonatologyHos.No : 425280 Mrd.No : 319549 Ward : I NB NICU

D.O.A : 07.08.09 D.O.D :09.08.09************************************************************************REF. BY: DR.J.AMBA BHAVANI., PLACE: MADURAI

DIAGNOSIS: PRE TERM (33 WEEKS) / AGA / MALE


TO R/O EARLY ONSET OF SEPSIS

PDA WITH MODERATE PAH

SURFACTANT THERAPY GIVEN

COURSE:

This Pre term ( 33 weeks) / AGA / male / born at private hospital by LSCS

(Indication : previous LSCS ) on 07.08.09 with H/o. Baby cried soon after birth

developed cyanosis and respiratory distress since birth, for that referred to MMHRC on

07.08.09 for further management, Maternal H/o. G5 P3 A2 L2, H/o. recurrent UTI at 7

months, treated. No Maternal H/o. PIH, GDM & PROM. O/E. Baby’s activity & cry

were weak, colour : Peripheral cyanosis +, CFT : > 3sec, grunting respiration +,

tachypnoeic +, Spo2 – 60-70% with the oxygen hood immediately intubated and

connected to ventilator support. no birth injury, CVS: S1, S2 heard, RS: RR > 60/mt,

chest indrawing +, Bilateral air entry equal, P/A: soft, CNS: NNR sluggish, External

genitalia – left undescended testis. Baby was investigated : Peripheral smear showed HB

– 16.5gm%, TC – 13,000 cells & platelet count – 2.1 lakhs, Blood sugar : 48mg/dl.

Chest x-ray showed bilateral reticular pattern with air bronchogram. Echo showed small

PDA 3mm with L R shunt, PFO +, moderate pulmonary hypertension, TR moderate.

Baby was managed with Mechanical ventilator support, Iv fluids, Iv. Antibiotics, Inj.

calcium gluconate, Inj. Vitamin K & surfactant (3 doses). Now baby is maintaining

oxygen saturation (Spo2 – 100%) with mechanical ventilator support of Fio2 – 70%.

Since parents want to continue further management at some other hospital discharged AT

REQUEST on 08.08.09

INVESTIGATION :



HAEMOGLOBIN 16.5 gm/dl 08/08/2009 TOTAL COUNT 13,000 cells/cumm 08/08/2009 PCV 48 % 08/08/2009 MCV 102 FL 08/08/2009 MCH 34 PG 08/08/2009 MCHC 33 % 08/08/2009 RDW 17.5 % 08/08/2009 RBC 4.7 MILL/Cumm 08/08/2009 MPV 7.2 FL 08/08/2009 NEUTROPHILS 40 % 08/08/2009 LYMPHOCYTE 58 % 08/08/2009 EOSINOPHIL 02 % 08/08/2009 PLATELET COUNT 2.1 Lakhs/Cumm 08/08/2009

GLUCOMETER SUGAR 9PM:48mg/dl 08/08/2009

ECHO SHOWED ON 08.08.09 : SITUS SOLITUS, LEVOCARDIA, SMALL PDA

SEEN (3 MM), L R SHUNT, NORMAL RELATED GREAT VESSELS, PFO +, NO

COARCTATION, MODERATE PULMONARY HYPERTENSION, IMPRESSION : CONGENITAL HEART DISEASE, SMALL PDA, PFO, MODERATE TR, MODERATE PULMONARY HYPERTENSION.

Name : B/o. Suba Age/Sex : NB/ F Dept : Neonatology

Hos.No: 426283 Mrd.No : 320146 Ward: IL.NB. NICUD.O.A : 14.08.09 D.O.D : 20.08.09 ************************************************************************

DIAGNOSIS: TERM / IUGR MECONIUM ASPIRATION WITH RESPIRATORY DISTRESS

COURSE:

This Term / IUGR / female baby born at MMHRC on 14.08.09 by LSCS

(Indication : Primi with Oligohydramnios) with H/o. baby cried immediately after birth

and had poor activity and feeding, hence admitted at NICU for further management, H/o.

Thick meconium stained liquor +. No maternal H/o. PIH, GDM, PROM, Fever, UTI &

Hypothyroidism. O/E. Baby’s activity & cry were weak. Colour : Pink, CFT < 3 sec,

dyspnoeic, tachypnoeic, no birth injury, no obvious external anomaly. CVS: S1 & S2

heard, RS: RR 66 / min Bilateral air entry equal. P/A: soft, CNS : NNR sluggish. Baby

was investigated : HB – 19.8mg/dl, TC : 22,600, platelet count – 3.1 lakhs, Blood sugar

& serum creatinine were normal. Baby was managed with oxygen, Iv fluids, Iv

antibiotics, Inj. Calcium gluconate & single sided phototherapy. With above measures

baby became active and had no respiratory distress. Now baby is on breast feeds, hence

discharged today.

INVESTIGATION :

Investigation Result Unit DateHAEMOGLOBIN 19.8 [TWICE RPT] gm/dl 15/08/2009 TOTAL COUNT 22,600 cells/cumm 15/08/2009 PCV 58 % 15/08/2009 MCV 102 FL 15/08/2009 MCH 34 PG 15/08/2009 MCHC 33 % 15/08/2009

RDW 17 % 15/08/2009 RBC 5.7 MILL/Cumm 15/08/2009 MPV 7.4 FL 15/08/2009 NEUTROPHILS 78 % 15/08/2009 LYMPHOCYTE 20 % 15/08/2009 EOSINOPHIL 02 % 15/08/2009 PLATELET COUNT 3.1 Lakhs/Cumm 15/08/2009 CREATININE 0.4 mg /dl 15/08/2009

Name : B/o. Kasiammal Age / Sex: NB/M Dept : NeonatologyHos.No : 427217 Mrd.No : 320747 Ward : I NB NICU

Name : B/o. Kasiammal Age / Sex: NB/M Dept : NeonatologyHos.No : 427217 Mrd.No : 320747 Ward : I NB NICUD.O.A :23.08.09 D.O.D :26.08.09************************************************************************

DIAGNOSIS: THICK MECONIUM ASPIRATION

RESPIRATORY DISTRESS

COURSE:

This Term / AGA / female / born at MMHRC by LSCS (Indication : Fetal distress

with thick meconium stained liquor ) on 23.08.09. H/o. Baby cried soon after birth &

developed respiratory distress since birth for that admitted at NICU for further

management. H/o. Thick meconium stained liquor +. No maternal H/o. PIH/GDM/PROM

& Hypothyroidism. O/E. Baby’s activity & cry were weak, Colour : pink, CFT : < 3sec,

Tachypnoeic +, no birth injury, no obvious external anamoly. CVS: S1, S2 heard, RS:

RR : 60/mt, Mild lower chest indrawing +, P/A: soft, CNS: NNR sluggish. Baby was

investigated peripheral smear showed Neutrophilic leukocytosis. Blood sugar was

normal. Baby was managed with oxygen, Iv. Fluids, Iv. Antibiotics, Inj. Calcium

gluconate & Inj. Vitamin K. With these above measures baby’s respiration became

normal and started on small tube feeds. Now baby is taking breast feeds & discharged

today with advice to continue following.

INVESTIGATION :

Investigation Result Unit DateHAEMOGLOBIN 17.0 [TWICE RPT] gm/dl 23/08/2009 TOTAL COUNT 21,100 cells/cumm 23/08/2009 PCV 50 % 23/08/2009 MCV 106 FL 23/08/2009 MCH 35 PG 23/08/2009 MCHC 33 % 23/08/2009 RDW 16.7 % 23/08/2009

RBC 4.7 MILL/Cumm 23/08/2009 MPV 8.1 FL 23/08/2009 NEUTROPHILS 83 % 23/08/2009 LYMPHOCYTE 15 % 23/08/2009 EOSINOPHIL 02 % 23/08/2009 PLATELET COUNT 2.9 Lakhs/Cumm 23/08/2009

PERIPHERAL SMEAR SHOWED ON (24.08.09): RBCs show normochromic






Admission weight : 3.145kg

Discharge weight : 3.050kg

Name : B/o. Eluvakkal Age/Sex : NB/ F Dept : NeonatologyHos.No: 426224 Mrd.No : 320132 Ward: IL.NB. NICUD.O.A : 14.08.09 D.O.D : 29.08.09 ************************************************************************

DIAGNOSIS: TERM / IUGR / BIRTH ASPHYXIA THIN MECONIUM ASPIRATION

COURSE:

This Term / IUGR / female baby born at MMHRC by normal vaginal delivery on

14.08.09. H/o. baby had weak cry at birth, resuscitated with one cycle of ambu mask

ventilation & had respiratory distress since birth. H/o. Cord around the neck +, H/o.

Thick meconium stained liquor +. For that admitted at NICU for further management.

Antenatally USG abdomen showed cadiomegaly, hepatomegaly & ascites. Maternal H/o.

severe Oligohydraminios +, G4 P1 L1 A2, 1st child had CHD. No maternal H/o. PIH,

GDM & PROM. O/E. Baby’s activity & cry were weak. Colour : cyanosis, CFT < 3 sec,

dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anomaly. CVS: S1 &

S2 +, RS: RR 60/mint, inter costal retraction +, P/A: soft, CNS : NNR sluggish. Baby

was investigated peripheral smear showed leukocytosis. Blood sugar was normal. Serum

creatinine – 1.7mg/dl, 0.8mg/dl (17.08.09), karyotyping sent, report awaited. Baby was

managed with mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium

gluconate, Inj. Vitamin K and Ionotrophic support. ET tip culture showed coagulase

negative staphycococus, antibiotics were changed according to culture sensitivity. With

these above measures, baby’s respiration became normal, activity improved so weaned

from the ventilator on 24.08.09 & tapering of Ionotropes done. Baby was started on small

tube feeds & tolerating feeds well. Now baby is taking breast feeds & discharged today

with the advice to continue the following.

INVESTIGATION :



HAEMOGLOBIN 14.1 gm/dl 14/08/2009 TOTAL COUNT 21,400 cells/cumm 14/08/2009 PCV 42 % 14/08/2009 MCV 99 FL 14/08/2009 MCH 33 PG 14/08/2009 MCHC 33 % 14/08/2009 RDW 15.4 % 14/08/2009 RBC 4.2 MILL/Cumm 14/08/2009 MPV 8.7 FL 14/08/2009 NEUTROPHILS 62 % 14/08/2009 LYMPHOCYTE 37 % 14/08/2009 EOSINOPHIL 01 % 14/08/2009 PLATELET COUNT 1.8 Lakhs/Cumm 14/08/2009 CREATININE 1.7 mg /dl 15/08/2009 CREATININE 0.8 mg /dl 17/08/2009

PERIPHERAL SMEAR SHOWED ON (14.08.09): RBCs shows normochromic




IMPRESSION : LEUKOCYTOSISName : B/o. Sorna Gowri Age/Sex : NB/ F Dept : NeonatologyHos.No: 427884 Mrd.No : 321209 Ward: IL.NB. NICUD.O.A : 28.08.09 D.O.D : 30.08.09 ************************************************************************

DIAGNOSIS: MECONIUM ASPIRATION NEONATAL SEIZURE BILATERAL PNEUMOTHORAX

COURSE:

This Boderline Term / IUGR / female born at private hospital by normal vaginal

delivery on 28.08.09. H/o. Birth asphyxia +, Thick meconium stained, Liquor +,

Resuscitated, intubated, ambu bag, ventilation given, then & referred to MMHRC on

28.08.09 for further management. Maternal H/o. Polyhydramnios +. Maternal H/o. Fetal

distress +. Antenatal USG abdomen showed ? Reversal of diastolic flow. No maternal

H/o. PIH, GDM. O/E. Baby’s activity & cry : weak. Colour : Pink, peripheral cyanosis

+, CFT < 3 sec, tachypnoeic +, lower chest indrawing +, low set of ears +, cleft palate +,

no birth injury, CVS: S1 & S2 heard, RS: RR >60/mt, LCI +, P/A : Soft, CNS : NNR

sluggish. Baby was investigated peripheral smear showed HB : 17.9gm%, TC : 19,300

cells & Platelet count : 1.1 lakhs, Blood sugar & serum creatinine were normal. Baby was

managed with mechanical ventilator support, Iv. Fluids, Iv antibiotics, Inj. Calcium

gluconate & Inj. Vitamin K. As baby had hypotension, Inj. Dopamine infusion was

started. On 29.08.09. baby had convulsion, Inj. Gardenol was added. Baby had recurrent

seizures, not controlled with Inj. Gardenol, so Inj. Eptoin was added. On 30.08.09. Baby

had desaturation. Chest X-ray was taken, which showed Bilateral pneumothorax - ICD

was done, on both sides. Even with these above measures, baby had desaturation

followed by bradycardia, Inj. Atropine and Inj. Adrenaline were given. CPR was carried

out. But baby could not be revived & DECLARED DEAD on 30.08.09.

INVESTIGATION :



HAEMOGLOBIN 17.9 gm/dl 29/08/2009 TOTAL COUNT 19300 cells/cumm 29/08/2009 PCV 54 % 29/08/2009 MCV 109 FL 29/08/2009 MCH 36 PG 29/08/2009 MCHC 33 % 29/08/2009 RDW 21.6 % 29/08/2009 RBC 4.9 MILL/Cumm 29/08/2009 MPV 8.2 FL 29/08/2009 NEUTROPHILS 80 % 29/08/2009 LYMPHOCYTE 19 % 29/08/2009 EOSINOPHIL 01 % 29/08/2009 PLATELET COUNT 1.1 Lakhs/Cumm 29/08/2009 CREATININE 0.5 mg /dl 29/08/2009

PERIPHERAL SMEAR SHOWED ON (28.08.09): RBCs show normocytes and

macrocytes. Nucleated RBCs 5/100 WBCs. WBC count shows neutrophilic leukocytosis.

No atypical or immature cells. DC: Neutrophils: 86%, Eosinophils: 01%, Monocytes:

03%, Lymphocytes: 10%. Platelets count just adequate. IMPRESSION :

NEUTROPHILIC LEUKOCYTOSIS

SEP 09Hos.No : 426693 Mrd.No : 320442 Ward : I NB NICUD.O.A :19.08.09 D.O.D :01.09.09************************************************************************REF.BY.DR. SABITHA SRIDHARAN PLACE : MADURAI

DIAGNOSIS: PRETERM (30 - 32 WEEKS) / LBW / FEMALE / TWIN - I RESPIRATORY DISTRESS SYNDROME SURFACTANT THERAPY GIVEN ON 19.08.09

CONGENITAL HEART DISEASE, (SMALL PDA(1 mm) / SMALL ASD (3 mm) & SEVERE PAH)

COURSE:

This pre term (30 - 32 weeks) / LBW / female / Twin I born at private hospital by

normal vaginal delivery on 19.08.09. H/o. Baby cried immediately after birth for that

referred to MMHRC on 19.08.09 for further management. No H/o. PIH / GDM / PROM.

O/E. Baby’s activity & cry were weak. Colour : Pink, peripheral cyanosis +, CFT > 3sec,

dyspnoeic+, tachypnoeic +, no birth injury, no obvious external anamoly, CVS: S1, S2

heard, RS: RR > 60/mt. Bilateral air entry equal, P/A: soft, CNS: NNR sluggish. Baby

was investigated peripheral smear, blood sugar & serum creatinine were normal. ECHO

showed CHD, Small ASD (3 mm), small PDA (1mm) & severe PAH. Chest x-ray

suggestive of RDS. Baby was managed with mechanical ventilator support, Iv fluids, Inj.

Calcium gluconate, Inj. Vitamin K, Ionotrophic support and 1 dose of Inj. Surfactant.

Three dose of Syp. Brufen was given for PDA closure. With these above measures,

baby’s respiration became normal. So weaned from the ventilator on 26.08.09 and started

on small tube feeds. Baby was slowly weaned from oxygen theraphy. ET – Tip culture

showed Enterobactor growth. Antibiotics were changed according to culture sensitivity.

Now baby’s activity improved & taking breast feeds well & discharged today with the

advice to continue further follow-up with the referral doctor.

INVESTIGATIONInvestigation Result Unit Date


HAEMOGLOBIN 18.4 [TWICE RPT] gm/dl 19/08/2009 TOTAL COUNT 6900 cells/cumm 19/08/2009 PCV 53 % 19/08/2009 MCV 107 FL 19/08/2009 MCH 37 PG 19/08/2009 MCHC 34 % 19/08/2009 RDW 15.6 % 19/08/2009 RBC 4.9 MILL/Cumm 19/08/2009 MPV 6.8 FL 19/08/2009 NEUTROPHILS 48 % 19/08/2009 LYMPHOCYTE 50 % 19/08/2009 EOSINOPHIL 02 % 19/08/2009 PLATELET COUNT 2.9 Lakhs/Cumm 19/08/2009 CREATININE 0.4 mg /dl 22/08/2009

PERIPHERAL SMEAR SHOWED ON (19.08.09): RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No atypical or immature cells. DC: Neutrophils: 40%, Eosinophils: 02%, Monocytes: 05%, Lymphocytes: 53%. Platelets count normal in number and morphology. ECHO SHOWED ON 21.08.09 : SITUS SOLITUS, LEVOCARDIA, 3 mm OSTIUM SECUNDUM TYPE OF ASD SEEN, L R SHUNT, IVS INTACT, MV, AV, PV NORMAL, GREAT VESSELS NORMALLY ARISING, SMALL 1mm PDA SEEN, L R SHUNT ONLY DURING SYSTOLE, NO COARCTATION, NO PERICARDIAL EFFUSION, NORMAL LV AND RV FUNCTION. IMPRESSION : CONGENTIAL HEART DISEASE, SMALL ASD, SMALL PDA, SEVERE PAH.

Name : B/o. Vanitha Rex Age/Sex : NB/ F Dept : NeonatologyHos.No: 427202 Mrd.No : 320734 Ward: IL.NB. NICUD.O.A : 22.08.09 D.O.D : 08.09.09 ************************************************************************

REF.BY.DR.NANDHINI PANDIYAN., PLACE : MADURAI

DIAGNOSIS: PRETERM ( 32 – 34 WEEKS) WITH RESPIRATORY DISTRESS SURFACTANT THERAPHY GIVEN ON 24.08.09 CHD [SMALL ASD (2mm)]

COURSE:

This Pre term (34 – 35 weeks) / AGA / female born at private hospital by LSCS

( Ind : previous LSCS with Oligohydramnios) on 22.08.09. H/o. Baby cried immediately

after birth. baby had respiratory distress since birth, for that referred to MMHRC on

22.08.09 for further management. Maternal H/o. Decreased fetal movements +,

Oligohydramnios +. No maternal H/o. PIH & PROM. O/E. Baby’s activity & cry –

weak, peripheral cyanosis +, CFT < 3 sec, grunting +, tachypnoeic, no birth injury, no

obvious external anamoly, CVS: S1 & S2 heard, RS: RR > 60/mt, lower chest indrawing

+, P/A: soft, CNS : NNR sluggish. Baby was investigated : Peripheral smear showed

neutrophilic leukocytosis. Blood sugar was normal. Serum creatinine – 1.3mg/dl

(23.08.09) & 0.7mg/dl (27.08.09). ECHO showed CHD, Small ASD (2mm) with left to

right shunt. Baby was managed with mechanical ventilator support, Iv fluids, Iv

antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inj. Dopamine infusion. With these

above measures baby’s respiratory distress reduced & weaned from the ventilator on

01.09.09. Baby was started on small tube feeds. Baby was slowly weaned from the

oxygen therapy. ET Tip culture showed non – fermenting gram Negative Bacilli,

antibiotics were changed according to culture sensitivity. Now baby’s activity improved,

respiration became normal and taking breast feeds well. Baby is discharged today with

the advice to continue further follow-up with the referral doctor.

INVESTIGATION :



HAEMOGLOBIN 15.5 gm/dl 23/08/2009

TOTAL COUNT 19,000 [TWICE RPT] cells/cumm 23/08/2009

PCV 46 % 23/08/2009

MCV 97 FL 23/08/2009

MCH 32 PG 23/08/2009

MCHC 33 % 23/08/2009

RDW 15.6 % 23/08/2009

RBC 4.8 MILL/Cumm 23/08/2009

MPV 7.7 FL 23/08/2009


LYMPHOCYTE 20 % 23/08/2009

EOSINOPHIL 03 % 23/08/2009

PLATELET COUNT 3.1 Lakhs/Cumm 23/08/2009



PERIPHERAL SMEAR SHOWED ON 240.08.09 : RBCs show normochromic

normocytes and macrocytes, Nucleated RBCs 2/100 WBCs. WBC count shows

neutrophilic leukocytosis. No atypical or immature cells. Neutrophilic : 60%, Eosinophils

: 03%, Monocytes : 05%, Lymphocytes : 32%. Platelets count normal in number and

morphology.


ECHO SHOWED ON 28.08.09 : SITUS SOLITUS, LEVOCARDIA, SMALL

OSTIUM SECUNDUM TYPE OF ASD SEEN (2mm), L R, IVS INTACT, MV, AV,

PV NORMAL, NO PDA / COARCTATION, NORMAL LV FUNCTION, NO PAH.

IMPRESSION : CONGENITAL HEART DISEASE, SMALL ASD, L R SHUNT,

NO PAH

Name : B/o. Rajeswari Age/Sex : NB/ M Dept : NeonatologyHos.No: 426692 Mrd.No : 320441 Ward: IL.NB. NICUD.O.A : 19.09.09 D.O.D : 24.09.09 ************************************************************************

REF. BY : DR. SABITHA SRIDHARAN., PLACE : MADURAI

DIAGNOSIS: PRETERM (30-32 WEEKS) / LBW / MALE / TWIN II RESPIRATORY DISTRESS SYNDROME SURFACTANT THERAPY GIVEN ON 19.08.09 & 20.08.09 CONGENITAL HEART DISEASE SMALL PDA (2mm) / MODERATE ASD (3mm) / ? COARCATION

COURSE:

This Pre term (30-32 weeks) / LBW / Male / Twin II born at Private Hospital by

normal vaginal delivery on 19.08.09. H/o. Baby did not cry immediately after birth for

that referred to MMHRC on 19.08.09 for further management. No Maternal H/o PIH,

GDM & PROM. O/E. Baby’s activity & cry : weak, colour : pink, peripheral cyanosis +,

CFT > 3 sec, tachypnoeic +, dyspnoeic +, no birth injury, no obvious external anomaly.

CVS: S1 & S2 heard, RS: RR > 70/mt, Bilateral decreased air entry, P/A: soft, CNS :

NNR sluggish. Baby was investigated : Peripheral smear and Blood sugar were normal.

ECHO showed CHD, moderate sized ASD and small PDA, ? Coarctation. Chest x-ray

suggestive of RDS. Baby was managed with Mechanical ventilator support, Iv fluids, Iv

antibiotics, Inj. Calcium gluconate, Ionotrophic support & 2 doses of Surfactant . on

19.08.09 and 20.08.09. 3 doses of Syp. Brufan was given for PDA closure. Baby icteric

on day of life and was managed with single side phototherapy. Serum creatinine 1.2mg%

(22.08.09) and repeat serum creatinine – 0.9mg% (24.08.09). Baby developed rashes over

genitalia. Dermatologist’s opinion was obtained. With these above measures baby’s

respiration became normal, so weaning from ventilator was attempted on 29.05.09 and

was put on T-piece O2 on flow. Baby had apnoeic spells, hence was put on ventilator

again on 08.09.09. Repeat HB done showed 11.9mg/dl (02.09.09) and 10.6mg/dl

(08.09.09) respectively. 30ml of whole fresh blood was transfused on 08.09.09, intra and

post – transfusion period are uneventful. ET tip culture showed enterobactor growth.

Antibiotics were changed according to culture sensitivity. With these above measures

respiration improved, so weaned from ventilator on 11.09.09 and started on small tube

feeds. Baby was slowly weaned from oxygen therapy, now baby’s activity improved and

taking breast feeds well, hence discharged today with advice to continue the following.

INVESTIGATION :



HAEMOGLOBIN 15.9 gm/dl 19/08/2009 TOTAL COUNT 11,300 cells/cumm 19/08/2009 PCV 46 % 19/08/2009 MCV 110 FL 19/08/2009 MCH 37 PG 19/08/2009 MCHC 34 % 19/08/2009 RDW 14.6 % 19/08/2009 RBC 4.2 MILL/Cumm 19/08/2009 MPV 6.8 FL 19/08/2009 NEUTROPHILS 64 % 19/08/2009 LYMPHOCYTE 35 % 19/08/2009

EOSINOPHIL 01 % 19/08/2009 PLATELET COUNT 3.7 Lakhs/Cumm 19/08/2009 CREATININE 1.2 mg /dl 22/08/2009 CREATININE 0.9 mg /dl 24/08/2009

PERIPHERAL SMEAR SHOWED ON (19.08.09): RBCs show normochromic

normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count high normal.

No atypical or immature cells. DC: Neutrophils: 47%, Eosinophils: 01%, Monocytes:

05%, Lymphocytes: 47%. Platelets count normal in number and morphology.

ECHO SHOWED ON 28.08.09 : SITUS SOLITUS, LEVOCARDIA, 3mm OSTIUM

SECUNDUM TYPE OF ASD SEEN, L R SHUNT, IVS INTACT, 2mm PDA SEEN,

L R SHUNT, MV,, AV, PV NORMAL, RVSP = 25 mm of hg, NRMAL LV AND RV

FUNCTION, ? COARCTATION (POST DUCTAL), GRADIENT = 25mm of hg,

IMPRESSION : CONGENITAL HEART DISEASE, MODERATE SIZED ASD

AND SMALL PDA, ? COARCTATION



Syp. Deriphylline 6 drops TID x 2 weeks

Tab. Aldactone 1/6 th OD x 2 weeks

Axbex drops 5 drops OD x Till further advice

Evion drops 5 OD x Till further advice

Name : B/o. Selva Rajeswari Age/Sex : NB/ M Dept : NeonatologyHos.No: 432985 Mrd.No : 324667 Ward: IL.NB. NICUD.O.A : 12.10.09 D.O.D : 17.10.09 ************************************************************************

REF.BY.DR. NITHIYA DEVI PLACE : BODINAYAKKANUR

DIAGNOSIS: SEPTICEMIA WITH MECONIUM ASPIRATION SYNDROME CHD WITH PULMONARY HYPERTENSION

COURSE:

This term male baby was referred to MMHRC on 12/10/2009 H/o.

Respiratory Distress since birth. Maternal History: G4 P1 L1 A2mother with 39

weeks gestation, LSCS done on 12/10/09 at 2.45 p.m., (Ind: Thick Meconium

stained liquor / non progression of labour) Baby cried after resuscitation and had

respiratory distress since birth. No maternal H/o. PIH, GDM & PROM. O/E.

Baby’s activity & cry – weak, peripheral cyanosis+, CRT > 3 sec, Spo2 – 83%

with O2, CVS: S1 & S2 heard, RS: RR > 70/mt, lower chest indrawing +,

subcostal retraction+, tachypnoea +, dyspnea+. P/A: soft, no organomegaly, CNS :

NNR sluggish. Child was immediately intubated and connected to mechanical

ventilator support. Baby was investigated HB – 17.7gm%, TC : 14800, platelets –

50,000, CRP – +ve. Chest X – ray, showed Bilateral infiltrates. Echo showed:

ASD with pul Hypertension. Baby was treated with Iv fluids, Iv antibiotics, Inj.

Calcium gluconate, Inj. Vitamin K, Dopamine infusion and pulmonary

vasodilators. ABG 12th hourly monitored. As baby continued to have respiratory

distress and high Pco2, surfactant therapy given on 15/10/09. As the baby parents

were not willing for further management, baby is discharged AGAINST

MEDICAL ADVICE on 17.10.09.

INVESTIGATION :

PERIPHERAL BLOOD SMEAR STUDY

RBC 4.7 Cells/cumm 13-10-2009

HAEMOGLOBIN 17.7 13.6 to 19.6 g/dL 13-10-2009

TOTAL WBC COUNT 14800 10000 to 25000 Cells/cumm 13-10-2009

DIFFERENTIAL COUNT

Polymorphs 48 40 - 70 % 13-10-2009

Lymphocytes 49 25 - 50 % 13-10-2009

Monocytes 01 01 - 06 % 13-10-2009

Eosinophils 02 01 - 10 % 13-10-2009

Basophils 00 00 - 01 % 13-10-2009

PLATELET COUNT 50000 150000 to 450000 Cells/cumm 13-10-2009

PCV (HEMATOCRIT) 51 44 to 62 % 13-10-2009

MCV 109 76 to 96 Fl 13-10-2009

MCH 37 27 to 32 pg/cell 13-10-2009

MCHC 34 32 to 36 % 13-10-2009

RDW 12.4 20 to 42 % 13-10-2009

MPV 7.0 6 to 10.2 Fl 13-10-2009

BIO CHEMISTRY

CREATININE (Jaffe

Kinetic) 0.8 0.4 to 1.4 mg/dL 14-10-2009

MICROBIOLOGY

CRP-C REACTIVE

PROTEIN

POSITIVE 24 MICROGRAM /ML 13-10-2009

PATHOLOGY


.

RBCs show normochromic normocytes and macrocytes.

Nucleated RBCs 2/100WBCs.

WBC count shows neutrophilic leukocytosis.

No atypical or immature cells.

13-10-2009

DIFFERENTIAL COUNT : NeutroPhils :38%

Eosinophils :01%

Monocytes :05%

Lymphocytes :56%

13-10-2009

Platelets Count diminished 13-10-2009

IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS.

THROMBOCYTOPENIA.

13-10-2009

ECHO SHOWED ON 14.10.09 : SITUS SOLITUS, LEVOCARDIA, 6 mm OSTIUM

SECUNDUM TYPE OF ASD SEEN,(MODERATE SIZED) L R SHUNT, NO

COARCTATION, PULMONARY HYPERTENSION IMPRESSION :

CONGENTIAL HEART DISEASE, OS ASD (MODERATE SIZED) L R

SHUNT, WITH PULMONARY HYPERTENSION.

OCT 09Name : B/o. Priya Age/Sex : NB/ F Dept : NeonatologyHos.No: 430666 Mrd.No : 323082 Ward: IL.NB. NICUD.O.A : 23.09.09 D.O.D : 02.10.09 ************************************************************************

REF. BY : DR. GOMATHI., PLACE : THIRUMANGALAM

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION

COURSE:

This term female baby delivered by LSCS (Ind : Fetal distress with thick

meconium stained liquor) said to have cried immediately after birth but soon

developed respiratory distress and referred to MMHRC for further management.

H/o. grunting +. No maternal H/o. PIH, GDM, Fever with rash or hypothyroidism.

O/E. Baby cry and activity poor with severe respiratory distress. Peripheries –

cyanosis, CFT > 3 sec, no birth injury, no obvious external anomaly. CVS: S1 &

S2 +, RS: Grunting +, SCR +, ICR +, Bilateral air entry, Bilateral occasional

crepitations, P/A: soft, CNS : NNR weak. Baby was investigated : Hb : 17.0, TC :

23,200, platelet count – 2.8 lakhs, CRP – Positive, Blood sugar – 30mg/dl, serum

creatinine – 0.9. Baby was managed with Mechanical ventilator support, Iv fluids,

Iv antibiotics, Inj. Gardenol & Domstal drops. With above measures baby cry and

activity poor. Since parents were not willing for further management, baby is

discharged AGAINST MEDICAL ADVICE on 02.10.09.

PERIPHERAL SMEAR (23.09.09): RBCs – Normal

WBCs – Normal

DC: Neutrophils: 61%, Eosinophils: 01%, Myleocytes : 01%, Lymphocytes: 37%.

Platelets count normal in number and morphology.

IMPRESSION : NORMAL SMEAR STUDY

Name : B/o. Dorkas Suganya Age/Sex : NB/ F Dept : Neonatology

Hos.No: 431128 Mrd.No : 323377 Ward: IL.NB. NICUD.O.A : 27.09.09 D.O.D : 03.10.09 ************************************************************************

DIAGNOSIS: PRETERM (30-32 WEEKS)/ LBW / FEMALE RESPIRATORY DISTRESS WITH BIRTH ASPHYXIA (SURFACTANT THERAPY ON 27.09.09)

COURSE:

This preterm IUGR female baby delivered by LSCS (Ind: Severe PIH with

reversal of diastolic flow in fetus) at MMHRC on 27.09.09. Baby cried after

stimulation admitted for respiratory distress. Maternal H/o. PIH+ on

antihypertensives. No H/o. GDM / UTI / hypothyroidism / fever with rash. USG

done showed IUGR and Reversal of diastolic flow. O/E. Baby cry and activity:

weak, peripheral cyanosis+, no icterus, respiratory distress+ SpO2 – 94% with O2,

no obvious external congenital anomaly. CVS: HR – 148 / min, S1, S2+, no

murmur, RS : RR – 74/min, SCR+, ICR+, BAE, no added sounds, P/A: soft, CNS:

Tone decreased, NNR sluggish. Baby was investigated, HB: 17.5g%, TC: 12,400

cells/cu.mm, platelets count – 1.6 lakhs, Blood Sugar : 54 mg%, serum creatinine :

1.4mg% repeat 0.9 (02.10.09) Chest x-ray suggestive of Hyaline Membrane

Disease. Baby was managed with nasal C-PAP ventilation, surfacant therapy, Iv

fluids, Iv antibiotics, Iv Aminophylline, Iv Calcium gluconate and Inj. Vitamin K.

Baby continued to have mild distress and had icterus on 3rd day, started on

phototherapy. FFP transfusion given on 01/10/09. On 03/10/09 baby developed

severe respiratory distress and had desaturation. Baby was intubated and connected

to mechanical ventilator support. Dopamine infusion was started. Baby had ET

tube bleeding hence WFB transfusion given. Inspite of all the above measures,

baby’s condition deteriorated and went into apnea, cardiac arrest and could not be

revived. Hence DECLARED DEAD on 03/10/09 at 5.00 am.

Name : B/o. Mahalakshmi Age/Sex : NB/ M Dept : NeonatologyHos.No: 428869 Mrd.No : 321846 Ward: IL.NB. NICUD.O.A : 06.09.09 D.O.D : 22.10.09 ************************************************************************

DIAGNOSIS: PRETERM (29 WEEKS) / VLBW / RESPIRATORY DISTRESS SYNDROME

SURFACTANT THERAPHY GIVEN ON 06.09.09

NEONATAL SEIZURE

COURSE:

This Pre term (29-30 weeks) / VLBW / male born at MMHRC by

LSCS ( Ind : HELLP Syndrome / Hypothyroidism / ISCI conception) to RH

negative mother on 06.09.09 at 7.50pm. H/o. Baby cried soon after birth and had

respiratory distress since birth. H/o. Baby had recurrent apnoea, intubated and

connected to mechanical ventilator support. Baby was admitted at NICU for

further management. Maternal H/o. Elderly primi, Maternal H/o. PIH + on anti

hypertensives. Maternal H/o. hypothyroid + an Tab. Eltroxin 50gm 1OD. No

maternal H/o. GDM. O/E. Baby’s activity & cry – weak, colour : pink, peripheral

cyanosis +, abnormal cyclic movement of four limbs+, CFT < 3 sec, lower chest

indrawing +, tachypnoeic +, no birth injury, no obvious external anamoly, CVS: S1

& S2 heard, RS: Bilateral air entry equal, LCI +, P/A: soft, CNS : NNR sluggish.

Mother blood group : B –ve. Baby’s Blood group : O +ve. Baby was investigated

peripheral smear, blood sugar, serum creatinine & seurm bilirubin were normal.

DCT – Negative. TSH : 5.31 uIU/ml. ECHO was normal. ET tip culture on

12.09.09 showed no growth. Chest x-ray suggestive of respiratory distress

syndrome. Baby was managed with mechanical ventilator support, Iv fluids, Iv

antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Inj. Gardenol, Inj.

Aminophylline, Inj. Dopamine and 1 dose of Inj. Surfactant. Series of ABG’s were

done & ventilator settings were adjusted according to that. Baby was stated on

small ryles tube feeds on 10.09.09. As baby had vomiting, Domstal drops was

added. Baby had GI bleed, Inj. Rantac was added and FFP transfusion was given

on 11.09.09. Baby had ET bleed with GI bleed -> FFP transfusion was given on

16.09.09 & 17.09.09. As baby had abdominal distension. USG abdomen was done

which showed distended stomach with no organomegaly. Baby’s ryles tube feed

was slowly raised. On 25.09.09 baby was pale, HB : 10.2mg%, packed cell

transfusion was given. As baby had difficultly in weaning from the ventilator for

more than 30 days, suspected Bronchopulmonary, dysplasia & started on diuretics

& steroids. With these above management baby was slowly weaned from the

ventilator. Baby was extubated on 09.10.09 and kept in oxygen hood. Et culture

showed Enterobactor growth on 13.10.09. antibiotics were added according to

culture sensitivity.

Name : B/o. Thilagavathy Age/Sex : NB/ M Dept : NeonatologyHos.No: 434949 Mrd.No : 325905 Ward: IL.NB. NICUD.O.A : 28.10.09 D.O.D : 29.10.09 ************************************************************************

DIAGNOSIS: PERINATAL ASPHYXIA THICK MECONIUM STAINED LIQUOR


COURSE:

This term male / AGA / baby referred to MMHRC as a case of meconium

stained liquor with respiratory distress. H/o. baby delivered by labour naturale on

28.10.09 at 6am. Birth weight : 3.2kg. H/o. Baby cried soon after birth but baby

then developed respiratory distress and cyanosis +. No Maternal H/o. PIH, GDM,

Hypothyroidism, UTI, drug intake. H/o. Cord around the neck once +. O/E. Baby

cry and activity : nil, severe respiratory distress +, no birth injury, no obvious

external congenital anomaly, cyanosis +, peripheral cold, CFT > 3sec, Spo2 : 42%

with oxygen. CVS: HR – 146/min, S1, S2 +, no murmur, RS : RR : 88/min, ICR

+, SCR +, Bilateral air entry +, Bilateral crepitation +, P/A : Soft, no

organomegaly, CNS : Drowsy, NNR absent. Baby was investigated showed Hb :

14.7g%, Tc : 17,400cells, platelets : 2.47 lakhs, CRP : Positive. Chest x-ray

showed Bilateral infiltrate. ABG showed metabolic acidosis ( HCO3 : 8.8mm) for

which bicarb correction given. Baby was immediately intubated and connected to

mechanical ventilator. Baby was managed with Iv. fluids, Iv. antibiotics, Iv.

Inotropes, Inj. Vitamin K and Inj. Calcium gluconate. Inspite of above measures

baby had desaturation condition of the baby continuously detoriated and went into

cardiac arrest. Baby was resuscitated with CPR and adrenaline, atropine. Inspite of

that baby could not be revived and DECLARED DEAD on 29.10.09 at 1.45am.

INVESTIGATION :

BLOOD BANK

BLOOD GROUPING & Rh TYPING

B POSITIVE 29-10-2009 / 10:54

RBC

4.13 29-10-2009 / 02:08

HAEMOGLOBIN 14.7 13.6 to 19.6 g/dL 29-10-2009 / 02:08

TOTAL WBC COUNT 17400 10000 to 25000 Cells/cumm 29-10-2009 / 02:08

DIFFERENTIAL COUNT

Polymorphs 85.0 40 - 70 % 29-10-2009 / 02:08

Lymphocytes 10 25 - 50 % 29-10-2009 / 02:08

Monocytes 04 01 - 06 % 29-10-2009 / 02:08

Eosinophils 01 01 - 10 % 29-10-2009 / 02:08

Basophils 00 00 - 01 % 29-10-2009 / 02:08

PLATELET COUNT 247000 150000 to 450000 Cells/cumm 29-10-2009 / 02:08

PCV (HEMATOCRIT) 43 44 to 62 % 29-10-2009 / 02:08

MCV 106 76 to 96 Fl 29-10-2009 / 02:08

MCH 35 27 to 32 pg/cell 29-10-2009 / 02:08

MCHC 33 32 to 36 % 29-10-2009 / 02:08

RDW 17.6 20 to 42 % 29-10-2009 / 02:08

MPV 6.2 6 to 10.2 Fl 29-10-2009 / 02:08

CRP-C REACTIVE PROTEIN

C- Reactive Protein POSITIVE 89 Mg/l 29-10-2009 / 00:13

Name : B/o. Revathy Age/Sex : NB/ F Dept : NeonatologyHos.No: 435212 Mrd.No : 326113 Ward: IL.NB. NICUD.O.A : 30.10.09 D.O.D : 02.11.09 ************************************************************************

REF. BY : DR. SABARIRAJA., PLACE : SIVAGANGAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION OF NEWBORN

COURSE:

This term / IUGR / female baby was born at private hospital by LSCS

(Ind : Previous LSCS with scar tenderness) on 30.10.09 at 7.45pm. H/o. Thick

meconium stained liquor +. Baby did not cry immediately after birth had weak cry

after resuscitation. Baby had respiratory distress with cyanosis. Since birth for that

referred to MMHRC on 30.10.09 for further management. No Maternal H/o. PIH,

GDM & PROM. O/E. Baby activity’s & cry – weak. Peripheral cyanosis +, CFT >

3 sec, dyspnoeic +, tachypnoeic +, grunting +, no birth injury, no obvious external

anomaly. CVS: S1 & S2 +, RS: RS : RR @70/mt, lower chest indrawing +,

supraclavicuar indrawing +, Bilateral crepitations +. P/A: soft, CNS : NNR

sluggish. Baby was investigated peripheral smear showed : Hb : 18.3gms%, TC :

18,000cells/mm3, platelet count – 1.1 lakhs. Blood sugar was normal. chest x-ray

suggestive of Bilateral meconium infiltration. serum creatinine : 1.2mg/dl. Baby

was managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj.

Calcium gluconate & Inj. Vitamin K & Ionotrophic support. series of ABG’s were

done and ventilator settings were adjusted according to that. On 01.11.09, baby had

desaturation with the ventilator support, ABG taken which showed (PCO2 : 86, Po2 :

63.5 & Hco3 : 30) Ventilator settings were raised. With these above measures

baby’s saturation maintained. Now baby is maintaining oxygen saturation (Spo2 :

98%) with Fio2 of 100%. Since parents were not willing for further management.

Baby is discharged AGAINST MEDICAL ADVICE on 02.11.09 at 2.30pm.

INVESTIGATION

BLOOD BANK


B POSITIVE 31-10-2009 / 10:07

HAEMATOLOGY & CLINICAL PATHOLOGY


RBC

5.0 Cells/cumm 31-10-2009 / 17:42



DIFFERENTIAL COUNT

Polymorphs 44 40 - 70 % 31-10-2009 / 17:42

Lymphocytes 47 25 - 50 % 31-10-2009 / 17:42

Monocytes 08 01 - 06 % 31-10-2009 / 17:42

Eosinophils 01 01 - 10 % 31-10-2009 / 17:42

Basophils 00 00 - 01 % 31-10-2009 / 17:42



MCV 112 76 to 96 Fl 31-10-2009 / 17:42

MCH 36 27 to 32 pg/cell 31-10-2009 / 17:42

MCHC 32 32 to 36 % 31-10-2009 / 17:42

RDW 12.4 20 to 42 % 31-10-2009 / 17:42

MPV 7.8 6 to 10.2 Fl 31-10-2009 / 17:42

BIO CHEMISTRY

CREATININE (Jaffe Kinetic) 1.2 0.4 to 1.4 mg/dL 01-11-2009 / 18:54

MICROBIOLOGY


C- Reactive Protein POSITIVE 35 MG/L 01-11-2009 / 08:42

PATHOLOGY


.



WBC count shows leukocytosis.


31-10-2009 / 17:42


Eosinophils :01%

Monocytes :05%

Lymphocytes :59%

31-10-2009 / 17:42

Platelets Count slightly diminished 31-10-2009 / 17:42

IMPRESSION : -- 31-10-2009 / 17:42

NOV 09Name : B/o. Nalini Age/Sex : NB/ M Dept : NeonatologyHos.No: 435995 Mrd.No : 326588 Ward: IL.NB. NICUD.O.A : 05.11.09 D.O.D : 06.11.09 ************************************************************************

REF. BY : DR. ANBURAJAN., PLACE : THENI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION

OF NEWBORN

COURSE:

This term / AGA / male baby was born at private hospital by LSCS ( Ind :

Multipara with fibroid / maternal fever ) on 05.11.09. H/o. Meconium stained

liquor +. Baby had weak cry after birth & baby had respiratory distress since birth

and had apnoea for that referred to MMHRC on 05.11.09 for further management.

Maternal H/o. fever with rigor – 1 day. No H/o. PIH, GDM & PROM. O/E.

Baby’s activity & cry : nil, cyanosed, CFT : prolonged, peripheral pulses : weak.

Hypotension +, tachypnoeic +, Spo2 : 40% with O2 hood, immediately intubated

and with tube & bag ventilation Spo2 : 58%, no birth injury, no obvious external

anamoly, CVS : S1 S2 heard, RS : RR : 78/mt, Bilateral crepitations +, lower chest

indrawing +, P/A : soft, CNS : NNR not elicitable. Hypotonia +. Baby was

investigated, ABG initially showed acidosis. (High Pco2 : 92.8 with Hco3 : 11.3)

corrected with Hco3. baby’s peripheral smear showed HB : 13.4gms%, TC :

17,400cells and platelet count : 1.9 lakhs. Blood sugar were normal. Chest x-ray

showed Bilateral meconium infiltration. CRP was negative. Blood culture was

sent, report awaited. Baby was managed with Mechanical Ventilator support, Iv

fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Inj. Dopamine & Inj.

Surfactant. As baby had persistent cyanosis with hypotension, Inj. Nor – adrenaline

infusion was started. As ABG’s showed high Pco2 ventilator mode changed as

HFV ventilator settings were raised. Even with these above measures, baby had

desaturaion with the ventilator support. Grave prognosis was explained to the

parents. Since parents were not willing for further management, baby is discharged

AGAINST MEDICAL ADVICE on 06.11.09 at 11.30am.

INVESTIGATION :

BLOOD BANK


B NEGATIVE 06-11-2009 / 12:11


RBC

3.88 06-11-2009 / 03:04



DIFFERENTIAL COUNT

Polymorphs 75 40 - 70 % 06-11-2009 / 03:04

Lymphocytes 20 25 - 50 % 06-11-2009 / 03:04

Monocytes 04 01 - 06 % 06-11-2009 / 03:04

Eosinophils 01 01 - 10 % 06-11-2009 / 03:04

Basophils 00 00 - 01 % 06-11-2009 / 03:04



MCV 105 76 to 96 Fl 06-11-2009 / 03:04

MCH 34 27 to 32 pg/cell 06-11-2009 / 03:04

MCHC 32 32 to 36 % 06-11-2009 / 03:04

RDW 18.2 20 to 42 % 06-11-2009 / 03:04

MPV 7.1 6 to 10.2 Fl 06-11-2009 / 03:04


C- Reactive Protein NEGATIVE 05-11-2009 / 23:24

Name : B/o. Thilleswari Age/Sex : NB/ M Dept : NeonatologyHos.No: 435817 Mrd.No : 326483 Ward: IL.NB. NICUD.O.A : 04.11.09 D.O.D : 08.11.09

************************************************************************

DIAGNOSIS: PRETERM ( 32– 34 WEEKS) / VLBW WITH RESPIRATORY DISTRESS SURFACANT THERAPHY GIVEN ON 04/11/2009 ? IVH

COURSE:

This pre–term (32 – 34 weeks) VLBW (B.W – 1.195kg) / Male baby was

born at MMHRC on 04/11/2009 by Normal vaginal delivery. H/o. Baby had weak

cry after birth with Apgar score – 7/10 at 1 min and 8/10 at 5 min. Baby had

Respiratory distress since birth for that admitted at NICU for further management.

Maternal H/o. GDM & PROM. O/E: Baby’s activity & cry – weak, colour: pink,

CFT < 3 sec, dyspnoeic+, tachypnoeic+, no birth injury, no obvious external

anamoly. CVS: S1, S2 heard, RS – RR > 60/mt, lower Chest Indrawing+, SCR+,

P/A: soft, CNS: NNR sluggish. Baby was investigated peripheral smear, Blood

sugar & serum creatinine were normal. Chest X-ray suggestive of RDS. Baby was

managed with C–PAP, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj.

Vitamin K & one dose of Inj. Surfactant on 07/11/2009. Baby had peripheral

cyanosis followed by desaturation, Soda – bi carbonate given – had Apnoea

connected to mechanical Ventilator support and started on Ionotropes. Even with

these above measures baby’s had desaturation followed by Bradycardia.

Resuscitated with 3 doses Inj. Atropine & Inj. Adenaline. CPR was carried out. But

could not be revived & DECLARED DEAD ON 08/11/2009 at 2.45 P.M.

Name : B/o. Bhavani Twin II Age/Sex : NB/ F Dept : NeonatologyHos.No: 436129 Mrd.No : 326678 Ward: IL.NB. NICUD.O.A : 06.11.09

D.O.D : 13.11.09 ************************************************************************

DIAGNOSIS: PRETERM (30 – 32 WEEKS) / LBW / PERINATAL ASPHYXIA/ RESPIRATORY DISTRESS / RECURRENT APNEA

SURFACTANT THERAPY GIVEN ON 06.11.09

Name : B/o. Indumathi Age/Sex : NB/ F Dept : NeonatologyHos.No: 435109 Mrd.No : 326045 Ward: IL.NB. NICUD.O.A : 29.10.09 D.O.D : 12.11.09 ************************************************************************

REF. BY : DR. LATHA MURUGAN., PLACE : MADURAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERINATAL ASPHYXIA MILD PPHN

COURSE:

This term / AGA / female baby was referred to MMHRC on 29.10.09 as a

case of Meconium aspiration syndrome. Baby born at private hospital on 29.10.09

at 9.15pm by normal vaginal delivery. H/o. thick meconium stained liquor. Baby

did not cry immediately, had weak cry after stimulation. H/o. resuscitation with

bag and mask ventilation. Maternal H/o. Fever – 1 week, 15 days before delivery.

O/E. Baby’s activity and cry weak, peripheral cyanosis +, CRT > 3sec, RS : RR :

70/min, tachypnoeic +, lower chest indrawing +, P/A : Soft, CVS: S1 & S2 +,

murmur +, CNS : NNR, not elicitable. Baby had Spo2 of 60% with O2 hood. Baby

was intubated and connected to mechanical ventilator. Baby was investigated with

HB : 19gm%, TC : 12,800, platelet – 2 lakhs, Blood sugar : 384mg/dl, CRP :

Positive, serum creatinine : 0.9. ET culture and blood culture showed no growth.

Chest x-ray showed Meconium aspiration syndrome. Baby was managed with

Mechanical ventilator, Iv fluids, Inj. Ronem, Inj. Aztreonem, Syp. Osteocalcium,

Domstal drops. Inj. Gardenol, Inj. Pavlon, Inj. Dopamine and mucolite drops. With

these above measures baby respiration improved, activity improved and tolerating

RTF. Baby was weaned form ventilator on 09.11.09 and was maintaining on C-

PAP. Since baby attenders not willing to continue treatment baby was discharged

AGAINST MEDICAL ADVICE on 12.11.09.

INVESTIGATION :



BLOOD BANK


O POSITIVE 30-10-2009 / 11:28



RBC

3.38 31-10-2009 / 16:05



DIFFERENTIAL COUNT

Polymorphs 70.0 40 - 70 % 31-10-2009 / 16:05

Lymphocytes 20.0 25 - 50 % 31-10-2009 / 16:05

Monocytes 6.0 01 - 06 % 31-10-2009 / 16:05

Eosinophils 2.0 01 - 10 % 31-10-2009 / 16:05

Basophils 1.0 00 - 01 % 31-10-2009 / 16:05



MCV 107 76 to 96 Fl 31-10-2009 / 16:05

MCH 35 27 to 32 pg/cell 31-10-2009 / 16:05

MCHC 33 32 to 36 % 31-10-2009 / 16:05

RDW 17.3 20 to 42 % 31-10-2009 / 16:05

MPV 7.7 6 to 10.2 Fl 31-10-2009 / 16:05

BIO CHEMISTRY


MICROBIOLOGY


C- Reactive Protein POSITIVE 48 MICROGRAM/ML 31-10-2009 / 07:38

PATHOLOGY


.

RBCs show normochromic normocytes and macrocytes. 31-10-2009 / 16:05





Eosinophils :02%

Monocytes :05%

Lymphocytes :23%

31-10-2009 / 16:05

Platelets Count normal in Number and morphology 31-10-2009 / 16:05

IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 31-10-2009 / 16:05

ECHO SHOWED ON 05.11.09 : SITUS SOLITUS, LEVOCARIDA, SMALL

MUSCULAR VSD, L R SHUNT, IAS ANEURYSM +, NO SHUNT, NO PDA /

COARCTATION. IMPROESSION : CONGENITAL HEART DISEASE, SMALL

MUSCULAR VSD, L SHUNT, IAS ANEURYSM, MILD PAH

DR. A. KANNAN., MD., DCH., SR. CONSULTANT.

Name : B/o. Abirami Age/Sex : NB/ F Dept : NeonatologyHos.No: 436179 Mrd.No : 326727 Ward: IL.NB. NICUD.O.A : 07.11.09 D.O.D : 14.11.09 ************************************************************************

REF. BY : DR. JEYA CHITRA, PLACE : MADURAI

DIAGNOSIS: THICK MECONIUM ASPIRATION PERINATAL ASPHYXIA

COURSE:

This term / AGA / female baby was born at private hospital by LSCS ( IND :

Postdated with maternal fever ) on 07.11.09 at 6.28am. H/o. Thick meconium

stained liquor +, resuscitated with ET tube suctioning & after with ambu bag

ventilation, baby’s respiration was established, baby had respiratory distress since

birth, for that referred to MMHRC on 07.11.09 for further management. Maternal

H/o. High grade fever with thrombocytopenia + at the time of delivery. No

Maternal H/o. PIH, GDM & PROM. O/E. Baby’s activity – sluggish, cry : irritable,

colour : pink, CFT < 3sec, tachypnoeic +, no birth injury, no obvious external

anamoly, CVS: S1 & S2 +, RS: RR @ 60/mt, lower chest indrawing +, P/A : soft,

CNS : Irritable. Baby was investigated : peripheral smear showed Neutrophilic

leukocytosis. Blood sugar & serum creatinine were normal. CRP was Negative.

Blood culture showed no growth. Chest x-ray showed Bilateral meconium

infiltration. Baby was managed with C-PAP, Iv. Fluids, Iv. antibiotics, Inj.

Calcium gluconate & Inj. Vitamin K. With these above measures baby’s

respiration became normal, weaned from the C-PAP on 11.11.09 and started on

small tube feeds. Now baby is active, taking oral feeds, had no vomiting and

discharged today with the advice to continue further follow-up with the referral

doctor.

INVESTIGATION :

BLOOD BANK


AB POSITIVE 07-11-2009 / 14:32



RBC

5.11 07-11-2009 / 19:24



DIFFERENTIAL COUNT

Polymorphs 75 40 - 70 % 07-11-2009 / 19:24

Lymphocytes 15 25 - 50 % 07-11-2009 / 19:24

Monocytes 06 01 - 06 % 07-11-2009 / 19:24

Eosinophils 04 01 - 10 % 07-11-2009 / 19:24

Basophils 00 00 - 01 % 07-11-2009 / 19:24



MCV 108 76 to 96 Fl 07-11-2009 / 19:24

MCH 35 27 to 32 pg/cell 07-11-2009 / 19:24

MCHC 32 32 to 36 % 07-11-2009 / 19:24

RDW 18.2 20 to 42 % 07-11-2009 / 19:24

MPV 8.0 6 to 10.2 Fl 07-11-2009 / 19:24

BIO CHEMISTRY


MICROBIOLOGY



PATHOLOGY


.





07-11-2009 / 19:24


Eosinophils :03%

Monocytes :05%

Lymphocytes :17%

07-11-2009 / 19:24



ADVICE ON DISCHARGE


Name : B/o. Shajitha Banu Age/Sex : NB/ M Dept : NeonatologyHos.No: 434937 Mrd.No : 325899 Ward: IL.NB. NICUD.O.A : 28.10.09 D.O.D : 25.11.09 ************************************************************************

REF. BY : DR. VENKATESAN., PLACE : KARAIKUDI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME CHD-MODERATE SIZE ASD MILD VALVULAR PS BRONCHOPULMONARY DYSPLASIA

COURSE:

This term / AGA / male baby was born at private hospital by normal vaginal

delivery on 28.10.09. H/o. Thin meconium stained liquor +. H/o. Baby cried soon

after birth. H/o. Respiratory distress since birth for that referred to MMHRC on

28.10.09 for further management. Mother is on Antipsychiatric drugs Tab.

Olenzepine, Tab. Lorazepam & Tab. Oxycarbaine. No H/o. PIH, GDM &

Hypothyroidism. O/E. Baby activity & cry : weak, peripheral cynanosis +, CFT >

3 sec, dyspnoeic +, tachypnoeic +, no birth injury & no obvious external

anomaly. CVS: S1 & S2 heard, RS:RR @ 72/min, ICR +, SCR +. P/A: soft, CNS :

NNR sluggish. Baby was investigated : Peripheral smear, Blood sugar & serum

creatinine were normal. Chest x-ray (28.10.09) showed Bilateral meconium

infiltration. ECHO done which showed moderate size ASD with Mild Valvular PS.

Baby was managed with Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj.

Vitamin K & Ionotrophic support. As baby had raised Respiratory distress,

connected to mechnical ventilator support on 29.10.09. with these above measures,

baby’s respiratory distress reduced, weaned from the ventilator on 02.11.09 &

started on small tube feeds. As baby had desaturation on 05.11.09, again connected

to mechanical ventilator support. Baby had difficulty in weaning from the

ventilator, Repeat chest x-ray done - which suggestive of Bronchopulmonary

dysplasia. Baby was started on diuretics & steroids. With these above

management, baby’s respiration improved so weaned form the ventilator on

11.11.09 & ryles tube was gradually raised. Baby was slowly weaned from the

oxygen. Now baby’s activity improved, respiration became normal & taking oral

feeds. Baby is discharged today with the advice to conitnue further follow-up with

the referral doctor.

INVESTIGATION :

BLOOD BANK


O POSITIVE 29-10-2009 / 09:51



RBC

4.5 29-10-2009 / 15:07



DIFFERENTIAL COUNT

Polymorphs 89 40 - 70 % 29-10-2009 / 15:07

Lymphocytes 07 25 - 50 % 29-10-2009 / 15:07

Monocytes 03 01 - 06 % 29-10-2009 / 15:07

Eosinophils 01 01 - 10 % 29-10-2009 / 15:07

Basophils 00 00 - 01 % 29-10-2009 / 15:07



MCV 110 76 to 96 Fl 29-10-2009 / 15:07

MCH 36 27 to 32 pg/cell 29-10-2009 / 15:07

MCHC 33 32 to 36 % 29-10-2009 / 15:07

RDW 18.3 20 to 42 % 29-10-2009 / 15:07

MPV 7.7 6 to 10.2 Fl 29-10-2009 / 15:07

BIO CHEMISTRY


PATHOLOGY


.


No nucleated RBCs or hemoparasites.

WBC count shows leukocytosis.


29-10-2009 / 15:07


Eosinophils :01%

Monocytes :03%

Lymphocytes :08%

29-10-2009 / 15:07


IMPRESSION : -- 29-10-2009 / 15:07

ADVICE ON DISCHARGE

Tab. Aldarline 25mg 1/5 th OD x 2 weeks

Syp. Deriphylline 8 drops TID x 2weeks

C-Pink drops 4 drops OD x 2 weeks

REVIEW AFTER 2 WEEKS

DR. A. KANNAN., MD., DCH., SR. CONSULTANT

Name : B/o. Tamilarasi Age/Sex : NB/ M Dept : NeonatologyHos.No: 438175 Mrd.No : 328083 Ward: IL.NB. NICUD.O.A : 24.11.09 D.O.D : 01.12.09 ************************************************************************

DIAGNOSIS: BIRTH ASPHYXIA ( CORD AROUND THE NECK) MECONIUM ASPIRATION ACUTE RENAL FAILURE

COURSE:

This term / AGA / male baby was born at MMHRC by normal vaginal

delivery on 24.11.09 at 3.45am. H/o. Baby did not cried immedietly after birth.

H/o. Baby had weak cry after suctioning and tactle stimulation. H/o. Cord around

the neck +. H/o. Meconium stained liquor +. H/o. Baby had respiratory distress &

cyanosis after birth for that admitted at NICU for further management. M H/o.

Hypothyroidism +, on Tab. Eltroxin 100mg OD. No M h/o. PIH, GDM, PROM &

Maternal fever. O/E. Baby’s activity & cry – weak. Peripheral cyanosis +, CFT <

sec, dyspnoeic +, tachypnoeic +, no birth injury & no obvious external abamoly,

CVS : S1, S2 heard, RS : RR @ 70/mt, Inter costal & Sub constal retractions +,

P/A : Soft, CNS : NNR sluggish. Baby was investigated peripheral smear, Blood

sugar and serum creatinine (26.11.09) were normal. TSH : 1.29uu/ml. CRP :

Positive (24.11.09). Et tip culture showed no growth. Blood culture report awaited.

Baby was managed with mechanical ventilator support, Iv fluids, Iv antibiotics, Inj.

Calcium gluconate, Inj. Vitamin K & Ionotrophic support. On 30.11.09. baby had

convulsion, Inj. Gardenol was added. With these above measures, baby’s

respiratory ditress reduced weaned from the ventilator on 25.11.09 & was

extubated on 27.11.09. baby had again developed respiratory distress with

desaturation, intubated and connected to mechnical ventilator support on 30.11.09.

As baby had decreased urine output, serum creatinine checked which was 1.9mg/dl

so managed with Lasix infusion & fluid was restricted. Baby had GI bleed,

platelet count was only : 20,000 on 30.11.09, PRP transfusion was given. As

baby’s ABG showed acidosis (Hco3 – 13), corrected with Inj. NaHco3. Now baby

is in mechanical ventilator support, with Fio2 : 100%, maintaining Spo2 : 98%.

Since parents were not willing for further management, baby is discharged

AGAINST MEDICAL ADVICE on 01.12.09 @ 1pm.

INVESTIGATION :



BLOOD BANK


B POSITIVE 24-11-2009 / 13:44



RBC

4.2 24-11-2009 / 18:36



DIFFERENTIAL COUNT

Polymorphs 75 40 - 70 % 24-11-2009 / 18:36

Lymphocytes 18 25 - 50 % 24-11-2009 / 18:36

Monocytes 05 01 - 06 % 24-11-2009 / 18:36

Eosinophils 02 01 - 10 % 24-11-2009 / 18:36

Basophils 00 00 - 01 % 24-11-2009 / 18:36



MCV 108 76 to 96 Fl 24-11-2009 / 18:36

MCH 37 27 to 32 pg/cell 24-11-2009 / 18:36

MCHC 34 32 to 36 % 24-11-2009 / 18:36

RDW 18.4 20 to 42 % 24-11-2009 / 18:36

MPV 6.8 6 to 10.2 Fl 24-11-2009 / 18:36

BIO CHEMISTRY



TSH (CLIA) 1.29 0.34 to 5.6 µU/mL 24-11-2009 / 13:13

MICROBIOLOGY



C- Reactive Protein POSITIVE 48 MICROGRAM / ML 30-11-2009 / 22:19

PATHOLOGY


.

RBCs show normochromic normocytes.


WBC count shows mild neutrophilic leukocytosis.


24-11-2009 / 18:36


Eosinophils :02%

Monocytes :05%

Lymphocytes :18%

24-11-2009 / 18:36


IMPRESSION : -- 24-11-2009 / 18:36

Name : B/o. Annalakshmi Age/Sex : NB/ M Dept : NeonatologyHos.No: 437982 Mrd.No : 327931 Ward: IL.NB. NICUD.O.A : 22.11.09 D.O.D : 03.12.09 ************************************************************************

REF. BY : DR. ARIVALAHAN., PLACE : KARAIKUDI

DIAGNOSIS: MECONIUM ASPIRATION NEONATAL SEPSIS THROMBOCYTOPENIA

COURSE:

This term / AGA / male baby was born at private hospital by LSCS (Ind :

Mother had polioattak over legs) on 22.11.09. H/o. Meconium stained liquor +.

Ho. Baby cried soon after birth. H/o. Baby had respiratory distress & cyanosis.

since birth baby was referred to MMHRC on 22.11.09 as a case of ? cyanosis heart

disease for further management. No H/o. Cord around the neck. No MH/o. PIH,

GDM & Fever. O/E. Baby’s activity – sliuggish, cry : weak, peripheral cyanosis +,

CFT > 3 sec, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external

anomaly. CVS: S1 & S2 +, RS: RR @ 72 / mt, SCR +, ICR +, Bilateral air entry

equal, P/A : soft, CNS : Irritable, NNR sluggish. Baby was investigated peripheral

smear & Blood sugar were normal. Serum creatinine : 1.2mg/dl, (22.11.09),

0.7mg/dl (27.11.09). blood culture showed klebsiella growth. ECHO showed small

mailto:RR@72/mt

PFO, otherwise normal study. Baby was managed with Mechanical ventilator

support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K &

Ionotrophic support. With these above measures baby’s respiratory distress

reduced with the ventilator support. Ryles tube feeds started. Baby developed

icterus with petechial spots over the abdomen, serum bilirubin checked T :

20.1mg/dl, & D : 6.4mg/dl. At that time platelet count was only 20,000. Baby was

managed with FFP & PRP transfusion. As baby had abdominal distension, RTF

was gradually raised. Repeat blood culture sent, report awited. On 02.12.09, baby

had decreased urine output, fluid restricted & Inj. Lasix infusion was started. On

02.12.09 baby was pale, HB checked, it was – 6.7gms%, managed with whole

fresh blood transfusion. Now baby is in mechanical ventilator support with Fio2 :

35%, maintaining oxygen saturation of 98-100% & tolerating tube feeds. Since

parents were not willing for further management, baby is discharged AGAINST

MEDICAL ADVICE on 03.12.09 @ 5pm.

INVESTIGATION :













BLOOD BANK


A POSITIVE 23-11-2009 / 09:58



RBC

4.12 23-11-2009 / 17:16



DIFFERENTIAL COUNT

Polymorphs 70 40 - 70 % 23-11-2009 / 17:16

Lymphocytes 19 25 - 50 % 23-11-2009 / 17:16

Monocytes 10 01 - 06 % 23-11-2009 / 17:16

Eosinophils 01 01 - 10 % 23-11-2009 / 17:16

Basophils 00 00 - 01 % 23-11-2009 / 17:16



MCV 99 76 to 96 Fl 23-11-2009 / 17:16

MCH 34 27 to 32 pg/cell 23-11-2009 / 17:16

MCHC 34 32 to 36 % 23-11-2009 / 17:16

RDW 16.1 20 to 42 % 23-11-2009 / 17:16

MPV 6.7 6 to 10.2 Fl 23-11-2009 / 17:16

BIO CHEMISTRY




BILIRUBIN - TOTAL & DIRECT

BILIRUBIN - TOTAL (Diazo) 20.1 0.5 to 1.1 mg/dL 30-11-2009 / 18:32

BILIRUBIN - DIRECT (Diazo) 6.4 0.2 to 0.5 mg/dL 30-11-2009 / 18:32

MICROBIOLOGY



PATHOLOGY


.

RBCs show normochromic normocytes.




23-11-2009 / 17:16


Eosinophils :01%

Monocytes :05%

Lymphocytes :24%

23-11-2009 / 17:16



ECHO SHOWED ON 24.11.09 : SITUS SOLITUS, LEVOCARDIA, PFO +,

GOOD LV FUNCTION, NO PDA / COARCTATION, NO PULMONARY

HYPERTENSION. IMPRESSION : PFO +, OTHERWISE NORMAL

STUDY.

Name : B/o. Dhanalakshmi Age/Sex : NB/ F Dept : NeonatologyHos.No: 439857 Mrd.No : 329084 Ward: IL.NB. NICUD.O.A : 05.12.09 D.O.D : 11.12.09 ************************************************************************

DIAGNOSIS: BIRTH ASPHYXIA MECONIUM ASPIRATION SYNDROME

NEONATAL SEIZURE ACUTE RENAL FAILURE

COURSE:

This term / AGA / female baby was born at Private hospital by normal

vaginal delivery on 05.12.09. H/o. Birth asphyxia +, H/o. Baby developed

respiratory distress since birth. H/o. Meconium stained liquor +. Baby was referred

to MMHRC on 05.12.09 for further management, MH/o. Fever – 5 days before

delivery +. No MH/o. PIH & GDM. O/E Baby’s activity’s & cry – weak, CFT >

3sec, peripheral cyanosis +, dyspnoeic +, tachypnoeic +, no birth injury, no

obvious external anamoly. CVS: S1 & S2 heard, RS: RR @62/mt, Bilateral

crepitations +, SCR +. P/A: soft, CNS: NNR sluggish. Baby was investigated

peripheral smear showed HB : 17.4gms%, TC : 34,800cells & Platelet count : 2.3

lakhs. CRP : Positive. Serum creatinine : 1mg/dl, Blood culture showed no growth

(06.12.09). Repeat blood sugar sent, report awaited. Baby was managed with C-

PAP, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Dopamine

infusion. As baby had persisitent cyanosis. ECHO done shich showed IAS

Aneurysm, Small os ASD with L-> R shunt, No PAH. Baby had distress,

connected to ventilator support on 07.12.09. As baby had decreased urine output,

Repeat serum creatinine on 10.12.09, showed 1.7mg/dl, managed with Inj. Lasix

infusion. As baby had hypotension with low perfusion, Inj. Nor adrenaline infusion

was started on 10.11.09. Even with these above measures baby developed

bradycarida, followed by cardiac arrest. 3 deses of Inj. Atropine and Inj.

Adrenaline were given. CPR was carried out. But could not be revived &

DECLARED DEAD on 11.12.09 @ 10.25am.

INVESTIGATION :

BLOOD BANK


A NEGATIVE 06-12-2009 / 13:22



RBC

4.7 Cells/cumm 07-12-2009 / 16:54



DIFFERENTIAL COUNT

Polymorphs 85 40 - 70 % 07-12-2009 / 16:54

Lymphocytes 11 25 - 50 % 07-12-2009 / 16:54

Monocytes 03 01 - 06 % 07-12-2009 / 16:54

Eosinophils 01 01 - 10 % 07-12-2009 / 16:54

Basophils 00 00 - 01 % 07-12-2009 / 16:54



MCV 106 76 to 96 Fl 07-12-2009 / 16:54

MCH 34 27 to 32 pg/cell 07-12-2009 / 16:54

MCHC 18.3 32 to 36 % 07-12-2009 / 16:54

RDW 7.4 20 to 42 % 07-12-2009 / 16:54

MPV 7.4 6 to 10.2 Fl 07-12-2009 / 16:54

BIO CHEMISTRY



MICROBIOLOGY


C- Reactive Protein POSITIVE 48microgram/ml 06-12-2009 / 01:48

PATHOLOGY


.

RBCs show normochromic normocytes and

macrocytes.


WBC count shows neutrophilic leukocytosis with

07-12-2009 / 16:54

shift to left.

No atypical cells.

DIFFERENTIAL COUNT : Myelocytes : 02%

Stab : 04%

NeutroPhils :78%

Eosinophils :01%

Monocytes :05%

Lymphocytes :10%

07-12-2009 / 16:54

Platelets Count normal in Number and

morphology

07-12-2009 / 16:54

IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS WITH

SHIFT TO LEFT.

07-12-2009 / 16:54

Name : B/o. Malar vizhi Age/Sex : NB/ M Dept : NeonatologyHos.No: 441935 Mrd.No : 330591 Ward: IL.NB. NICUD.O.A : 23.12.09 D.O.D : 26.12.09 ************************************************************************

REF. BY : DR. GAYATHREE., PLACE : THENI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME

COURSE:

This 1 day male baby referred to MMHRC on 23.12.09 with respiratory

distress. Baby delivered by outlet forceps. H/o. Thick meconium stained liquor +

H/o. Baby cried soon after birth but soon developed grunting and respiratory

distress. Maternal History : H/o. Severe vaginal candidiasis - 1 week before

delivery. No Maternal H/o. GDM, PIH, PROM, Fever with rash. O/E. Baby’s cry

& activity – moderate, CFT < 3 sec, no pallor, not icteric, no cyanosis, no

clubbing, no edema, no generalized lymphadenopathy. RS : tachypnoeia + (RR :

66/min) mild LCI +, CVS : S1 S2 +, no murmur, P/A : soft, CNS : Intact. Baby

was investigated : Hb : 20%, TC : 16,400, Platelet count : 2.5lakhs, CRP : Positive,

serum creatinine : 0.7, Blood culture report awaited. Baby was managed with Iv

fluids, Iv antibiotics, Inj. Taxim, Inj. Amikacin and Inj. Fluconazole. With these

above measures baby activity and cry good, respiratory distress decreased hence

discharged today with advice to continue the further follow-up with the referral

doctor.

INVESTIGATION

BLOOD BANK


B POSITIVE 23-12-2009 / 10:07



RBC

5.72 23-12-2009 / 17:39



DIFFERENTIAL COUNT

Polymorphs 80 40 - 70 % 23-12-2009 / 17:39

Lymphocytes 10 25 - 50 % 23-12-2009 / 17:39

Monocytes 08 01 - 06 % 23-12-2009 / 17:39

Eosinophils 02 01 - 10 % 23-12-2009 / 17:39

Basophils 00 00 - 01 % 23-12-2009 / 17:39



MCV 109 76 to 96 Fl 23-12-2009 / 17:39

MCH 35 27 to 32 pg/cell 23-12-2009 / 17:39

MCHC 32 32 to 36 % 23-12-2009 / 17:39

RDW 17.5 20 to 42 % 23-12-2009 / 17:39

MPV 8.1 6 to 10.2 Fl 23-12-2009 / 17:39

BIO CHEMISTRY


MICROBIOLOGY



PATHOLOGY


.





23-12-2009 / 17:39


Eosinophils :02%

23-12-2009 / 17:39

Monocytes :05%

Lymphocytes :13%


IMPRESSION : -- 23-12-2009 / 17:39

ADVICE ON DISCHARGE

Inj. Taxim 150mg IV BD x 6 days

Inj. Amikacin 40mg IV OD x 6 days

Inj. Fluconazole 18mg IV OD x 14 days

Name : B/o. Ayisha Banu Age/Sex : NB/ F Dept : NeonatologyHos.No: 442898 Mrd.No : 331137 Ward: IL.NB. NICUD.O.A : 29.12.09 D.O.D : 31.12.09 ************************************************************************

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISITENT PULMONARY HYPERTENSION (PPHN)

COURSE:

This Term / AGA female baby referred to MMHRC on 31.12.09 as a

case of respiratory distress, who delivered on 29.12.09 at 8.20am by normal

vaginal delivery. H/o. Meconium stained liquor +. No H/o. Cord around the neck

and baby cried immediately after birth but developed respiratory distress and

cyanosis about 2 hours after birth. No H/o. Vomiting, convulsion. O/E : Cry and

activity – moderate, CRT > 3 sec, cyanosis +, no pallor, no icterus,

lymphadenopathy, pedal edema. RS : 78/mnt, ICR +, SCR +, tachypnoeic, CVS :

S1, S2 +, P/A : Soft, CNS : intact. Baby was investigated HB : 19.5, TC : 18,200,

Platelet count : 1.2 lakhs, CRP : Negative. Repeat CRP done on 31.12.09 :

Positive, TC : 15,600 (31.12.09), serum creaitinine : 1.0. Chest x-ray showed MAS

– Meconium infiltrates. Baby was managed with Mechanical ventilator support,

Ionotropes, Iv. Antibiotics, Inj. Taxim, Inj. Ampicillin, Inj. Calcium gluconate, Inj.

Vitamin K and Tab. Sildenotil. Blood culture and sent report awaited. Even with

above measures baby’s general condition continuously deteriorated, baby went into

brady cardia & cardiac arrest on 31.12.09 at 2.10pm. baby was started on all

cardiac resuscitation, measures but could not be revived, so baby was

DECLARED DEAD on 31.12.09 at 2.30am.

INVESTIGATION HAEMATOLOGY & CLINICAL PATHOLOGY


BLOOD BANK


A POSITIVE 30-12-2009 / 10:27



RBC

5.06 30-12-2009 / 17:37



DIFFERENTIAL COUNT

Polymorphs 83 40 - 70 % 30-12-2009 / 17:37

Lymphocytes 10 25 - 50 % 30-12-2009 / 17:37

Monocytes 06 01 - 06 % 30-12-2009 / 17:37

Eosinophils 01 01 - 10 % 30-12-2009 / 17:37

Basophils 00 00 - 01 % 30-12-2009 / 17:37



MCV 113 76 to 96 Fl 30-12-2009 / 17:37

MCH 38 27 to 32 pg/cell 30-12-2009 / 17:37

MCHC 33 32 to 36 % 30-12-2009 / 17:37

RDW 21.5 20 to 42 % 30-12-2009 / 17:37

MPV 8.0 6 to 10.2 Fl 30-12-2009 / 17:37

BIO CHEMISTRY


MICROBIOLOGY



C- Reactive Protein POSITIVE 12 MG / L 31-12-2009 / 13:14

PATHOLOGY


.



WBC count normal.


30-12-2009 / 17:37


Eosinophils :01%

Monocytes :05%

Lymphocytes :11%

30-12-2009 / 17:37


IMPRESSION : -- 30-12-2009 / 17:37

JAN 10Name : B/o. Kavitha Age/Sex : NB/ M Dept : NeonatologyHos.No: 442241 Mrd.No : 330772 Ward: IL.NB. NICUD.O.A : 25.12.09 D.O.D : 13.01.10 ************************************************************************

REF. BY : DR. ILAYARAJA., PLACE : ARANTHANGIE

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME NEONATAL SEIZURE

COURSE:

This term / AGA / male baby born at private hospital by normal vaginal

delivery on 25.12.09 at 3.05am with H/o. baby not cried immediately after birth,

and severe respiratory distress, and irritable cry since birth after resuscitation. No

convulsion. Maternal History of Thick meconium stained liquor. No maternal H/o.

PIH, GDM, Fever with rashes, recurrent UTI, PROM & Cord around the neck.

O/E. Baby’s activity & cry : weak, colour : cyanosis, CFT > 3sec, severe

respiratory distress +, no pallor, not icteric, no clubbing, no generalized edema, no

obvious external congenital anamolies and no birth injury. Spo2 : 60% with

oxygen therapy, CVS : S1 S2 Heard. No murmur, Rs : Bilateral air entry equal,

crepts +, P/A : Soft, no organomegaly, CNS : NNR sluggish. hence baby was

intubated and was shifted to NICU for mechanical ventilator support. Baby was

investigated HB: 17.8gms%, TC : 24,500, Platelet count : 2.6 lakhs, CRP :

Negative. Blood sugar & serum creatinine were normal. Serum potassium : 4.5,

Blood culture – no growth, ET Tip Culture sent on (25.12.09) : no growth. Chest x-

ray suggestive of meconium aspiration syndrome. Baby was managed with

Mechanical ventilator support, Ionodropes, Iv fluids, Iv antibiotics, ionodropes, Inj.

Rantac, Inj. Gardenol, Inj. Calcium gluconate, Domstal drops, Mucolite drops and

chest physiotherapy. With these above measures baby respiration became normal

and was weaned from ventilator on 09.01.09 and started on small tube feeds. Baby

tolerate feed well. Baby is on direct breast feeds, hence discharged today with

advice to continue the follow-up with the referral doctor.

INVESTIGATION HAEMATOLOGY & CLINICAL PATHOLOGY

TOTAL WBC COUNT (Coulter Principle) 21100 6000 to 18000 Cells/cumm 05-01-2010 / 13:34

BLOOD BANK


O POSITIVE 25-12-2009 / 14:38



RBC (Coulter Principle)

4.94 25-12-2009 / 14:10

HAEMOGLOBIN (Photometric Measurement) 17.8 13.6 to 19.6 g/dL 25-12-2009 / 14:10


DIFFERENTIAL COUNT (VCS Technology)

Polymorphs 80 40 - 70 % 25-12-2009 / 14:10

Lymphocytes 15 25 - 50 % 25-12-2009 / 14:10

Monocytes 04 01 - 06 % 25-12-2009 / 14:10

Eosinophils 01 01 - 10 % 25-12-2009 / 14:10

Basophils 00 00 - 01 % 25-12-2009 / 14:10

PLATELET COUNT (Plt Histogram) 261000 150000 to 450000 Cells/cumm 25-12-2009 / 14:10

PCV (Hct) (Calculated) 53 44 to 62 % 25-12-2009 / 14:10

MCV (RBC Histogram) 107 76 to 96 Fl 25-12-2009 / 14:10

MCH (Calculated) 36 27 to 32 pg/cell 25-12-2009 / 14:10

MCHC (Calculated) 33 32 to 36 % 25-12-2009 / 14:10

RDW (RBC Histogram) 17.7 20 to 42 % 25-12-2009 / 14:10

MPV (Plt Histogram) 7.4 6 to 10.2 Fl 25-12-2009 / 14:10

BIO CHEMISTRY

Plasma CREATININE (Jaffe Kinetic) 0.8 0.4 to 1.4 mg/dL 27-12-2009 / 07:28

POTASSIUM (ISE) 4.5 3.5 to 5 mEq/L 25-12-2009 / 13:14

MICROBIOLOGY



ADVICE ON DISCHARGE

Tab. Gardenol 20mg HS x Till further advice


Mucolite drops 5 drops TID x 2 weeks

Name : B/o. Ponnulakshmi Age/Sex : NB/ M Dept : NeonatologyHos.No: 443456 Mrd.No : 331480 Ward: IL.NB. NICUD.O.A : 03.01.10 D.O.D : 12.01.10 ************************************************************************REF.BY.DR.SUNITHA., PLACE : MADURAI

DIAGNOSIS: PRETERM (30-32 WEEKS) WITH RDS (SURFACTANT GIVEN) NEONATAL ENCEPHALOPATHY WITH SEIZURE

Name : B/o. Deepa Age/Sex : NB/ M Dept : NeonatologyHos.No: 444326 Mrd.No : 332105 Ward: IL.NB. NICUD.O.A : 11.11.10 D.O.D : 11.01.10 ************************************************************************

REF. BY : DR. SUNITHA., PLACE : MADURAI

DIAGNOSIS: MECONIUM ASPIRATION CONGENITAL HEART DISEASE – SMALL ASD, SMALL PDA, PPHN ACUTE RENAL FAILURE

COURSE:

This postdated /AGA/ baby referred to MMHRC as a case of meconium

aspiration syndrome, baby delivered by LSCS (Indication : post dated preganacy)

on 10.01.10 at 10.35pm. H/o. baby resuscitated at birth. No H/o. convulsions, No

Maternal H/o. PIH, GDM, Hypothyroid, fever with rash. O/E. Baby’s activity &

cry : weak, no obvious external congenital anamolies, CVS : S1 S2 +, RS : Nasal

flaring +, SCR +, ICR +, Bilateral air entry +, bilateral crepts +, P/A : Soft, CNS :

NNR sluggish. Baby was intubated and connected to mechanical ventilator. Baby

was investigated HB : 17.8, Tc : 21,600, platelets : 1.3 lakhs, CRP : Negative.

Blood sugar : 68mg/dl, serum creatinine : 1.3 lakhs (11.01.10), serum creatinine :

1.2. blood urea : 39 (14.01.10), TC : 11,800 (15.01.10). serum creatinine : 2.8

(16.01.10). Blood culture and ET aspiration culture showed no growth. ECHO

showed CHD, Small ASD, Mild PAH, Small PDA. Baby’s Pco2 ventilator

settings changed accordingly. Baby had hypotension and was managed with

Inotropes. Depite treatment baby had persistent hypoglycemia. Blood sugar

monitored 6th hourly and correction given. Baby was planned for dialysis as baby’s

attenders not willing to continue treatment baby is discharge AT REQUEST on

10.01.10.

Name : B/o. Patchaiammal Age/Sex : NB/ F Dept : NeonatologyHos.No: 445995 Mrd.No : 333193 Ward: IL.NB. NICUD.O.A : 24.01.10 D.O.D : 25.01.10 ************************************************************************

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME BIRTH ASPHYXIA

COURSE:

This term / AGA / female baby was born at MMHRC by normal vaginal

delivery on 24.01.10. H/o. Thick meconium stained liquor + ( foul smelling). H/o.

Baby did not cry immedietly after birth. Baby cried after tactle stimulation &

suctioning. H/o. Baby developed respiratory distress since birth for that admitted at

NICU for further management. H/o. Peripheral cyanosis +. MH/o. Eclampsia + -

on MgSo4 therapy. Unhealthy placenta +. No MH/o. GDM. O/E. After

resuscitation, baby’s activity & cry : weak, peripheral cyanosis +, CFT > 3sec,

dyspnoeic +, tachypnoeic +, grunting +, not anaemic, not icteric, no birth injury,

no obvious external anomaly. CVS: S1 & S2 heard, RS: RR @ 68 / mt, Lower

chest indrawing +, SCR +, P/A : soft, CNS : NNR sluggish. Baby was investigated

peripheral smear showed HB : 17.1gms%, TC : 10,300cells & platelet count 2.2

lakhs. CRP : Positive. Blood culture sent, report awaited. Chest x-ray suggestive of

Bilateral meconium infiltration. Baby was managed with mechanical ventilator

support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K &

mailto:RR@72/mt

Ionotrophic support. ABG’s done which showed (Pco2 – 50, Po2 : 35 with

Hyperkalemia), ventilator settings were adjusted & corrected with calcium

gluconate & asthalin nebulization. serum K+ : 3.9 (25.01.10). Now baby is in

mechanical ventilator support with Fio2 : 100%, with maintaining oxygen

saturation (Spo2 : 99%). Since parents were not willing for further management,

baby is discharged AGAINST MEDICAL ADVICE on 25.01.10 at 8pm.

INVESTIGATION

BLOOD BANK


O POSITIVE 25-01-2010 / 09:55




4.4 25-01-2010 / 11:42




Polymorphs 63 40 - 70 % 25-01-2010 / 11:42

Lymphocytes 33 25 - 50 % 25-01-2010 / 11:42

Monocytes 03 01 - 06 % 25-01-2010 / 11:42

Eosinophils 01 01 - 10 % 25-01-2010 / 11:42

Basophils 00 00 - 01 % 25-01-2010 / 11:42








BIO CHEMISTRY


MICROBIOLOGY


C- Reactive Protein POSITIVE 24 MICROGRAM /ML 24-01-2010 / 22:30

PATHOLOGY


.

RBCs show macrocytic normochromic.

Nucleated RBCs+

Hemoparasites Nil.

WBC count shows neutrophilic shift to left +.


25-01-2010 / 11:42

DIFFERENTIAL COUNT : NeutroPhils :63% 25-01-2010 / 11:42

Eosinophils :01%

Monocytes :03%

Lymphocytes :33%

Platelets Count Adequate 25-01-2010 / 11:42

IMPRESSION : --- 25-01-2010 / 11:42

FEB 10Name : B/o. MuthuMari Age/Sex : NB/ F Dept : NeonatologyHos.No: 448623 Mrd.No : 334770 Ward: IL.NB. NICUD.O.A : 13.02.10 D.O.D : 17.02.10 ************************************************************************REF.BY.DR.PRABAKAR NAVAMANI., PLACE : MADURAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH PERSISTENT PULMONARY HYPERTENSION ? SEPTICEMIA

COURSE: This term / AGA / female baby born at private hospital on 13.02.10 at 6.15am by normal vaginal delivery with H/o. Cried immediately after birth and developed respiratory distress after 2 hours and was sent to the referral doctor hospital. Since baby had increased respiratory distress, was referred to MMHRC for further management. No H/o. Cord around the neck and convulsion. Maternal H/o: Mother had fever at 32 weeks of gestation. H/o. Meconiums stained liquor +. No H/o. UTI, PIH, GDM, Bronchial Asthma and hypothyroidism. O/E : Baby’s activity and cry : weak, CFT > 3sec, Respiratory distress +, Tachypnoea +, Nasal flaring +, no pallor, no birth injury, no cyanosis, no clubbing, no obvious external anomaly. CVS : S1 S2 heard, RS : Bilateral air entry +, dysnoea +, sub costal retraction +, P/A : Soft, CNS : NNR sluggish. Since baby had a weak cry / activity with increased respiratory distress. Baby was investigated HB : 19gms%, Tc : 37,300, Platelet count : 2.2 lakhs, CRP : Negative. Micro ESR : 1mm, Blood sugar was normal, serum creaitnine : 1.1 (15.02.10) 1 (16.02.10). serum potassium : 5.2 (15.02.10), 4.4 (17.02.10). Blood culture showed no growth. ET aspiration culture showed Klebseila growth. According to the culture and sensitivity Iv. Antibiotics changed. Planned for ECHO but baby’s parents were not willing. Baby was managed with mechanical ventilator support, Iv. Flduis, Iv. Antibitoics, Inj. Dopamine infusion, Inj. Gardenol started since baby had convulsion after admission, Inj. Rantac and Syp. Osteocalcium & Inj. Vitamin K. Since baby had tachypnoea planned for ECHO but baby’s parents were not willing for further management and baby was discharged today AGAINST MEDICAL ADVICE on 17.02.10.

INVESTIGATION BLOOD BANK


A POSITIVE 14-02-2010 / 15:41




5.34 15-02-2010 / 13:18






MCH (Calculated) 35.5 27 to 32 pg/cell 15-02-2010 / 13:18




BIO CHEMISTRY





MICROBIOLOGY



PATHOLOGY


.



WBC count neutrophilic leukocytosis with

shift to left.


15-02-2010 / 13:18


Eosinophils :01%

Monocytes :05%

Lymphocytes :26%

15-02-2010 / 13:18

Platelets count Adequate. 15-02-2010 / 13:18

IMPRESSION : -- 15-02-2010 / 13:18

INVESTIGATION




Polymorphs 65 40 - 70 % 15-01-2010 / 13:50

Lymphocytes 20 25 - 50 % 15-01-2010 / 13:50

Monocytes 14 01 - 06 % 15-01-2010 / 13:50

Eosinophils 01 01 - 10 % 15-01-2010 / 13:50

Basophils 00 00 - 01 % 15-01-2010 / 13:50



4.8 11-01-2010 / 21:26




Polymorphs 67 40 - 70 % 11-01-2010 / 21:26

Lymphocytes 22 25 - 50 % 11-01-2010 / 21:26

Monocytes 10 01 - 06 % 11-01-2010 / 21:26

Eosinophils 01 01 - 10 % 11-01-2010 / 21:26

Basophils 00 00 - 01 % 11-01-2010 / 21:26








BLOOD UREA (Urease GLDH ) 39 15 to 40 mg/dL 14-01-2010 / 09:20





MICROBIOLOGY







11-01-2010 / 21:26


Eosinophils :01%

Monocytes :05%

Lymphocytes :27%

11-01-2010 / 21:26



TREATMENT GIVEN :

Weight : 2.675kg

Mechanical ventilator (IMV + HEV + IRV )

Iv. Fluids

Inj. Dopamine 48mg in 50ml IVF - 2/min

Inj. Lasix

Inj. Taxim 130mg IV BD

Inj. Ampicillin 130mg IV BD

RTF 5ml Q12 hourly

Name : B/o. Sabeela Banu Age/Sex : NB/ M Dept : NeonatologyHos.No: 446597 Mrd.No : 333598 Ward: IL.NB. NICUD.O.A : 29.01.2010 D.O.D : 19.02.2010 ******************************************************************************REF.BY.DR.PUSHPALATHA GOKULNATH., PLACE : MADURAI

DIAGNOSIS: PRETERM (30 WEEKS) / SURFACTANT GIVEN ON 29.01.10/ CHD : OS ASD, L-> R SHUNT 2:1, MILD TR, MILD PAH NEONATAL SEIZURE

M AR 10Name : B/o. Shanthi Age/Sex : NB/ M Dept : NeonatologyHos.No: 452750 Mrd.No : 337266 Ward: IL.NB. NICUD.O.A : 15.03.10 D.O.D : 16.03.10 ************************************************************************REF.BY.DR. JAYA LAKSHMI., PLACE : THIRUMANGALAM

DIAGNOSIS: PERINATAL ASPHYXIA WITH MECONIUM ASPIRATION SYNDROME

COURSE:

This Term male baby was referred to MMHRC on 15.03.10 with H/o. severe

respiratory distress since birth. Maternal History : 22 years, Primi, No H/o. PIH,

GDM, hypothyroidism UTI. H/o. Fever 2 days before delivery lasted for 1 day

took Iv. Antibiotics. Delivered by LSCS (Ind: Poor progression of labour) No H/o.

PROM, Cord around the neck. H/o. Thick Meconium stained liquor +. Baby did

not cry after birth and developed severe respiratory distress soon after birth and

referred here for further management. O/E: Baby cry and activity – weak, severe

respiratory distress +, cyanosis of both palms & soles +, CFT > 3sec, HR : 130/m,

RR : 70/m, Temp : 98.6oF, no pallor, not icteric, no external anomalies seen, CVS :

S1 S2 heard, systolic murmur in pulm area +, RS : Tachypnea +, dyspnea +, ICR,

SCR, supra sternal retractions +, P/A : soft, hepatomegaly +, BS +, CNS : AF :

Normal, NNR : Sluggish. baby was intubated and connected to mechanical

ventilator and investigated HB : 14.9gm%, TC : 31,000cells/mm, Platelet count :

1.4 lakhs, CRP : Negative, Blood culture sent, ABG showed severe metabolic

acidosis, Hco3 correction given, ventilator settings changed accordingly baby was

managed with IV. Fluids, Iv. Antibiotics, Inj. Dopamine infusion, Inj. Vitamin K,

Inj. Gardenol. As baby continued to have hypotension, Inj. Noradrenaline started.

ECHO done showed normal study. Repeat ABG taken also showed severe

metabolic acidosis for which correction given Inspite of above measures baby

continued to have cyanosis. Prognosis of the condition was well explained to the

parents. Since they are not willing for further management, baby was discharged

AGAINST MEDICAL ADVICE on 16.03.10.

INVESTIGATION

BLOOD BANK


B POSITIVE 16-03-2010 / 10:16




4.53 16-03-2010 / 13:21










MICROBIOLOGY



PATHOLOGY


.

RBCs show macrocytic normochromic .

Nucleated RBCs+

Hemoparasites Nil.


shift to left


16-03-2010 / 13:21


Eosinophils :04%

Monocytes :05%

Lymphocytes :24%

16-03-2010 / 13:21


IMPRESSION : -- 16-03-2010 / 13:21

Name : B/o. Devi Age/Sex : NB/ M Dept : NeonatologyHos.No: 453050 Mrd.No : 337403 Ward: IL.NB. NICUD.O.A : 17.03.10 D.O.D : 20.03.10 ************************************************************************REF.BY.DR.MUTHU PANDIAN., PLACE : MANAMADURAI

DIAGNOSIS: PERINATAL ASPHYXIA WITH MECONIUM ASPIRATION SYNDROME WITH SEVERE PULMONARY HYPERTENSION

COURSE:

This Term new born male baby delivered by LSCS (Ind : Fetal distress) on

17.03.10 at 2.45pm referred to MMHRC with H/o. baby did not cry soon after

birth and developed severe respiratory distress since birth. Maternal history : Primi,

23 years. No H/o. PIH, GDM, recurrent UTI, fever with rash, bleeding PV. H/o.

Thick Meconium staining of liquor +. O/E : Baby cry & activity – weak, colour :

peripherial cyanosis +, CFT < 3sec, severe respiratory distress +, (Nasal flaring,

sub costal & intercostal indrawing +), no external congenital anomalies seen. HR :

148/m, RR : 68/m, Temp : 98.6oF, Spo2 : 75% with 5 liters of Oxygen, RS :

Bilateral crepts +, CVS : S1 S2 +, no murmurs +, P/A : Soft, CNS : NNR sluggish.

Baby was intubated and connected to mechanical ventilator support and

investigated HB : 17gms%, TC : 23,000cells, Platelet count : 2.6 lakhs, CRP :

negative, serum creatinine : 0.9mg%. ECHO showed severe TR with severe PAH.

Baby was started on Iv. Fluids, Iv. Antibiotics, Iv. Inotropes, Inj. Calcium

gluconate, Pulmonary vasodilators. ABG showed severe respiratory acidosis and

hypercarbia, hence treated with high frequency ventilation. Since baby had fresh

bleeding from ET Tube FFP transfusion given. But baby continued to have

desaturation. Condition of the baby was well explained to the parents. As they are

not willing for further management, discharged AGAINST MEDICAL ADVICE

on 20.03.10.

INVESTIGATION

BLOOD BANK


O POSITIVE 18-03-2010 / 10:53




4.6 18-03-2010 / 12:42










BIO CHEMISTRY


MICROBIOLOGY



PATHOLOGY


.

RBCs show microcytic normochromic .

Nucleated RBCs+

Hemoparasites Nil .


shift to left .


18-03-2010 / 12:42


Eosinophils :01%

Monocytes :3%

Lymphocytes :15%

18-03-2010 / 12:42


IMPRESSION : -- 18-03-2010 / 12:42

Name : B/o. Bagavidhya Age/Sex : NB/ M Dept : NeonatologyHos.No: 451650 Mrd.No : 336564 Ward: IL.NB. NICUD.O.A : 08.03.2010 D.O.D : 24.03.2010

*****************************************************************************

DIAGNOSIS: PRETERM (33 – 34 WEEKS) WITH RESPIRATORY DISTRESS SYNDROME SURFACTANT II DOSES GIVEN ON 08.03.10

Name : B/o. Suguna devi Age/Sex : NB/ M Dept : NeonatologyHos.No: 453027 Mrd.No : 337394 Ward: IL.NB. NICUD.O.A : 17.03.2010 D.O.D : 23.03.2010 ************************************************************************

DIAGNOSIS: PRETERM WITH RESPRIATORY DISTRESS SYNDROME (SURFACTANT THERAPY GIVEN) SEPTICEMIA

APR 10

Name : B/o. Karthiga Age/Sex : NB/ M Dept : NeonatologyHos.No: 456014 Mrd.No : 339461 Ward: IL.NB. NICUD.O.A : 12.04.10 D.O.D : 18.04.10 ************************************************************************

DIAGNOSIS: PERINATAL ASPHYXIA

NEONATAL SEIZURE


RIGHT SIDED PNEUMOTHORAX

CHD (OS ASD WITH PULMONARY HYPERTENSION)

ACUTE RENAL FAILURE

COURSE:

This Term / AGA / male baby was born at private hospital by LSCS (Ind:

Cord around the neck with fetal distress) on 10th April 2010 @ 11p.m. Baby was

said to have cried soon after birth but developed poor activity and had cyanosis

followed by respiratory distress and convulsion on 1st day of life and hence referred

to MMHRC for further management. H/o. Cord around the neck and thick

meconium staining of liquor+. O/E: No cry or activity, CRT > 3 sec, cyanosis+. No

pallor / icterus / edema. No obvious external congenital anomalies seen. HR:

160/min, regular, Resp. rate: 74/min, Afebrile. RS: Tachypneic. ICR and SCR+.

Air entry diminished on right side. No adventitious sounds. CVS : S1 & S2+,

Normal. No murmurs. P/A: Soft, No organomegaly. CNS: Neonatal reflexes could

not be elicited. Anterior fontanelle – Normal. Baby was investigated Hb: 14.8gm

%, TC: 22,700cells/mm3. Platelet count: 2.9 lakhs/mm3. CRP – Positive (48mg/dl).

Chest X – ray right sided Pneumothorax. Blood Culture revealed No growth of

Organisms. Baby was endrotracheally intubated, connected to Mechanical

Ventilator. Chest tube was placed on right side on 12th April 2010. 2D ECHO was

suggestive of small OS ASD with LR shunt and moderate pulmonary

hypertension (on 17 April 2010). Baby was managed with Iv. Fluids, Iv.

Antibiotics, Inj. Calcium gluconate, Inj. Gardenal, Inj. Eptoin and Tab. Cavetra.

Inj. Aminophyllin and Inj. Lasix infusion was given to treat acute renal failure.

Even with these above management, general condition of baby kept deteriorating

and on 18 April, 2010, baby developed cardiac arrest was resuscitated as per latest

guidelines but couldn’t be reviewed and was “DECLARED DEAD” on 18 April

2010 at 5.45a.m.

INVESTIGATION:

BLOOD BANK


O POSITIVE 13-04-2010 / 09:37



HAEMOGLOBIN (Photometric

Measurement) 14.8 11.2 to 19.6 g/dL 13-04-2010 / 11:25

TOTAL WBC COUNT (Coulter

Principle)

2270

0 6000 to 18000 Cells/cumm 13-04-2010 / 11:25

PLATELET COUNT (Plt Histogram) 29000

0

150000 to 450000 Cells/

cumm 13-04-2010 / 11:25


TOTAL RBC COUNT (Coulter

Principle) 4.5 4.9 to 5.6 Mill/Cumm 13-04-2010 / 11:25






BIO CHEMISTRY




MICROBIOLOGY



PATHOLOGY


.

RBCs show macrocytic

normochromic.

No nucleated RBCs or

hemoparasites.

WBC count neutrophilic leukocytosis

with shift to left.


13-04-2010 / 11:25


Eosinophils :01%

Monocytes :05%

Lymphocytes :18%

13-04-2010 / 11:25


IMPRESSION : -- 13-04-2010 / 11:25

Name : B/o. Gomathi Age/Sex : NB/ M Dept : NeonatologyHos.No: 455561 Mrd.No : 339172 Ward: IL.NB. NICUD.O.A : 08.04.10 D.O.D : 18.04.10 ************************************************************************

DIAGNOSIS: PRETERM (32 WEEKS) / LBW / MALE RESPIRATORY DISTRESS SYNDROME /

SURFACTANT 1 DOSE GIVEN ON 08.04.10 BIRTH ASPHYXIA ? SEPTICEMIA

Name : B/o. Jeyaleela Age/Sex : NB/ F Dept : NeonatologyHos.No: 456647 Mrd.No : 339837 Ward: IL.NB. NICUD.O.A : 16.04.2010 D.O.D : 24.04.2010 *****************************************************************************REF.BY.DR.JOSPHINE CHANDRAKALA., PLACE : MADURAI

DIAGNOSIS:PRETERM WITH BIRTH ASPHYXIA RESPIRATORY DISTRESS SYNDROME (SURFACTANT 2 DOSES GIVEN) ACUTE RENAL FAILURE

Name : B/o. Vajila Banu Age/Sex : NB/ F Dept : NeonatologyHos.No: 458208 Mrd.No : 340972 Ward: IL.NB. NICUD.O.A : 28.04.2010 D.O.D : 29.04..2010 ************************************************************************

DIAGNOSIS: RESPIRATORY DISTRESS SYNDROME WITH HYPOTENSION SURFACTANT 1ST DOSE GIVEN ON 28.04.10

MAY 10Name : B/o. Anandhavalli Age/Sex : NB/ M Dept : NeonatologyHos.No: 457491 Mrd.No : 340495 Ward: IL.NB. NICUD.O.A : 23.04.10 D.O.D : 03.05.10************************************************************************

DIAGNOSIS: PRETERM WITH RESPIRATORY DISTRESS SYNDORME (33-34 WEEKS) SEPTICEMIA SURFACTANT THERAPHY GIVEN ON 23.04.10

JUNE 10Name : B/o. Nithya Age/Sex : NB/ F Dept : NeonatologyHos.No: 464105 Mrd.No : 344685 Ward: IL.NB. NICUD.O.A : 08.06.10 D.O.D : 09.06.10************************************************************************REF.BY.DR. REVATHI JANAKIRAM., PLACE : MADURAI

DIAGNOSIS: PRETERM (27-28 WEEKS) / ELBW / TWIN II RESPIRATORY DISTRESS SYNDORME SURFACTANT GIVEN ON 08.06.10

Name : B/o. Selvi Age / Sex: NB/M Dept : NeonatologyHos.No : 462757 Mrd.No : 343880 Ward : I NB NICUD.O.A : 30.05.10 D.O.D :17.06.10************************************************************************REF.BY.DR. MANIMEGALAI., PLACE : KARAIKUDI

DIAGNOSIS: TERM / MALE / BIRTH ASPHYXIA


COURSE:

This Term two days old Male baby was referred to MMHRC on 30.05.10 as

a case of ? Meconium aspiration syndrome. Baby delivery by emergency LSCS

(Ind: MSAF with fetal bradycardia) on 29.05.2010 @ 5.35p.m., H/o. Baby didn’t

cry immediately after birth, cried after initial resuscitation. H/o. Baby developed

respiratory distress since birth. H/o. Meconium aspiration+. No H/o. cyanosis,

convulsions, jaundice. No Maternal H/o. PIH, GDM, PROM, fever with rash, UTI,

Hypothyroidism. Baby was initially managed with oxygen in the referral hospital,

but respiratory distress increased with cyanosis baby was referred here for further

management. O/E: Baby cry and activity – weak, peripheral cyanosis+, CFT > 3

sec, no pallor, no icterus, no birth injury, no obvious external anamoly. CVS: S1

S2 heard, no murmurs, RS: Dyspnoea+, RR @ 70/mt, Bilateral air entry reduced,

SCR+, ICR+, P/A: Soft, no organomegaly, CNS : NNR +. Baby was investigated

peripheral smear showed HB : 14.1mg/dl, TC : 19,200 cells/mm3 & Platelet count :

2.5 lakhs. CRP : Positive. Blood culture no growth. ET aspiration culture no

growth. Serum creatinine 0.6 mg/dl (31.05.10), Serum Bilirubin T: 5.1mg%, D:

0.6mg%. Chest x – ray showed features of MAS. ECHO showed normal study.

Baby was intubated and connected to mechanical ventilator support, series of ABG

taken, ventilator settings changed accordingly. Baby was managed with Iv. Fluids,

Iv. Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Deriphylline drops and

single side phototheraphy. Baby was weaned from the ventilator, managed with

oxygen. With these above measures baby’s respiratory distress settled. Baby was

started on ryles tube feeds, initially not tolerating the feeds, had vomiting managed

with Anti emetic drops. Now baby is active tolerating the feeds, hence baby is

discharged today with advice to continue the further follow-up with the referral

doctor.

INVESTIGATION:



BLOOD BANK


AB POSITIVE 31-05-2010 / 11:26







0

150000 to 450000 Cells/

cumm 31-05-2010 / 11:12


TOTAL RBC COUNT (Coulter Principle) 4.7 4.9 to 5.6 Mill/Cumm 31-05-2010 / 11:12






BIO CHEMISTRY




Plasma BILIRUBIN - TOTAL (Diazo) 5.1 0.4 to 1.1 mg/dL 30-05-2010 / 22:46

Plasma BILIRUBIN - DIRECT (Diazo) 0.6 0.1 to 0.5 mg/dL 30-05-2010 / 22:46

MICROBIOLOGY


C- Reactive Protein POSITIVE 48 MICRO GRAM/ML 30-05-2010 / 22:32

PATHOLOGY


.


normochromic .



with shift to left.


31-05-2010 / 11:12


Eosinophils :00%

Monocytes :03%

Lymphocytes :09%

31-05-2010 / 11:12


IMPRESSION : -- 31-05-2010 / 11:12

ADVICE ON DISCHARGE

Inj. Ronem 125mg IV BD x 5 days

Tab. Caverta 25mg 1/5 BD x 5 days

Deriphylline drops 8 drops TID x 1 week

Admission weight : 2.900 kg

Discharge weight : 2.825 kg

Name : B/o. Malathy Age/Sex : NB/ F Dept : NeonatologyHos.No: 464931 Mrd.No : 345118 Ward: IL.NB. NICUD.O.A : 14.06.10 D.O.D : 25.06.10 ************************************************************************REF.BY.DR. RAJINI PREMATLATHA., PLACE : MADURAI

DIAGNOSIS: TERM / FEMALE / MECONIUM ASPIRATION SYNDROME CONGENITAL HEART DISEASE (OS ASD)

COURSE:

This term female baby was referred to MMHRC on 14.06.10 with H/o.

Respiratory distress since birth. Baby born by normal vaginal delivery on 14.06.10

at 5.30am. H/o. Baby didn’t cry immediately after birth, cried after tactile

stimulation, H/o. Baby developed respiratory distress since birth. H/o. Meconium

aspiration +. No H/o. cord around the neck, cyanosis, convulsions. Maternal H/o.

GDM, 3rd month of gestation., treated with insulin. Maternal H/o. PIH, treated with

drugs. No maternal H/o. Hypothyroidism, fever with rash / UTI. Baby was initially

managed in referral hospital, as respiratory distress increased, referred here for

further management. O/E : Baby’s activity & cry : weak, CFT > 3sec, CVS : S1 S2

+, RS : RR @ 68/min, grunting, dyspnoea +, SCR +, ICR +, P/a : Soft, CNS : NNR

+. Baby was intubated and connected to mechanical ventilator support. Series of

ABG taken, ventilator settings changed accordingly. Baby was investigated

showed HB : 15.5gms%, TC : 19,200 cells/mm3 & Platelet count : 3 lakhs. CRP :

Negative. ECHO showed congenital heart disease, OS ASD (5-6mm). Baby was

managed with Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, antiemetics drops,

ionotropes. Baby was slowly weaned from ventilator & started on ryles tube feeds.

With these above measures, baby’s active, respiratory distress settled, tolerating

feeds well and discharged today with advice to continue further follow-up with the

referral doctor.

INVESTIGATION

BLOOD BANK


B POSITIVE 14-06-2010 / 17:02







0

150000 to 450000 Cells/

cumm 15-06-2010 / 09:52








BIO CHEMISTRY




Plasma BILIRUBIN - TOTAL (Diazo) 9.6 0.4 to 1.1 mg/dL 16-06-2010 / 17:37

Plasma BILIRUBIN - DIRECT (Diazo) 0.5 0.1 to 0.5 mg/dL 16-06-2010 / 17:37

MICROBIOLOGY



PATHOLOGY


.


normochromic .



with shift to left.


15-06-2010 / 09:52


Eosinophils :00%

Monocytes :05%

Lymphocytes :16%

15-06-2010 / 09:52


IMPRESSION : -- 15-06-2010 / 09:52

ADVICE ON DISCHARGE


Mucolite drops 5 drops TID x 2 weeks

Admission weight : 3.6 kg

Discharge weight : 3.6 kg

JULY 10Name : B/o. Fathu munisha Age/Sex : NB/ M Dept : NeonatologyHos.No: 467629 Mrd.No : 346802 Ward: IL.NB. NICUD.O.A : 03.07.10 D.O.D : 03.07.10 ************************************************************************

DIAGNOSIS: TERM / BIRTH ASPHYXIA / MECONIUM ASPIRATION SYNDROME / (L) CTEV ? ARTHROGRYPOSIS

COURSE:

This term male baby was born by emergency LSCS (Ind : PIH with

oligohydraminos with breech presentation) on 02.07.10 @ 10.23 pm (EDD :

23.07.10) H/o. Baby didn’t cry after birth, H/o. Meconium aspiration +. Baby was

intubated and aspiration of meconium done. Apgar of 5min – 6/10, after these

initial resuscitation measures, baby developed spontaneous respiration, but had

severe distress. Baby was reintubated and connected to mechanical ventilator. H/o.

thick meconium stained liquor +. Maternal H/o. PIH. Past 3 months. H/o. PROM

for 7hrs. No maternal H/o. GDM, fever with rash UTI. O/E : Baby’s on ventilator

support. Peripheries cold, peripheral cyanosis +, not icteric, not anaemic, webbing

of neck + restricted movement of right and left elbow joint, knee joints (L) CTEV

with over lapping of 2nd digit over thumb. CVS : S1 S2 +, no murmurs, RS :

Bilateral air entry +, P/A : Soft, CNS : NNR absent. Baby was managed with

ventilator support, (series of ABG taken, ventilator settings changed accordingly),

Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, ionotropes. Condition of the

baby and prognosis was well explained to parents. Since parents were not willing

for further management, baby is discharged AGAINST MEDICAL ADVICE on

03.07.10.

INVESTIGATIONBLOOD BANK


B POSITIVE 03-07-2010 / 10:05







0

150000 to 450000 Cells/

cumm 03-07-2010 / 13:04








PATHOLOGY

.

RBCs show macrocytic normochromic .


WBC count neutrophilic leukocytosis.


03-07-2010 / 13:04


Eosinophils :00%

Monocytes :05%

Lymphocytes :21%

03-07-2010 / 13:04

Plalets Count adequate ( seen in

clumps).

03-07-2010 / 13:04

IMPRESSION : -- 03-07-2010 / 13:04

Name : B/o. Sathiya Age/Sex : NB/ M Dept : NeonatologyHos.No: 467798 Mrd.No : 346877 Ward: IL.NB. NICUD.O.A : 03.07.10 D.O.D : 05.07.10 ************************************************************************REF.BY.DR.MURUGADASS., PLACE : MADURAI

DIAGNOSIS: TERM / MECONIUM ASPIRATION SYNDROME / SEVERE PERSISTENT PULMONARY HYPERTENSION OF NEWBORN

COURSE:

This term male baby was referred to MMHRC on 03.07.10 as a case of

meconium aspiration with birth asphyxia. Baby born by normal vaginal delivery

on 03.07.10 at 8.40pm. H/o. Baby didn’t cry after birth (resuscitation details not

known). H/o. Thick Meconium stained liquor and aspiration +. H/o. Baby

developed respiratory distress since birth. No H/o. cyanosis, convulsions, cord

around the neck. No Maternal H/o. PIH, GDM, Hypothyroidism, fever with rash.

O/E : Baby’s cry and activity : weak, CFT > 3 sec, peripheral cyanosis +, not

icteric, not anaemic, no external anamoly, CVS : S1 S2 +, no murmurs, RS :

Bilateral air entry equal, RR : 90/mt, SCR +, ICR +, grunting +, P/A : Soft, CNS :

NNR sluggish. Baby was intubated & connected to mechanical ventilator support.

ABG showed progressive, hypercarbia with hypoxia. ventilator settings changed

accordingly. Baby was investigated showed Hb : 18.7gm%, TC : 26,000, platelet :

2.3 lakhs. Chest x-ray showed features of meconium aspiration. Baby was

managed with ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium

gluconate, inotropes & pulmonary vasodilators. Since parents wants to continue

the further treatment in Government Hospital, baby is discharged AT REQUEST

on 05.07.10

INVESTIGATION

BLOOD BANK


O POSITIVE 04-07-2010 / 12:48







0

150000 to 450000 Cells/

cumm 05-07-2010 / 12:25








PATHOLOGY

.



Hemoparasites Nil.

WBC count neutrophilic leukocytosis.


05-07-2010 / 12:25


Eosinophils :04%

Monocytes :02%

Lymphocytes :34%

05-07-2010 / 12:25


IMPRESSION : -- 05-07-2010 / 12:25

AUGUST 10Name : B/o. Sathya Priya Age/Sex : NB/ M Dept : NeonatologyHos.No: 473753 Mrd.No : 350618 Ward: IL.NB. NICUD.O.A : 12.08.10 D.O.D : 14.08.10 ************************************************************************REF.BY.DR. SAVITHRI., PLACE : MADURAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PPHN ? CONGENITAL HEART DISEASE COURSE:

This term AGA, male baby was born by normal vaginal delivery on

12.08.2010 at 10.45p.m., H/o. Baby cried soon after birth, developed respiratory

distress since birth. H/o. Thick meconium stained liquor +. No H/o. convulsion /

cyanosis at birth. Maternal history: Primi, 25 years. H/o. Fever 2 days back before

delivery. No H/o. GDM / PIH / Hypothyroidism / fever with rash / eclampsia.

O/E: Baby cry – weak, activity – weak, colour – pale, CFT > 2 sec. Severe

respiratory distress +. Saturation was 70% with 5 liters of O2, tachypnea +,

dyspnea +. CVS: S1 S2 heard, no murmur, RS : Tachypnea +, ICR, SCR +,

Bilateral crept +. P/A: Soft, CNS: NNR. Sluggish. Baby was immediately

intubated and connected to mechanical ventilator. Baby was investigated HB:

13.7gm%, TC: 20,500cells/mm, Platelet count: 2.5lakhs. Chest x – ray was

showing bilateral infiltrates. ABG taken, showed severe respiratory acidosis,

ventilator settings changed accordingly. Baby was treated with Iv Fluids, Iv.

Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K. Baby developed 2 episodes of

convulsions managed with anticonvulsants. As baby had hypotension, inotropes

were started. ABG periodically monitored showed persistently high PcO2, low

PO2 inspite of maximum ventilator support. Baby had persistent hypotension,

Noradrenaline infusion started. PPHN was suspected hence pulmonary vasodilators

were started and planned for Echo to rule out CHD. Now baby is on high

frequency ventilatory support maintained Spo2 of 85% only. The condition of the

baby and the prognosis were explained to the parents. They were not willing for

further management, baby was discharged AGAINST MEDICAL ADVICE on

14.08.10.

INVESTIGATION:BLOOD BANK


A POSITIVE 13-08-2010 / 15:54







0

150000 to 450000 Cells/

cumm 13-08-2010 / 18:31








PATHOLOGY

RBCs show normochromic normocytes

and macrocytes.


WBC count shows leukocytosis with

shift to left.


13-08-2010 / 18:31


Eosinophils :02%

Monocytes :03%

Lymphocytes :19%

13-08-2010 / 18:31


morphology

13-08-2010 / 18:31

IMPRESSION : LEUKOERYTHROBLASTIC BLOOD

PICTURE.

13-08-2010 / 18:31

Name : B/o. Prabavathy Age/Sex : NB/ M Dept : NeonatologyHos.No: 474061 Mrd.No : 350824 Ward: IL.NB. NICUD.O.A : 16.08.2010 D.O.D : 17.08.2010 ************************************************************************REF.BY. DR.UMAMAHESWARI., PLACE : SINGAMPUNARI

DIAGNOSIS: PRETERM (31 – 32 WEEKS) VERY LOW BIRTH WEIGHT RESPIRATORY DISTRESS SYNDROME

( ONE DOSE OF SURFACTANT GIVEN)

Name : B/o. Shanthi Age/Sex : NB/ M Dept : NeonatologyHos.No: 470943 Mrd.No : 348818 Ward: IL.NB. NICUD.O.A : 24.07.10 D.O.D : 10.08.10 ************************************************************************

DIAGNOSIS: BIRTH ASPHYXIA WITH SEIZURE HIE STAGE II MECONIUM ASPIRATION SYNDORME

COURSE:

This Term / AGA / male baby born on 23.07.10 at 9.50am via labour

naturalis was referred to MMHRC with H/o. Baby didn’t cry after birth and H/o.

Meconium stained liquor. Mother is a primi para with no H/o. PIH, GDM,

Recurrent UTI or fever with rash. H/o. Difficult second stage of labour. Baby

didn’t cry soon after birth and was resuscitated with O2 and suctioning. Baby had

weak cry after that. H/o. meconium staining of liquor with ? aspiration. No H/o.

cyanosis, cord around the neck. Baby had 2-3 episodes of convulsions at referral

hospital. O/E : Baby had poor activity and no cry. Colour : Pink, CFT < 3 sec, HR :

156/min, regular RR : 68/min, Spo2 : 96% with O2, No Pallor, cyanosis, edema,

no birth injuries, no external congenital anomalies, CVS : S1 S2 +, normal, no

murmurs, RS : Distress + (ICR, SCR and nasal flaring +), Tachypnea +, Bilateral

air entry equal, No adventitious sounds, P/A : soft, no organomegaly, CNS :

Sluggish reflexes and hypotonia suggestive of encephalopathy. In emergency

department baby had apnea with Spo2 falling to 55% with cyanosis. Baby was first

given ambu – mask ventilation and then intubated and connected to mechanical

ventilator. Baby had one more episode of convulsion there. Baby was managed

with Iv. Fluid, Iv. Antibiotics, anticonvulsants and other supportive and

symptomatic treatment measures. With these baby’s general condition improved,

started on oral feeds and discharged with following advice.

INVESTIGATION

Glucometer

GLUCOMETER SUGAR

10am 115 mg/dl 06-08-2010 / 14:54

10pm 95 mg/dl 06-08-2010 / 14:55

10am 99 mg/dl 06-08-2010 / 14:57

10PM 88 mg/dl 11-08-2010 / 09:30

10AM 86mg/dl 11-08-2010 / 12:13

10AM 84 mg/dl 11-08-2010 / 13:00

10PM 102 mg/dl 11-08-2010 / 13:01

BLOOD BANK


APOSITIVE 25-07-2010 / 12:28





TOTAL WBC COUNT (Coulter Principle) 15700 10000 to 25000 Cells/

cumm 26-07-2010 / 11:50


0

150000 to 450000 Cells/

cumm 26-07-2010 / 11:50








BIO CHEMISTRY





MICROBIOLOGY


C- Reactive Protein POSITIVE 12 MICRO GRAM/ML 24-07-2010 / 21:02

PATHOLOGY


.


normochromic.

Nucleated RBCs+.

Hemoparasites Nil.

WBC count normal in number

morphology with neutrophilic

preponderance.


26-07-2010 / 11:50

DIFFERENTIAL COUNT : NeutroPhils :87% 26-07-2010 / 11:50

Eosinophils :01%

Monocytes :02%

Lymphocytes :10%


IMPRESSION : -- 26-07-2010 / 11:50

ADVICE ON DISCHARGE


Tab. Fluconazole 50mg ½ OD x 7 days

DR. A. KANNAN., MD., DCH., SR. CONSULTANT

Name : B/o.Kaladevi Age/Sex : NB/ M Dept : NeonatologyHos.No: 472829 Mrd.No : 350061 Ward: IL.NB. NICUD.O.A : 07.08.10 D.O.D : 15.08.10 ************************************************************************DIAGNOSIS: BIRTH ASPHYXIA WITH SEIZURE MECONIUM ASPIRATION SYNDORME ACUTE RENAL FAILURE

HIE STAGE 2

COURSE:

This 2 days old Term / AGA / Male baby was born at private hospital by

LSCS (Ind : Previous LSCS) on 05.08.10 @ 10.30am. H/o. Birth asphyxia +. H/o.

Baby had respiratory distress since birth. H/o. Poor feeding, fever & drowsiness

since 2nd day of life. H/o. Convulsion – 5 episodes on 2nd day of life. H/o.

Meconium aspiration +. Baby was treated as meconium aspiration syndrome /

septicemia / meningitis at GH (Paramakudi) & brought to MMHRC on 07.08.10

for further management. MH/o. Typhoid in fever 2nd trimester +. No MH/o. PIH,

GDM & PROM. O/E : Baby’s activity & cry : poor, grunting respiration +,

dyspnoeic +, CFT > 3 sec, peripheral cyanosis, tachypneia +, no obvious external

anomaly, CVS : S1 S2 heard, RS : RR @ 72/mt, LCI +, Grunting +, P/A : Liver 3

cm palpable, spleen 1cm +, CNS : Hypotonia +, NNR sluggish. Baby was

investigated peripheral smear showed Hb : 14.4gms%, TC : 33,100 cells/mm3 &

platelet count : 2.2 lakhs, PCV : 44. Serum creatinine : 1.3mg/dl (07.08.10),

0.8mg/dl (09.08.10) & 0.4mg/dl (14.08.10). CRP : Positive. Serum K+ : 2.9mg/dl.

Blood culture showed no growth. Chest x-ray suggestive of bilateral infiltrations.

Baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics,

Inj. Calcium gluconate, Inj. Dopamine infusion & Inj. Gardenol. As baby had

decreased urine output with increased renal parameters managed with Inj. Lasix &

Hypokalemia was corrected with oral KCl. Series of ABG’s were done, ventilator

settings were adjusted accordingly to that. Baby was started on small ryles tube

feeds, but had abdominal distension so feeding withheld. Baby’s repeat serum

creatinine became normal & urine output improved. Now baby is in mechanical

ventilator support with Fio2 70%, maintaining Spo2 98% & in NPO. Since parents

were not willing for further management, baby is discharged AGAINST

MEDICAL ADVICE on 15.08.10 @ 9pm.

INVESTIGATION

Glucometer

GLUCOMETER SUGAR

6AM 41mg/dl 11-08-2010 / 12:26

12PM HI 11-08-2010 / 12:27

2PM HI 11-08-2010 / 12:27

5PM 329mg/dl 11-08-2010 / 12:28

BLOOD BANK


B POSITIVE 07-08-2010 / 10:08







0

150000 to 450000 Cells/

cumm 07-08-2010 / 10:17








BIO CHEMISTRY






MICROBIOLOGY



PATHOLOGY


.


Nucleated RBCs+

Hemoparasites Nil.


with shift to left .


07-08-2010 / 10:17


Eosinophils :01%

Monocytes :03%

Lymphocytes :16%

07-08-2010 / 10:17


IMPRESSION : -- 07-08-2010 / 10:17

Name : B/o. Kavitha Age/Sex : NB/ M Dept : NeonatologyHos.No: 473705 Mrd.No : 350602 Ward: IL.NB. NICUD.O.A : 13.08.10 D.O.D : 17.08.10 ************************************************************************REF.BY.DR. BASKAR., PLACE : MADURAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH HIE COURSE:

This term male new born baby was referred to MMHRC an 13.08.10 as a

case of birth asphyxia with respiratory distress. Baby was born by normal vaginal

delivery on 11.08.10 @ 4.30 a.m. H/o. Meconium staining of liquor (thick) +. No

H/o. PROM, cord around the neck. Baby had weak cry after birth with H/o.

meconium aspiration.. H/o. respiratory distress since birth. Hence referred to

MMHRC for further management. No H/o. cyanosis, convulsion, jaundice,

bleeding manifestations. Maternal history: 23 years. No H/o. PIH, GDM, fever

with rash, seizure, hypothyroidism in antenatal period. O/E: Baby cry & activity –

weak, CFT < 3sec, colour: central cyanosis+, SpO2 : 70% with O2 5lit//min.

severe respiratory distress +, tachypnea with RR of 80/min. IC and SC retractions

+. No signs of dehydration / No external congenital anamolies. HR : 146/min,

regular, BP : 71 mmHg, CVS : S1 S2 heard, no murmur, RS : Bilateral air entry

equal, severe respiratory distress +, P/A : soft, no organomegaly, CNS :

encephalopathy +, NNR sluggish. Baby was investigated Hb : 21.8mg%, Tc :

14,900cells, Platelet count : 1.6 lakhs, PCV : 60, CRP : Negative. Serum creatinine

: 0.4mg%. Peripheral smear showed neutrophilic preponderance with shift to left.

Baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics,

Inj. Calcium gluconate and Inj. Vit K. ABG was periodically monitored, ventilator

settings changed accordingly. Baby’s continued to be dusky and cyanosis, BP was

falling, Inotropes were started and planned for ECHO. The condition of the baby

and prognosis were explained to the attenders. As they were not willing for the

further management, child discharged “AGAINST MEDICAL ADVICE” on

17.08.10 @ 3.p.m.



O POSITIVE 13-08-2010 / 09:22







0

150000 to 450000 Cells/

cumm 13-08-2010 / 10:32








BIO CHEMISTRY



MICROBIOLOGY



PATHOLOGY


.

RBCs show erthrocytosis.Macrocytic

normochromic .


WBC count neutrophilic

prepondrance shift to left.


13-08-2010 / 10:32


Eosinophils :00%

Monocytes :01%

Lymphocytes :24%

13-08-2010 / 10:32


IMPRESSION : -- 13-08-2010 / 10:32

Name : B/o. Sonia Age/Sex : NB/ F Dept : NeonatologyHos.No: 473335 Mrd.No : 350386 Ward: IL.NB. NICUD.O.A : 11.08.10 D.O.D : 19.08.10 ************************************************************************REF.BY.DR.GURUSUNDAR., PLACE : MADURAI

DIAGNOSIS: TERM / AGA / BIRTH ASPHYXIA MECONIUM ASPIRATON SYNDROME

COURSE:

This Term / AGA / female baby was referred to MMHRC on 11.08.10 as a

case of birth asphyxia with meconium aspiration syndrome. Baby was born by

normal vaginal delivery on 10.08.10 at 3.26am. H/o. baby didn’t cry immediately

after birth, cried after 10 mints of resuscitation with O2, tactile stimulation, baby

and mask ventilation. H/o. Respiratory distress +. Baby was treated with Iv. Fluids,

Inj. Vitamin K, Inj. Gardenol and referred here for further management. No H/o.

cyanosis, convulsion at admission. Maternal History : Primi, 24 years. No Maternal

H/o. GDM, PIH, Hypothyroidism, fever with rash. No H/o. PROM, Cord around

the neck. H/o. Meconium stained liquor. O/E : Baby’s cry – irritable, activity :

moderate, CFT < 3 sec, HR : 150/m, RR : 76/min. No pallor, not icteric, no

cyanosis, no external anomaly, CVS : S1 S2 heard, RS : dyspnoea +, tachypnoea +,

Bilateral air entry +, Bilateral crepts +, P/A : Soft, CNS : NNR sluggish. Baby was

admitted at NICU investigated which showed normal haemogram, CRP : Positive.

(12 meq), serum creatinine : 0.8mg/dl. Blood culture showed no growth. Chest x-

ray showed bilateral infiltrations. ECHO showed 2-3 mm PDA. No pulmonary

hypertension. Baby was started on treatment with Nasal C-PAP with 5 liters of O2,

Iv. Fluids, Iv. Antibiotics, Iv. Anticonvulsants. Baby’s respiratory distress was

increasing, hence intubated and connected to mechanical ventilator after 4hrs of

admission. ABG showed metabolic acidosis. Bicarbonate correction given. On

13.08.10, baby had poor perfusion with hypotension, hence Inotropic support

started. ABG taken showed severe respiratory acidosis, ventilatory settings

changed accordingly, and ABG periodically recorded. Baby was having

persistently high PCO2 with high frequency ventilation, baby

respiratory distress mildly decreased. Baby was started on RTF and gradually

increased, tolerating well. Now baby is on SIMV mode of ventilation with FIO2 :

35%, Freq: 50, P max – 25, PeeP : 6. As the parents were not willing for further

management discharged AGAINST MEDICAL ADVICE on 19.08.10.

INVESTIGATION

BLOOD BANK


AB POSITIVE 11-08-2010 / 09:58







0

150000 to 450000 Cells/

cumm 11-08-2010 / 12:31








BIO CHEMISTRY

Plasma Creatinine (Jaffe Kinetic) 0.7 0.4 to 1.4 mg/dL 12-08-2010 / 14:07


MICROBIOLOGY



PATHOLOGY


.

RBCs show erythrocytosis with poorly

preserved morphology.



with shift to left.


11-08-2010 / 12:31


Eosinophils :01%

Monocytes :05%

11-08-2010 / 12:31

Lymphocytes :11%


IMPRESSION : -- 11-08-2010 / 12:31

Name : B/o. Karpagam Age/Sex : NB/ F Dept : NeonatologyHos.No: 472617 Mrd.No : 349874 Ward: IL.NB. NICUD.O.A : 05.08.10 D.O.D : 20.08.10 ************************************************************************REF.BY.DR. AMUTHAKALAVALLI., PLACE : MELUR

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME BIRTH ASPHYXIA

HIE STAGE 2 COURSE:

This term (4 days post dated) / AGA / female baby / delivered by LSCS (Ind

: Post dated with fetal distress) on 05.08.10 at 7.34am in a private hospital was

admitted with H/o. respiratory distress since birth. Mother is 28 years old, para 2,

second degree consanguinously married with no significant antenatal

conmplications. Baby had 3 rounds of cord around the neck and liquor was

meconium stained with ? aspiration of meconium. Baby cried soon after birth. H/o.

Respiratory distress since birth that increased gradually, hence baby was referred

here for further management. No H/o. Convulsion, cyanosis, jaundice. After

admission, baby had one episode of convulsion. O/E: Baby’s cry & activity –

weak, severe respiratory distress +, CFT > 3 sec, peripheral cyanosis +. No pallor,

icterus, edema, no external anomalies seen. CVS : S1 S2 +, normal, no murmurs.

RS : Severe respiratory distress +, ICR, SCR, Nasal flaring +, Tachypnea +,

Bilateral air entry equal, NVBS heard, no adventitious sounds, SpO2 : 84%

without O2 P/A : Soft, no organomegaly, CNS : NNR sluggish. Features of

encephalopathy +. Baby was immediately intubated and connected to mechanical

ventilator. On investigation Total WBC count was elevated 42,400/mm3. Hb was

normal. Serum creatinine was 1.2 but improved to 0.6mg% with treatment CRP

was negative. Baby was managed with Iv. Fluid, Iv. Antibiotics, anticonvulsant,

mechanical ventilator and other symptomatic and supportive therapeutic measures.

Baby’s general condition improved. Baby was weaned from the ventilator and

feeds introduced gradually. Baby was discharged in stable condition with

following advice.

INVESTIGATIONGlucometer

GLUCOMETER SUGAR

1AM 136 mg/dl 11-08-2010 / 14:40

4AM 169 mg/dl 11-08-2010 / 14:41

7AM 156 mg/dl 11-08-2010 / 14:41

1PM 130 mg/dl 11-08-2010 / 14:42

7PM 110 mg/dl 11-08-2010 / 14:44

2AM 145 mg/dl 11-08-2010 / 14:44

8AM 127 mg/dl 11-08-2010 / 14:45

4PM 125 mg/dl 11-08-2010 / 14:45

10PM 136 mg/dl 11-08-2010 / 14:46

4AM 164 mg/dl 11-08-2010 / 14:46

12PM 108 mg/dl 11-08-2010 / 14:47

8PM 112mg/dl 11-08-2010 / 14:47

BLOOD BANK


O POSITIVE 06-08-2010 / 10:07







0

150000 to 450000 Cells/

cumm 06-08-2010 / 18:30








BIO CHEMISTRY





MICROBIOLOGY



PATHOLOGY


.


and macrocytes.NRBCs 15/100 WBCs.



with shift to left.

06-08-2010 / 18:30


DIFFERENTIAL COUNT : Myelocytes :02%

NeutroPhils :70%

Stab :04%

Eosinophils :00%

Monocytes :03%

Lymphocytes :21%

06-08-2010 / 18:30


morphology

06-08-2010 / 18:30

IMPRESSION : LEUKOERTHROBLASTIC BLOOD

PICTURE.

06-08-2010 / 18:30

ADVICE ON DISCHARGE


Domstal drops 6 drops TID x 1 week

Tab. Gardenal 15mg HS x 3 months

Name : B/o. Benazir Begam Age/Sex : NB/ F Dept : NeonatologyHos.No: 472663 Mrd.No : 349954 Ward: IL.NB. NICUD.O.A : 06.08.10 D.O.D : 20.08.10 ************************************************************************REF.BY.DR.PEER MOHAMED., PLACE : MADURAI

DIAGNOSIS: BIRTH ASPHYXIA WITH NEONATAL SEIZURE HIE STAGE 2 MECONIUM ASPIRATION SYNDROME

COURSE:

This Pre term (34-36 weeks) / AGA / female baby deliverd by LSCS (Ind :

fetal distress) was referred to MMHRC for respiratory distress since birth. Mother

is 23 years / primi / on fertility treatment for 5 years. No H/o. PIH, GDM, Fever

with rash, hypothyroidism during antenatal period. EDD was 15.09.10. Amniotic

fluid was thick meconium stained and blood stained. Placenta was unhealthy. No

H/o. cord around the neck. Baby was delivered at 4.30am on 06.08.10. Baby cried

soon after birth but then developed respiratory distress. No H/o. cyanosis or

convulsion. O/E : Baby cry and activity were moderate. Trunk was pink,

acrocyanosis +, CFT < 3 sec, HR : 110/min, regular. Mean arterial pressure : 65

mm/of/Hg. RR : 60/min, regular, Spo2 : 80% without oxygen and 90% with

5lit/min oxygen via hood. No pallor, icterus, edema. No external congenital

anomalies. No signs of dehydration. CVS : S1 S2 +, normal, no murmurs, RS :

Mild distress + (sub costal indrawing and nasal flaring +), Bilateral air entry equal,

NVBS heard over both lung fields, Bilateral firn crepts +. P/A : soft, no

organomegaly. CNS : Moving all four limbs. AF normal. NNR sluggish. On

investigation: Complete blood count and serum creatinine were normal. CRP was

negative and blood culture revealed no growth of organisms. Baby developed

convulsion during course of stay in hospital. Baby was managed with bubble

CPAP, Iv. Antibiotics, Iv. Fluids, anticonvulsants and other symptomatic &

supportive treatment measures. With this baby’s respiratory distress subsided and

general condition improved. Feeds were gradually introduced which was well

tolerated by baby. Hence baby was discharged with following advice.

INVESTIGATION

Glucometer

GLUCOMETER SUGAR

1PM 112 mg/dl 11-08-2010 / 09:31

7PM 80mg/dl 11-08-2010 / 09:32

2pm 173 mg/dl 11-08-2010 / 09:40

10PM 95 mg/dl 11-08-2010 / 12:30

4AM 158 mg/dl 11-08-2010 / 12:58

10AM 117 mg/dl 11-08-2010 / 12:59

4PM 113 mg/dl 11-08-2010 / 12:59

10PM 129 mg/dl 11-08-2010 / 13:00

BLOOD BANK


B POSITIVE 06-08-2010 / 10:28







0

150000 to 450000 Cells/

cumm 06-08-2010 / 18:20








BIO CHEMISTRY


MICROBIOLOGY



PATHOLOGY


.


and macrocytes.NRBCs 2/100 WBC.


WBC count normal .


06-08-2010 / 18:20


Eosinophils :02%

Monocytes :02%

Lymphocytes :34%

06-08-2010 / 18:20


morphology

06-08-2010 / 18:20

IMPRESSION : -- 06-08-2010 / 18:20

ADVICE ON DISCHARGE

Tab. Gardenal 15mg HS x 3 months

Syp. Eptoin 1.5ml BD x 3 months

Syp. Deriphylline 8 drops TID x 1 month

Tab. Cavetra 25mg 1/5 th BD x 1 month

Tab. Aldactone 25mg 1/5th OD x 1 month

Domstal drops 6 drops TID x 1 week

Name : B/o. Punitha devi Age/Sex : NB/ M Dept : NeonatologyHos.No: 475966 Mrd.No : 352040 Ward: IL.NB. NICUD.O.A : 28.08.10 D.O.D : 30.08.10 ************************************************************************REF.BY.DR. MUTHUARASAN., PLACE : PARAMAKUDI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERINATAL ASPHYXIA PPHN COURSE:

This term / AGA / male baby was born at private hospital by LSCS (Ind : Failed

induction) on 28.08.10 @ 1.40pm. Baby was deeply asphyxiated, cried after, tracheal toileting

bag and mask ventilation. H/o. Thick meconium stained liquor +. Since baby had severe distress

baby was referred to MMHRC on 28.08.10 for further management. No H/o. cord around the

neck. Maternal history : G2 A1. No Maternal H/o. PIH, PROM, GDM & fever with rash. O/E :

baby’s activity & cry : nil, cyanosed, dyspnoeic +, tachypnoeic +, not icteric, no birth injury &

no obvious external anamoly, CVS : S1 S2 heard, RS : ICR +, SCR +, RR@80/mnt, Bilateral air

entry +, bilateral crepts +, P/A : Soft, CNS : NNR absent. Baby was investigated peripheral

smear showed Hb : 15gms%, TC : 16,200 cells/mm3 & platelet count : 2.8 lakhs, PCV : 45.

CRP : Positive, serum creatinine : 1.3mg/dl (30.08.10). Baby was managed with mechanical

ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inotropic

support. ABG showed PH : 7.182, Pco2 : 80.9, Po2 : 20.7 with HCo3 : 29. ventilator settings

were changed accordingly. Now baby is on mechanical ventilator support, with high frequency

mode with Fio2 100%, maintaining Spo2 : 98%. Condition & prognosis of the baby were well

explained to the parents, since parents were not willing for further management, baby is

discharged AGAINST MEDICAL ADVICE on 30.08.10 @ 8.30pm.

INVESTIGATION

BLOOD BANK


A POSITIVE 29-08-2010 / 13:25





0

150000 to 450000 Cells/

cumm 30-08-2010 / 11:53










C- Reactive Protein POSITIVE 48 ul/ml 30-08-2010 / 18:49



WBC count neutrophilia with toxic

changes.


30-08-2010 / 11:53


Eosinophils :01%

Monocytes :02%

Lymphocytes :16%

30-08-2010 / 11:53


morphology

30-08-2010 / 11:53

IMPRESSION : -- 30-08-2010 / 11:53

Name : B/o. Bhuvaneswari Age/Sex : NB/ F Dept : NeonatologyHos.No: 475533 Mrd.No : 351772 Ward: IL.NB. NICUD.O.A : 26.08.2010 D.O.D : 03.09.2010 ************************************************************************DIAGNOSIS: PRETERM (30 – 32 WEEKS) / AGA RESPIRATORY DISTRESS SYNDROME SURFACTANT 1 DOSE GIVEN NEC / RH INCOMPATIBILITY

SEP 10Name : B/o. Abirami Age/Sex : NB/ M Dept : NeonatologyHos.No: 476819 Mrd.No : 352616 Ward: IL.NB. NICUD.O.A :04.09.2010 D.O.D :06.09.2010************************************************************************

DIAGNOSIS: PRETERM (28-30 WEEKS) / VLBW / RESPIRATORY DISTRESS SYNDROME ( 1 DOSE OF SURFACTANT GIVEN ON 04.09.10 ) / SHOCK

Name : B/o. Vidhya Age/Sex : NB/ M Dept : NeonatologyHos.No: 472603 Mrd.No : 349870 Ward: IL.NB. NICUD.O.A : 05.08.10 D.O.D : 02.09.10 ************************************************************************REF.BY.DR. SABARI RAJA., PLACE : SIVAGANGAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME HYPOXIC ISCHEMIC ENCEPHALOPATHY STAGE I CHRONIC LUNG DISEASE COURSE:

This term / AGA / male baby was delivered via LSCS on 04.08.10 at

6.30pm was admitted on the first day of life with H/o. Respiratory distress since

birth. Mother is 25 years old, primi with H/o. GDM and PIH during antenatal

period. No H/o. fever with rash, hypothyroidism, recurrent UTI during antenatal

period. H/o. Meconium staining of amniotic fluid. No H/o. PROM or cord around

the neck. Baby cried soon after birth, H/o. Respiratory within 2 hours after birth.

No H/o. Convulsion or cyanosis. Baby was managed with in a private hospital

with O2, Iv. Fluids, Iv. Antibioitcs and since distress didn’t subside, baby was

referred here for further management. O/E : baby had moderate cry and activity,

colour : pink, CFT < 3 sec, no pallor, icterus, cyanosis, edema, no external

congenital anamolies. No signs of dehydration. RS Tachypnoea + with RR of

80/min, regular, Spo2 : 85% (in room air), nasal flaring, sub costal and intercostals

indrawing +, bilateral NVBS +, crepts heard over both lung fields. CVS : S1 S2 +,

normal. No murmur, P/A : Soft, no organomegaly, CNS : Moving all four limbs,

NNR sluggish, AF : Normal. On investigation : complete blood count, blood sugar

and serum creatinine were normal. CRP was positive (48mg/dl). Chest x – ray

showed bilateral infiltrates. Blood culture showed no growth of organisms. Baby

was intubated and connected to mechanical ventilator support. During the course

of stay in hospital baby recived blood transfusion thrice (whole fresh blood once

and packed cell twice). Baby was on ventilator for 14 days. Baby was managed

with Iv. Fluids, Iv. Antibiotics, inotropes, vaso pressors and pulmonary

vasodilators (cavetra). Baby was also started on diuretics as weaning from the

ventilator was difficult and CLD was suspected. Other symptomatic and supportive

treatment measures were instituted. Enteral feeds was introduced but baby

developed abdominal distension, NEC was suspected and managed conservatively

with Nil per oral, then gradually feeds wre gradually introduced. With these above

management baby’s general condition improved, respiratory distress subsided, now

taking feeds well, hence baby was discharged with following advice.

INVESTIGATIONGlucometer

GLUCOMETER SUGAR

2AM 95 mg/dl 11-08-2010 / 13:03

10AM 73 mg/dl 11-08-2010 / 13:04

6PM 79 mg/dl 11-08-2010 / 13:04

2AM 79 mg/dl 11-08-2010 / 13:05

BLOOD BANK


O POSITIVE 06-08-2010 / 10:06






cumm 06-08-2010 / 18:18


0

150000 to 450000 Cells/

cumm 06-08-2010 / 18:18








BIO CHEMISTRY



MICROBIOLOGY



PATHOLOGY


.

RBCs show normochromic

normocytes macrocytes.NRBCs +.

Hemoparasites nil.


with shift to left.


06-08-2010 / 18:18


Stab :03%

Eosinophils :00%

Monocytes :02%

Lymphocytes :07%

06-08-2010 / 18:18

Platelets Count normal in Number

and morphology

06-08-2010 / 18:18


SHIFT TO LEFT.

06-08-2010 / 18:18

ADVICE ON DISCHARGE

Tab. Aldactone 1/4th OD x 2 weeks

Tab. Cacerta 1/5th BD x 1 weeks

Syp. Deriphylline 80 TID x 2 weeks

Syp. Domstal drops 80 TID x 2 weeks

Syp. Silybon 100 TID x 1 weeks

Name : B/o. Kousalya Age/Sex : NB/ F Dept : NeonatologyHos.No: 477497 Mrd.No : 353032 Ward: IL.NB. NICUD.O.A : 09.09.10 D.O.D : 09.09.10 ************************************************************************

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME ? PPHN COURSE:

This 1 day old term female baby as referred to MMHRC on 08.09.10 as a

case of Meconium aspiration. Baby delivered by LSCS (Ind: Fetal distress with

meconium stained Liquor) on 08.09.10 at 10.44a.m. H/o. Baby didn’t cry after

birth. H/o. respiratory distress since birth. H/o. Meconium aspiration+. No H/o.

cyanosis, convulsion at birth. No significant maternal history. O/E: Baby’s cry and

activity weak, CFT > 3 sec, peripheral cyanosis+. No pallor / icterus / external

anomaly. CVS : S1 S2 +, RS: RR @ 78/min, SCR+, ICR+. Bilateral air entry +,

Bilateral crepts +, P/A : Soft, no organomegaly, CNS : NNR sluggish. Chest x –

ray suggestive of meconium aspiration. Baby was intubated and connected to

mechanical ventilator. Managed with mechanical ventilator support, Iv. Fluids, Iv.

Antibiotics, Inotropes and supportive measures. In spite of all above measures

baby went into sudden cardiac arrest, resuscitation measures done as per the

guidelines, but could not be revived and DECLARED DEAD on 09.09.10 @

7.a.m.



A POSITIVE 09-09-2010 / 09:04







0

150000 to 450000 Cells/

cumm 09-09-2010 / 16:06








PATHOLOGY


and macrocytes.


WBC count shows neutrophilic

leukocytosis with shift to left.


09-09-2010 / 16:06


Eosinophils :01%

Monocytes :05%

Lymphocytes :21%

09-09-2010 / 16:06


morphology

09-09-2010 / 16:06


SHIFT TO LEFT.

09-09-2010 / 16:06

Name : B/o. Shanthi Age/Sex : NB/ M Dept : NeonatologyHos.No: 474075 Mrd.No : 350822 Ward: IL.NB. NICUD.O.A :16.08.2010 D.O.D :06.09.2010************************************************************************REF.BY.DR. JEYAM., PLACE : MELUR

DIAGNOSIS: MECONUM ASPIRATION WITH SEPTICEMIA HIE STAGE II – III WITH NEONATAL SEIZURES

COURSE:

This newborn male baby was referred to MMHRC on 16.08.10 as a case of

severe birth asphyxia. Baby was born by normal vaginal delivery on 15.08.10.

baby did not cry for about half an hour after birth and was resuscitated (details not

known). Baby was deeply cyanosed at birth. H/o. respiratory distress since birth.

H/o. Irritable cry since few hours after birth. No H/o. convulsion. No H/o. Cord

around the neck. H/o. Thick meconium stained liquor +. No H/o. PPROM II stage

of labour +. Maternal history : 27 years old P2 L1 A0, IIcm, conceived seven years

after first delivery, spontaneous conception. EDD : 15.08.10. No H/o. PIH, GDM,

Hypothyrodism, fever with rash. O/E : Irritable cry, moderate activity, colour :

pink, CRT < sec, HR : 130/mt, RR : 64/m right, Spo2 : 90% without O2 and 100%

with O2 via hood. MAP : 70 mmHg. No pallor, not icteric, no cyanosis, no edema,

no dehydration, no extneral congenital anamaly +, CVS : S1 S2 heard, no murmur,

RS : tachypnea +, SCR , ICR +, Nasal flaring +, Bilateral air entry equal, NVBS +,

no adventitious limbs, AF : normal. On investigations Hb : 18.8gm%, TC :

24,600cells, Platelet count : 1.8 lakhs, CRP : Negative (17.08.10), serum creatinine

: 1.0mg/dl (17.08.10), 0.5 (20.08.10). chest x-ray showed bilateral infiltrates. Baby

was managed with nasal C-PAP, O2, Iv. Fluids, Iv. Antibiotics, Inotrope support,

Iv. Anticonvulsant (developed convulsion after admission). During the hospital

course baby had abdominal distension developed icterus & respiratory distress

managed with phototherapy, and other supportive measures. Baby was gradually

weaned from nasal C-PAP, enteral feeding started, tolerating well. With these

above measures, baby’s cry and activity improved, on DBF, tolerating well, icterus

decreased, no further convulsion occurred. Hence discharged today to continue the

following advice.

INVESTIGATION

BLOOD BANK


A POSITIVE 16-08-2010 / 09:42






cumm 16-08-2010 / 11:35


0

150000 to 450000 Cells/

cumm 16-08-2010 / 11:35








BIO CHEMISTRY



MICROBIOLOGY



PATHOLOGY


.

RBCs show macrocytic normochromic

.NRBCs+

Hemoparasites nil.


with shift to left.


16-08-2010 / 11:35


Eosinophils :00%

Monocytes :05%

Lymphocytes :16%

16-08-2010 / 11:35


IMPRESSION : -- 16-08-2010 / 11:35

INVESTIGATION


Tab. Gardenol 15mg HS x 3 months

Syp. Silybon 10 drops TID x 2 weeks


Name : B/o.Ambujam Age/Sex : NB/ M Dept : NeonatologyHos.No: 477908 Mrd.No : 353277 Ward: IL.NB. NICUD.O.A :11.09.2010 D.O.D :12.09.2010************************************************************************REF.BY.DR. INDIRA RAJA., PLACE : MADURAI

DIAGNOSIS: PRETERM (28-30 WEEKS) / LBW RESPIRATORY DISTRESS SYNDROME SURFACTANT THERAPY GIVEN

Name : B/o. Karthika Age/Sex : NB/ F Dept : NeonatologyHos.No: 476724 Mrd.No : 352536 Ward: IL.NB. NICUD.O.A : 03.09.10 D.O.D : 06.09.10 ************************************************************************DIAGNOSIS: TERM / RESPIRATION DISTRESS THICK MECONIUM ASPIRATION SYNDORME PERINATAL ASPHYXIA COURSE:

This term / AGA / female baby was delivered by normal vaginal delivery on 03.09.10 at

MMHRC H/o. baby cried soon after birth developed respiratory distress since birth hence

admitted at NICU for further management. H/o. Thick meconium stained liquor +. No H/o.

cyanosis, convulsion at birth. Maternal history : 23 years, G4, P1, L1, A2, EDD : 09.09.10. No

H/o. PIH, GDM, fever with rash, UTI, Hypothyrodism . No H/o. Prolonged II stage of labour,

cord around the neck. O/E : baby’s cry : moderate, activity : good, HR : 140/m ®, RR : 52/min,

mean BP : 60 mmHg, Spo2 : 95% with O2. no pallor, not icteric, no cyanosis, no external

congenital anamoly, no birth injury. CVS : S1 S2 heard, RS : grunting +, SCR +, ICR +,

Bilateral air entry +, no added sounds, P/A : Soft, CNS : NNR +. On investigations Hb : 12.9gm

%, TC : 1, 58, 000cells (corrected count - 29000), platelet count : 2.8 lakhs, PCV : 38, serum

creatinine : 0.9mg/dl. CRP : Negative. Chest x-ray showed bilateral infiltrates. Peripheral smear

showed leukoerythroblastic picture with neutophilic leukocytosis. Baby was managed with

oxygen, Iv. Fluids, Iv. Antibiotics, Inj. Calcium glucaonte, Inj. Vitamin K. RTF started and

increased to full feeds, tolerating well. With these above measures baby’s respiratory distress

decreased, cry and activity improved, tolerating breast feeds and hence discharge today with the

advice to continue the following.

INVESTIGATION





TOTAL WBC COUNT (Coulter Principle) 15800

0 10000 to 25000 Cells/cumm 06-09-2010 / 10:20

PLATELET COUNT (Plt Histogram) 287000 150000 to 450000 Cells/

cumm 06-09-2010 / 10:20








BIO CHEMISTRY


MICROBIOLOGY



RBCs show normocytic

normochromic .Macrocytes +.NRBCs+ (

450/ 100 WBCs )

Hemoparasites nil.

WBC count - Corrected WBC count

29,000 cells / cumm.Neutrophilic

leukocytosis with shift to left.


06-09-2010 / 10:20


Band form :08%

Myelocytes :04%

Lymphocytes :40%

06-09-2010 / 10:20

Platelets Count Adequate. 06-09-2010 / 10:20

IMPRESSION : SUGGGESTIVE OF

LEUKOERYTHROBLASTIC PICTURE.

CLINICAL CORRELATION AND REPEAT

SMEAR IS SUGGESTED IF CLINICALY

WARRANTED.

06-09-2010 / 10:20

Name : B/o. Sangeetha Age/Sex : NB/ M Dept : NeonatologyHos.No: 481193 Mrd.No : 355246 Ward: IL.NB. NICUD.O.A :04.10.2010 D.O.D :16.10.2010************************************************************************

DIAGNOSIS: MECONUM ASPIRATION SYNDROME HIE STAGE II NEONATAL SEIZURES ACUTE RENAL FAILURE SPONTANEOUS PNEUMOTHORAX ICD DONE ON 06.10.10

COURSE:

This Term / AGA / male baby was born at private hospital by vaccum

extraction on 04.10.10 @ 5.30a.m. H/o. Baby didn’t cry immediately after birth,

cried after resuscitation (details not known). H/o. Meconium aspiration +. H/o.

Baby developed respiratory distress since birth, hence brought to MMHRC on

04.10.10 for further management. Maternal history : H/o. PROM – 15 hrs+, No

Maternal H/o. PIH / GDM / PROM & fever with rash. O/E : Baby’s activity & cry

– Nil, CFT – prolonged, peripheral cyanosis +, dyspnoeic +, tachypnoeic +, not

anemic, not icteric, no cyanosis, no birth injury & no obvious external anamoly.

CVS: S1 & S2 heard, RS : RR @ 72/mt, SCR + / LCI +, Bilateral air entry +,

bilateral crepts +, P/A: soft, CNS: NNR sluggish encephalopathy +. Baby was

investigated peripheral smear showed Hb : 14.8gm%, TC : 30,400cells/mm3,

Platelet count : 2.6 lakhs, PCV: 45. Serum creatinine : 1.5mg/dl (06.10.10),

0.6mg/dl (08.10.10), CRP: Negative. Chest x-ray suggestive of MAS. Baby was

managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj.

Calcium gluconate, Inj. Vitramin K & Inotropic support.Baby had convulsions – 2

episodes, (outside) Inj. Gardenol was added. Baby had raised Renal parameters

with decreased urine output managed with Inj. Lasix. ABG’s were done

periodically & ventilator settings were adjusted according. As baby had

desaturation on 06.10.10, Chest x – ray was taken which showed Pneumothorax

(right side). Hence ICD done and air let out. Baby had GI Bleed, Inj. Rantac was

added & 1 FFP transfusion was given on 07.10.10. With these above measures,

baby’s activity improved, respiratory distress settled, convulsions controlled so

weaned from the ventilator on 11.10.10. Baby was started on small Ryles tube

feeds & gradually raised. Repeat Serum creatinine became normal. Urine output

improved. Baby was slowly weaned from the oxygen & oral feeds tried. As air

entry improved on right side and chest x – ray became normal – ICD was removed.

Now Baby’s activity improved had no further convulsions & taking feeds oral well

hence discharged today with the advice to continue the following.



O POSITIVE 04-10-2010 / 15:59






0

10000 to 25000 Cells/

cumm 04-10-2010 / 18:42


0

150000 to 450000 Cells/

cumm 04-10-2010 / 18:42








BIO CHEMISTRY



MICROBIOLOGY



PATHOLOGY


RBCs show normochromic

normocytes and macrocytes.


WBC count neutrophilic

leukocytosis.


04-10-2010 / 18:42


Eosinophils :01%

Monocytes :05%

Lymphocytes :19%

04-10-2010 / 18:42

Platelets Count normal in Number

and morphology

04-10-2010 / 18:42


ADVICE ON DISCHARGE



OCT 10Name : B/o.Devasudha Age/Sex : NB/ M Dept : NeonatologyHos.No: 481130 Mrd.No : 355194 Ward: IL.NB. NICUD.O.A : 03.10.10 D.O.D : 14.10.10 ************************************************************************REF.BY.DR. SURYA PRABHA., PLACE : PARAMAKUDI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME

COURSE:

This term / AGA / male baby was referred to MMHRC on 03.10.10 as a case

of Meconium aspiration syndrome with respiratory distress. Baby was delivered by

LSCS (Ind : Previous LSCS with fetal distress) on 02.10.10. H/o. Meconium

aspiration +, cried soon after birth and developed respiratory distress since birth.

H/o. Grunting +. No H/o. Cord around the neck, cyanosis, jaundice at birth.

Maternal history : 30 years, G2, P1, L1 NCM parents. No H/o. PIH, GDM,

Hypothyroidism, UTI, fever with rash. O/E : Baby’s cry and activity : weak.

Colour : cyanosis+, CFT > 3 sec, no pallor / external congenital anomaly. CVS: S1

S2 +, RS : RR @ 88/mt, SCR +, ICR +, Grunting +, Bilateral+, Bilateral crepts+,

P/A : Soft, CNS : NNR absent. On investigations, Hb : 14.6g%, TC : 12800cells,

Platelet count – 2.3 lakhs. Serum creatinine – 0.6mg%. CRP : Positive (12). Blood

culture no grew organisms. Chest x-ray showed bilateral infiltrations. ECHO

showed OS ASD (4mm) with IAS aneurysm, no pulmonary hypertension. Baby

was managed with mechanical ventilator support, inotropic support, Iv. Fluids, Iv.

Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K. ABG was periodically

recorded, which was showing metabolic acidosis, correction with NaHco3 given

and ventilator settings changed accordingly. Inspite of mechanical ventilation,

ABG showed hypoxia and baby could not be weaned from the ventilator. Need for

prolonged ventilator support and the condition of the baby were well explained to

the parent. As they were not willing for further management, baby discharged

“AGAINST MEDICAL ADVICE” on 14.10.10.



O POSITIVE 03-10-2010 / 10:26






cumm 04-10-2010 / 13:02


0

150000 to 450000 Cells/

cumm 04-10-2010 / 13:02










C- Reactive Protein POSITIVE 12 MICRO GRAM /ML 04-10-2010 / 22:37

RBCs macrocytic normochromic.


hemoparasites seen.

WBC count mild leukocytosis seen.

No atypical or immature cells seen.

04-10-2010 / 13:02


Eosinophils :00%

Monocytes :03%

Lymphocytes :38%

04-10-2010 / 13:02

Platelets Count Adequate on smear 04-10-2010 / 13:02

IMPRESSION : MILD LEUKOCYTOSIS NOTED. 04-10-2010 / 13:02

Name : B/o.Sathiya priya Age/Sex : NB/ F Dept : NeonatologyHos.No: 479565 Mrd.No : 354348 Ward: IL.NB. NICUD.O.A : 23.09.10 D.O.D : .10.10 ************************************************************************REF.BY.DR. MATHIAZHAKAN., PLACE : BODINAYAKANUR

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME NEONATAL SEIZURE PPHN ? BRONCHO PULMONARY DYSPLASIA COURSE:

This term / AGA / female baby was born by at private hospital normal

vaginal delivery on 22.09.10 @ 3.30pm. H/o. Baby cried soon after birth. H/o.

Baby developed respiratory distress since birth. H/o. Meconium aspiration +. H/o.

Baby developed cyanosis & irritable cry for which baby was treated at referral

doctor clinic with oxygen Iv. Antibiotics & referred to MMHRC on 23.09.10 for

further management. Maternal history : G2 P1 L1 A0, H/o. PROM – 4 hrs. No

MH/o. PIH, GDM, Fever with rash & Hypothyroidism. O/E : Baby’s activity –

weak, cry : irritable, CFT > 3 sec, peripheral cyanosis +, dyspnoeic +, Tachypnoeic

+, not icteric, no birth injury, no obvious external anamoly, CVS : S1 S2 heard, RS

: RR@72/mt, LCI +, SCR +, Bilateral air entry equal, bilateral crepts +, P/A :

Soft, CNS : NNR sluggish. Baby was investigated peripheral smear showed Hb :

13.7gms%, TC : 15,900cells/mm3 & platelet count : 2.7 lakhs, PCV : 38, CRP :

Negative. Serum creatinine was normal. Chest x-ray suggestive of meconium

aspiration syndrome. ECHO showed CHD, OS ASD (8mm) with L -> R shunt

mild PHT. Baby was managed with mechanical ventilator support, Iv. Fluids, Iv.

Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inotropic support. Baby had

convulsion, Inj. Gardenol was added. Baby was started on small ryles tube feeds &

gradeually raised. ABG’s was done periodically & ventilator settings were adjusted

according to that. With these above measures baby’s respiratory distress settled

convulsions controlled so weaned form the ventilator on 05.10.10. As baby had

increased respiratory distress with desaturation, connected to C-PAP. Baby was

weaned from the C-PAP on 09.10.10 & put on oxygen hood. As baby had

difficulty in weaning from the oxygen, bronchopulmonary dysplasia was

suspected, Tab. Aldactone & deriphylline drops were added. Baby was slowly

weaned from the oxygen therapy & oral feeds tried. Now baby’s respiration

became normal, had no further convulsions active & taking oral feeds. Baby is

discharged today with the advice to continue further follow-up with the referral

doctor.

INVESTIGATION

BLOOD BANK


B POSITIVE 24-09-2010 / 09:54







0

150000 to 450000 Cells/

cumm 24-09-2010 / 11:32








BIO CHEMISTRY


MICROBIOLOGY







with shift to left.


24-09-2010 / 11:32


Eosinophils :00%

Monocytes :05%

Lymphocytes :27%

24-09-2010 / 11:32


IMPRESSION : -- 24-09-2010 / 11:32

ADVICE ON DISCHARGE

Deriphylline drops 8 drops TID x 2 weeks

Tab. Aldactone 25mg 1/4th OD x 2 weeks

Name : B/o. Bharakath nisha Age/Sex : NB/ F Dept : NeonatologyHos.No: 482821 Mrd.No : 356281 Ward: IL.NB. NICUD.O.A :14.10.2010 D.O.D :18.10.2010************************************************************************

DIAGNOSIS: PRETERM (29-30 WEEKS) / ELBW / RESPIRATORY DISTRESS SYNDROME /


Name : B/o. Jaringursiyatha TwinII Age/Sex : NB/ F Dept : NeonatologyHos.No: 483021 Mrd.No : 356423 Ward: IL.NB. NICUD.O.A :16.10.2010 D.O.D :16.10.2010************************************************************************

DIAGNOSIS: PRETERM (32-33 WEEKS) WITH RESPIRATORY DISTRESS SYNDROME HIE WITH SHOCK SURFACTANT THERAPY GIVEN

Name : B/o. Uma Maheswari Age/Sex : NB/ F Dept : NeonatologyHos.No: 484469 Mrd.No : 357472 Ward: IL.NB. NICUD.O.A : 27.10.10 D.O.D : 27.10.10 ************************************************************************REF.BY.DR. JENITHA., PLACE : ODDANCHATRAM

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION OF NEWBORN COURSE:

This term / AGA / female baby was born at private hospital by LSCS (Ind :

Meconium stained liquor with fetal distress) on 27.10.10 @ 12.30am. H/o. Baby

had weak cry at birth, had developed respiratory distress soon after birth. Baby was

admitted at referral doctor hospital, had cyanosis & hypoglycemia+ on correction

given, inotropes were started, baby had convulsion managed with Inj.

Phenobarbitone (outside) and referred to MMHRC on 27.10.10 for further

management. Maternal history : No MH/o. PIH, GDM, Fever with rash & UTI.

O/E : Baby’s activity & cry – poor, peripheral cyanosis +, CFT > 3 sec, perfusion –

poor, BP not recordable, dyspnoeic +, tachypnoeic +, dehydration +, not anaemic,

not icteric, no obvious external anamoly, CVS : S1 & S2 heard, no murmur, RS –

RR@80/mt, SCR+, ICR+, bilateral air entry +, Bilateral crepts+, P/A : Soft, CNS :

NNR absent, encephalopathy +. Baby was investigated, peripheral smear showed

Hb : 23.5gms%, Tc : 33,900cells/mm3 & platelet count : 1.1 lakhs, PCV : 74. Baby

was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj.

Dopamine infusion, Inj. Calcium gluconate and Inj. Vitamin K. Baby had

persistent hypotension with peripheral cyanosis, Inj. Nor – adrenaline infusion was

started. ABG done showed PH – 7.059, PCo2 : 81.4 & PO2 : 11.7 with Hco3 :

22.5, ventilator settings were changed accordingly. Even with these above

measures baby had desaturation, pulmonary vasodilators were started. Planned for

ECHO. Now baby is on mechanical ventilator support with Fio2 100% maintaining

Spo2 96% & with inotropes support. Since parents were not willing for further

management, baby is discharged “AGAINST MEDICAL ADVICE” on 27.10.10

@ 7.30PM.



O POSITIVE 27-10-2010 / 13:37



TOTAL WBC COUNT (Coulter

Principle) 23900

10000 to 25000 Cells/

cumm 27-10-2010 / 16:39


0

150000 to 450000 Cells/

cumm 27-10-2010 / 16:39








RBCs-Mild erythrocytosis seen.

Macrocytic normochromic

normocytes.


hemoparasites.

WBC - Marked neutrophilic

leukocytosis noted with shift to left .


27-10-2010 / 16:39


Eosinophils :01%

Monocytes :05%

Lymphocytes :22%

27-10-2010 / 16:39

Platelets Count Adequate. 27-10-2010 / 16:39


NOV10Name : B/o. Madhubala Age/Sex : NB/ F Dept : NeonatologyHos.No: 485258 Mrd.No : 357987 Ward: IL.NB. NICUD.O.A :01.11.2010 D.O.D :07.11.2010************************************************************************

DIAGNOSIS: SEVERE BIRTH ASPHYXIA PRETERM (28-30 WEEKS)

RESPIRATORY DISTRESS SYNDROME / 2 DOSES OF SURFACTANT THERAPY GIVEN

Name : B/o. Siva sankari Age/Sex : NB/ M Dept : NeonatologyHos.No: 483091 Mrd.No : 356472 Ward: IL.NB. NICUD.O.A : 17.10.10 D.O.D : 31.10.10 ************************************************************************

DIAGNOSIS: TERM / MAS / BIRTH ASPHYXIA SEPTICEMIA ? BPD

COURSE:

This term / AGA / Twin II / male baby was born at MMHRC by normal

vaginal delivery on 17.10.10. H/o. Baby didn’t cry soon after birth. H/o.

Meconium stained liquor +. Baby was intuabted & tracheal toileting given, after

that baby developed spontaneous respiration. H/o. respiratory distress since birth.

Maternal history : H/o.PROM +, H/o. fever for 1 day before delivery+. No MH/o.

GDM, PIH, UTI. O/E : baby’s activity & cry : moderate, CFT < 3 sec, colur : pink,

dyspneic +, tachypneic, no pallor / icterus / birth injury / obvious external

congenital anomaly. CVS : S1 & S2 heard, RS : RR@60/mt, SCR +, ICR+,

Bilateral+, P/A : Soft, CNS : NNR sluggish. Baby was investigated which showed

Hb : 15.5gm%, TC : 22,300cells/mm3 & platelet count : 2.1 lakhs, peripheral smear

showed neutron philic leukocytosis with shift to left. PCV : 47, serum creatinine

was normal. Blood culture showed no growth. CRP : Negative. Chest x-ray

showed bilateral infiltrates. Baby was managed with C-PAP, Iv. Fluids, Iv..

Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inotropic support. With

these above measues respiratory distress settled hence weaned form the C-PAP &

put on O2 hood. Baby was started on small ryles tube feeds & gradually raised. As

baby had abdominal distension kept in NPO for 72 hrs then ryles tuibe feeds

restarted. As baby had difficulty in weaning from the oxygen bronchopulmonary

dysplasia was suspected & Tab. Aldactone was added. Baby was slowly weaned

form the oxygen & oral feeds tried. Now baby is active, respiration became normal

& taking oral feeds well hence the baby is discharged today with the advice to

continue the following.

INVESTIGATION

BLOOD BANK


A POSITIVE 17-10-2010 / 14:46







0

150000 to 450000 Cells/

cumm 18-10-2010 / 11:15








BIO CHEMISTRY


MICROBIOLOGY



PATHOLOGY


RBC macrocytic normochromic.

No hemoparasites seen.


with shift to left.


18-10-2010 / 11:15


Eosinophils :00%

Monocytes :05%

Lymphocytes :22%

18-10-2010 / 11:15

Platelets Count Adequate on smear. 18-10-2010 / 11:15


ADVICE ON DISCHARGE


Syp. Domstal 5 drops TID x 2 weeks

Tab. Aldactone 25mg 1/6th OD x 2 weeksName : B/o.Yogeswari Age/Sex : NB/ M Dept : NeonatologyHos.No: 484879 Mrd.No : 357713 Ward: IL.NB. NICU

D.O.A : 29.10.10 D.O.D : 13.11.10 ************************************************************************REF.BY.DR. RAVISANKAR., PLACE : MADURAI

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH PPHN

COURSE:

This term / AGA / male baby was born at private hospital by normal vaginal

delivery on 29.10.10 @ 12.45pm. H/o. Baby had weak cry at birth. H/o. Meconium

aspiration + resuscitated at referral doctor clinic & refereed to MMHRC on

29.10.10 for further management. Maternal history : No MH/o. PIH, GDM, PROM

& fever with rash. O/E : Baby’s activity & cry – weak, had no spontaneous

respiration & cyanosed – immediately intuabted with ambu bag ventilation Spo2

picked up, not anemic, not icteric, no obvious external anamoly, CVS : S1 S2

heard, RS : Bilateral air entry equal with ET tube, P/A : Soft, no organomegaly,

CNS : NNR not elicitable. Baby was investigated peripheral smear showed Hb :

17.4gms%, TC : 6900cells/mm3 & platelet count : 1.9 lakhs, PCV : 52. CRP :

Positive. Serum creatinine was normal. Blood culture showed no growth. chest x-

ray suggestive of bilateral meconium infiltrations. Baby was managed with

mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate,

Inj. Vitamin K & Ionotrophic support. Series of ABG’s were done & ventilator

settings were adjusted according to that. Baby was started on small ryles tube feeds

on 01.11.10 & gradually raised. As baby had abdominal distension kept in NPO for

72 hrs. With these above measures baby’s abdominal distension reduced, so ryles

tube feeds restarted. As baby’s ABG’s showed raised Pco2, suspected PPHN &

managed with High frequency ventilation. Baby was slowly weaned from the

ventilator on 06.11.10 & Ionotropes were stopped. Baby was extubated on

09.11.10 & put on O2 hood. As baby’s respiratory distress settled gradually

weaned from the oxygen therapy & oral feeds tried. Now baby is active respiration

became normal & taking oral feeds. Baby is discharged today with the advice to

continue further follow-up with the referral doctor.



A POSITIVE 30-10-2010 / 09:44



HAEMOGLOBIN (Photometric 17.4 13.6 to 19.6 g/dL 30-10-2010 / 12:01

Measurement)



0

150000 to 450000 Cells/

cumm 30-10-2010 / 12:01








BIO CHEMISTRY


MICROBIOLOGY




RBCs - macrocytic normochromic.


WBC count within normal range

neutrophilic prepondarence noted


30-10-2010 / 12:01


Eosinophils :01%

Monocytes :05%

Lymphocytes :23%

30-10-2010 / 12:01

Platelet just adequate on smear 30-10-2010 / 12:01

IMPRESSION : NORMOCYTIC NORMOCHROMIC BIOOD

PICTURE

30-10-2010 / 12:01

Name : B/o. Siva sankari Age/Sex : NB/ M Dept : NeonatologyHos.No: 483090 Mrd.No : 356471 Ward: IL.NB. NICUD.O.A : 17.10.10 D.O.D : 22.11.10 ************************************************************************

DIAGNOSIS: BIRTH ASPHYXIA MAS NEONATAL SEIZURE SEPTICEMIA WITH NEC

COURSE:

This term / AGA / male / Twin I / was born at MMHRC by normal vaginal delivery on

17.10.10 @ 125am. H/o. Baby did n’t cry soon after birth. H/o. Thick mecnoium aspiration +,

baby was immediately intubated, tracheal toileting given. Baby developed severe respiratory

distress since birth – shifted to NICU for further management. Maternal history : H/o. PROM – 5

hrs. No H/o. PIH, GDM, UTI & hypothyroidism. O/E : baby’s activity & cry – weak, peripheral

cyanosis, CFT > 3 sec, dyspnoeic +, tachypnoeic +, no birth injury & no obvious external

anamoly, CVS : S1 S2 heard, RS : RR@ 80/mt, LCI +, SCR, Bilateral crepts +, P/A : Soft,

CNS : NNR sluggish. Baby was investigated peripheral smear showed HB : 16.6gms%, TC :

7500cells/mm3 & platelet count : 2.4 lakhs, PCV : 50, serum creatinine : 0.9mg/dl (19.10.10).

Chest x-ray showed bilateral extensive infiltrates. CRP : positive. Blood culture showed no

growth. baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj.

Calcium gluconate, Inj. Vitamin K & Inotropic support. Baby had convulsions on 18.10.10,

managed with Inj. Gardenol. Baby was started on small tyles tube feeds & gradually raised. Baby

had decreased urine output, managed with Inj. Lasix on 24.10.10. baby had abdominal

distension. NEC was suspected hence kept NPO. Baby was odematous with serum creatinine :

1.3mg/dl ( 30.10.10). Fluid restriction was done & Inj. Lasix added. On 30.10.10, baby had

bleeding from the injection sites and became pale, (HB was 6.5gms%), managed with WFB

transfusion. Baby had petechial spots, repeat platelet count was 20,000 only – managed with

platelet concentrate transfusion. With these above measures baby’s abdominal distension

reduced, small ryles tube feeds was restarted. Baby’s urine output improved & repeat serum

creatinine became normal (1.11.10). As baby had GI bleed & pallor +, managed with 1 WFB &

platelet transfusion OD for 4 days. Baby was weaned form the ventilator on 06.11.10 &

extubated on 08.11.10. but baby had again developed distress hence connected to C-PAP on

09.11.10. Baby had desaturation with the C-PAP, so intubated and again connected to

mechanical ventilator support on 13.11.10. As baby had difficulty in weaning form the

ventilator, BPD was suspected and Tab. Aldactone added. Baby again developed abdominal

distension with vomiting of feeds, antibiotics were changed and kept NPO again. Now baby is on

mechanical ventilator support with Fio2 100%, maintaining Spo2 of 95% & in NPO. Condition

& prognosis of the baby & need for prolonged ventilator support were well explained to the

parents. Since parents want to continue further management at Government Hospital, baby is

discharged AGAINST MEDICAL ADVCIE on 22.11.10 at 1pm.

INVESTIGATIONHAEMATOLOGY & CLINICAL PATHOLOGY



PLATELET COUNT (Plt Histogram) 20000 150000 to 450000 Cells/

cumm 31-10-2010 / 06:51

BLOOD BANK


O POSITIVE 17-10-2010 / 14:48







0

150000 to 450000 Cells/

cumm 18-10-2010 / 11:12








BIO CHEMISTRY






POTASSIUM (ISE) 3.5 3.5 to 5.1 mEq/L 18-11-2010 / 17:34


MICROBIOLOGY


C- Reactive Protein POSITIVE 24microgram/ml 19-10-2010 / 03:02

PATHOLOGY


.

RBC macrocytic normochromic .

No hemoparasites seen.

WBC count moderate neutrophilic

leukocytosis noted.


18-10-2010 / 11:12


Eosinophils :00%

Monocytes :05%

Lymphocytes :29%

18-10-2010 / 11:12

Platelets Count Adequate on smear. 18-10-2010 / 11:12


NOTED.

18-10-2010 / 11:12

Name : B/o. Bhuvaneswari Age/Sex : NB/ F Dept : NeonatologyHos.No: 487000 Mrd.No : 359168 Ward: IL.NB. NICUD.O.A : 15.11.10 D.O.D : 24.11.10 ************************************************************************

DIAGNOSIS: PRETERM / VLBW / SEVERE BIRTH ASPHYXIA WITH SHOCK ACUTE RENAL FAILURE RESPIRATORY DISTRESS SYNDROME SURFACTANT THERAPY GIVEN

Name : B/o. Subathra Age / Sex: NB/F Dept : NeonatologyHos.No : 488871 Mrd.No : 360323 Ward : I NB NICUD.O.A : 27.11.10 D.O.D :28.11.10************************************************************************REF.BY.DR.PUSHPALATHA GOKULNATH., PLACE : MADURAI

DIAGNOSIS: PRETERM (28-30 WEEKS) / VLBW


NEONATAL SEIZURE


DEC 10Name : B/o. Palaniammal Age / Sex: NB/F Dept : NeonatologyHos.No : 488534 Mrd.No : 360125 Ward : I NB NICUD.O.A : 24.11.10 D.O.D :01.12.10************************************************************************

DIAGNOSIS: PRETERM (28 - 30 WEEKS) / VLBW / RESPIRATORY DISTRESS SYNDROME CHD (SMALL PDA / SMALL ASD) ? SEPTICEMIA NEONATAL SEIZURE SURFACTANT THERAPHY GIVEN

Name : B/o. Manimegalai Age / Sex: NB/F Dept : NeonatologyHos.No : 490472 Mrd.No : 361429 Ward : I NB NICUD.O.A : 09.12.10 D.O.D :10.12.10************************************************************************

DIAGNOSIS: SEVERE BIRTH ASPHYXIA / MECONIUM ASPIRATION SYNDROME / IUGR / MULTI CYSTIC DYSPLASTIC KIDNEY

COURSE:

This term / IUGR / female baby delivered by LSCS (Ind : Severe

oligohydramnios AFI – 3) on 08.12.10 at 10.04pm at MMHRC. H/o. Baby was not

cried immediately after birth, (thick mecnoium stained liquor +). Baby cried after

tracheal toileting and bag and tube ventilation. Baby was shifted to NICU for

further management. Maternal history : 22 years, primi, conceived after infertility

treatment. Antenatal USG abdomen showed dysplastic left kidney + severe

oligohydramnios. Apgar score 1 mint 3/10, 5 mits 7/10. O/E : activity – weak, wt:

1.5kg, acrocyanosis +, no pallor. CVS : S1 S2 heard, murmur +, RS : NVBS, no

added sounds, no organomegaly, CNS : NNR absent. Child was investigated which

showed Hb : 14.5gms%, TC : 49,300cells/mm3, platelets – 80,000, PCV : 45%.

Blood culture sent, reports awaited. Chest x-ray showed cardiomegaly with

bilateral infiltrates. Child was managed with mechanical ventilator support, Iv.

Fluids, Iv. Antibiotics Inj. Calcium gluconate, Iv. Inotropes and Inj. Vitamin K.

ABG was done periodically and ventilator settings changed accordingly. USG

abdomen showed multi cytic dysplastic kidney. Urology opinion was obtained. As

baby had bleeding form injection site and platelet count was only 80,000, baby was

managed with platelet concentrate and FFP transfusion. Condition of the baby and

prognosis were explained to the parents. As they were not willing for further

management, baby was discharged “AGAINST MEDICAL ADVCIE” on

10.12.10.

INVESTIGATION :BLOOD BANK


A POSITIVE 09-12-2010 / 09:28





0 10000 to 25000 Cells/cumm 09-12-2010 / 10:30


0

150000 to 450000 Cells/

cumm 09-12-2010 / 10:30










RBC mild anisocytosis, predominantly

macrocytic normochromic. 33

NRBC/100 WBC.

No hemoparasites nil seen.

WBC count marked leukocytosis with

predominance of lymphocytes. Mild

shift to left in neutrophilic series noted.


09-12-2010 / 10:30

DIFFERENTIAL COUNT : Metamyelocytes :06%

NeutroPhils :21%

Monocytes :04%

Lymphocytes :69%

09-12-2010 / 10:30

Platelets Count just Adequate on smear

(90,000 cells/cumm)

09-12-2010 / 10:30

IMPRESSION : MARKED LEUKOCYTOSIS.

Adv:

1) Please correlate with clinical details

2) Coombs test, Tetic count.

09-12-2010 / 10:30

Name : B/o. Sasi kala Age / Sex: NB/M Dept : NeonatologyHos.No : 491926 Mrd.No : 362361 Ward : I NB NICUD.O.A : 18.12.10 D.O.D :19.12.10************************************************************************

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH BA WITH PROFOUND SHOCK

COURSE:

This term / AGA / male baby was delivered by LSCS (Ind : CPD with Grade

III MSAF) on 18.12.10 11.05am. H/o. Baby did not cry after birth, intubated and

referred to Christian hospital, hence baby was connected to ventilator, chest x-ray

was taken, showed bilateral haziness and desaturation and hence referred here for

further management. H/o. cyanosis +. Mother had UTI 2 days before delivery and

treated with antibiotics. No H/o. GDM, PIH, Hypothyroidism, fever with rash. O/E

: ET tube in site, Spo2 : 65% with bag & mask ventilator, peripheries were

cyanosed, HR : 170/mt, RR : 60/mt, no pallor, not icteric, no external anamoly +,

umbilicus : unhealthy +, CVS : S1 S2 heard, RS : Bilateral crepts +, P/A : Soft,

CNS : NNR sluggish. Baby was investigated Hb : 13.4, TC : 23400, platelet count ;

1.37 lakhs, blood culture sent report awaited. Chest x-ray showed bilateral

infiltrates. Baby was managed with mechanical ventilator, inotrope support, Iv.

Antibiotics and other supportive measures. ABG taken after 1hr showed, severe

metabolic acidosis, correction with NaHco3 given. Ventilator settings changed

accordingly. Bleeding from UVC site +, managed with packed cell transfusion.

Baby had desaturation followed by bradycardia and went for cardio respiratory

arrest and could not revived and “DECLARED DEAD” on 19.12.10 at 6am.



A POSITIVE 19-12-2010 / 09:42





0

150000 to 450000 Cells/

cumm 20-12-2010 / 10:10








RBC macrocytic normochromic .8

NRBC/100 WBC.

No nucleated RBCs or hemoparasites

seen.


lymphocytic prepondrance.Mild shift to

left noted.


20-12-2010 / 10:10


NeutroPhils :28%

Eosinophils :02%

Monocytes :07%

Lymphocytes :57%

20-12-2010 / 10:10


IMPRESSION : MODERATE LEUKOCYTOSIS WITH

SHIFT TO LEFT.

20-12-2010 / 10:10

Name : B/o. Nandhini Age / Sex: NB/M Dept : NeonatologyHos.No : 491929 Mrd.No : 362369 Ward : I NB NICUD.O.A : 18.12.10 D.O.D :29.12.10************************************************************************

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH NEONATAL SEIZRUE WITH ACUTE RENAL FAILURE

COURSE:

This term / AGA / male baby was referred to MMHRC on 18.12.10 as a

case of MAS. H/o. Baby didn’t cry immediately afterbirth APGAR 4 and 6. baby

was resusciated and referred here for further management. Maternal history : 34

years, primi, k/c/o hypothyroidism on T- Eltroxin H/o. PIH +. No H/o. GDM, fever

with rash, UTI. Baby was delivered by LSCS ( Ind : fetal distress with mild PIH).

O/E : baby ET tube in situ tachypnoea +, dyspnoea +. CFT > 3 sec, RS : air entry

equal on both sides, bilateral crpts +, CVS : S1 S2 +, P/A : Soft, liver 1cm

palpable, CNS : NNR sluggish. Baby was investigated which showed Hb : 13, TC :

26900, platelet : 2.62 lakhs, CRP : Negative. PCV : 40, TSH : 3.12. Repeat Hb :

12.3 (28.12.10), serum creatinine : 1.5 (1.12.10), 1.4 (22.12), 1.4 (24.12), 1.6

(26.12), 1.6 (28.12). Blood culture showed no growth. ET tip culture sent awaited.

Serum K+ : 1.4. USG abdomen showed heterogenous echogenic cystic lesion in

right lobe of liver (26.12.10). Child was managed with mechanical ventilator

support, Iv. Fluids, Iv. Antibiotics, Inj. Ratnac, Inj. Calcium gluconate, Iv.

Inotropes and Vitamin K. As child had GI bleed, FFP was transfused on 22.12.10.

renal failure was managed with fluid restriction and Inj. Lasix. With these above

measues child respiratory distress settled, hence started weaning form ventilator

(23.12.10) and extubated on 27.12.10. Child developed respiratory distress on

28.12.10 and hence reintubated and connected to mechanical ventilator. Despite

this measures baby had persistent renal failure and had hypokalemia which was

corrected with KCL. Baby went in to sudden cardiac arrest at 12.30am (24.12.10).

Despite active resuscitation, could not be revived & DECLARED DEAD on

24.12.10 at 1am.

INVESTIGATIONHAEMATOLOGY & CLINICAL PATHOLOGY



BLOOD BANK


O POSITIVE 19-12-2010 / 10:04






0

10000 to 25000 Cells/

cumm 20-12-2010 / 10:14


0

150000 to 450000 Cells/

cumm 20-12-2010 / 10:14








BIO CHEMISTRY







Serum Thyroid Stimulating Hormone

(CLIA) 3.12 0.34 to 5.6 µIU/mL 19-12-2010 / 15:44


MICROBIOLOGY



PATHOLOGY


.

RBC macrocytic normochromic.3

NRBC/100WBC.

No hemoparasites nil.


mild shift to left.


20-12-2010 / 10:14


NeutroPhils :46%

Eosinophils :02%

Monocytes :08%

Lymphocytes :39%

20-12-2010 / 10:14


IMPRESSION : MARKED LEUKOCYTOSIS. 20-12-2010 / 10:14

Name : B/o. Logeswari Age / Sex: NB/M Dept : NeonatologyHos.No : 482816 Mrd.No : Ward : I NB NICUD.O.A : 14.10.10 D.O.D :31.12.10************************************************************************

DIAGNOSIS: PRETERM WITH VLBW RESPIRATORY DISTRESS SYNDROME (SURFACTANT GIVEN ON 14.10.10) PDA ( SURGICAL CLOSURE DONE ON 16.11.10) NEONATAL SEIZURE BRONCHOPULMONARY DYSPLASIA

Documents

Thesis