1 / 18

SHIWANAND GOPE 90A NEONATOLOGY

Good ppt try to read

pratitmathura96
Download Presentation

SHIWANAND GOPE 90A NEONATOLOGY

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NEONATOLOGY CASE HISTORY VNMU SHIWANAND Gope 90A Ebiringha chinaekpera sandra 90A Shigwedha hileni N.n

  2. HISTORY • RH –ve WOMEN WITH 2ND PREGNANCY  • PREVIOUS BABY WAS NORMAL BUT Rh+VE • IT WAS A TERMED CHILD FULLY MATURED WITH GESTSTIONAL AGE 40 WEEKS AND IT WAS A NORMAL DELIVERY. • PREGNANCY ULTRASOUD WAS NORMAL.

  3. ANAMNESIS OF NEW BORN • BODY WEIGHT- 3KG • LENGTH- 57CM • AGE- 2 DAYS OLD • APGAR SCORE- 09 • ICTERUS APPEARED 1ST DAY OF LIFE AND ANEMIA.

  4. DIAGNOSIS • HEMOLYTIC DISEASE OF NEWBORN, RH INCOMPATIBILITY ICTERIC ANEMIC FORM, MODERATE GRADE. 

  5. STATUS LOCALIS • DAY 1-  • TEMPERATURE- 37DEGREE • BR- 43\MIN • HR- 153\MIN • ICTERUS OF HEAD AND TRUNK • LIVER AND SPLEEN SLIGHTLY ENLARGED

  6. STATUS LOCALIS  • DAY 2-  • TEMPERATURE – 37 DEGREE C • BR- 42 PER MIN • HR- 153 PER MIN • ICTERUS OF HEAD, TRUNK AND EXTREMITIES EXCEPT FOR FEET AND PALM • ANEMIA • STOOL AND URINE IS NORMAL

  7. CLINICAL FORM PRESENT • JAUNDICE • ANEMIA

  8. CLINICAL PRESENTATION SHOWING ANEMIA • PALLOR SKIN • LESS INTENSIVE JAUNDICE • MILD HEPATOSPLENOMEGALY ON ULTRASOUND

  9. CLINICAL PRESENTATION SHOWING JAUNDICE • ICTERIC AMNIOTIC FLUID • VERNIX CASEOSA AND UMBLICAL CORD • INTENSIVE JAUNDICE THAT APPEARS WITHIN FIRST 24 HOURS • 3 KARMER'S ZONE • LETHARGY DUE TO BILIRUBIN ENCEPHALOPATHY

  10. EVALUATION OF JAUNDICE • CLINICAL EXAMINATION SHOWS COLOUR OF SKIN AFTER SLIGHT PRESSING WITH THE FINGER TO THE DEPTH OF THE SUBCUTENEOUS FAT. • ACCORDING TO MODIFIED KRAMER'S SCALE SCORE IS 4 AS ICTERUS OF HEAD TRUNK AND EXTREMITIES EXCEPT FOR PALM AND FEET.  • SO ESTIMATED SERUM BILLIRUBIN LEVEL 250mcM/L

  11. LAB DIAGNOSTICS • ANEMIA • HYPERBILIRUBINEMIA {CORD BLOOD BILLIRUBIN MORE THAN 4mg\dL • PREVALANCE OF INDIRECT BILIRUBIN [NORMAL STOOL AND URINE COLOUR] • RETICULOCYTOSIS [30%] • BLOOD GROUP INCOMPATIBILITY • HYPOALBUMINEMIA • SMEAR SHOWS... POLYCHROMASIA, ANISOCYTOSIS, NO SPHEROCYTES.

  12. DIFFERENTIAL DIAGNOSIS

  13. TREATMENT PRINCIPLES • PHOTOTHERAPY • MEDICATIONS • EXCHANGE TRANSFUSION • ADEQUATE HYDRATION AND FEEDING • PREVENTION OF COMPLICATIONS  • ANTENATAL PROPHYLAXIS

  14. PHOTOTHERAPY • BABY WAS PLACED IN A SUPINE POSITION AFTER FEEDING. • THE BABY WAS UNDRESSED TO MAXIMISE THE AREA OF TREATMENT. • BABY WAS PROVIDED LIGHT PROOF PROTECTION TO PROTECT THE EYES • THE TEMPERATURE WAS CONTINUOUSLY MONITORED • CONTINUED WEIGHTTAKING WAS DONE TO SEE BABYS CONDITION AND STATE OF HYDRATION • FIBREOPTIC PHOTOTHERAPYBLANKETS WHERE USED. • CONTINUOUS PHOTOTHERAPY UP TO 16 –18 HRS WASPROVIDED EVERY DAY FOR 5 DAYS.

  15. STOPPING PHOTOTHERAPY • THE PHOTOTHERAPY WAS STOPPED AFTER THE SERUM BILIRUBIN HAS FALLEN TO 50mcmol\L

  16. FEEDING  • ENTERNAL FEEDING • CONTINUE LACTATION AND FEEDING SUPPORTS • MATERNAL EXPRESSED MILK WHEN ADDITIONAL FEEDS ARE INDICATED

More Related