PEDIATRICS – ACHIEVEMENTS

Double Volume Exchange Transfusion 

B/O  KIRUTHIKA  –  MALE  BABY

Late preterm / 35+2 wks / 2816 gms / AGA/ respiratory distress –EONS / ? congenital pneumonia / neonatal hyperbilirubinemia ( ABO incompatibility / hemolytic disease of new born )

A male baby born to the mother of  non – consanguineous marriage – delivered on 9/3/19 @ 11.30 am through LSCS in labour in view of previous LSCS. @ 35+2 wks of gestational age with  birth weight of 2816 gms which is appropriate for gestational age .Baby cried immediately after birth with APGAR of 7/10 and 8/10 on 1^ST and 5^th minute. Requiring no resuscitation .No external congenital malformation.

CLINICAL EXAMINATION;

RS:  RR – 60 – 80/Min  ,Mild Retractions + ,Spo2-> 95 % @ Npo2 2L / min BAE + – NVBS ,No added sounds.

CVS: H/R : 120-130/ min ,CFT – 2-3 Sec,S1 S2 +, No murmur

ABD; Soft, palpable spleen 1 cm below Lft costal margin, BS +

CNS:Tone – N; Cry – N , consolable ;Mental status – N ;BIND SCORE – zero

ISSUE AND COURSE IN HOSPITAL

Baby had respiratory distress since birth hence started on NPO2 @ 2L/Min and  chest x-ray was taken.

FINDINGS;   Prominent bronchovascular markings + ; ? right upperzone heterogenous opacity ;  ? patchy hyperinflation

In view of Early onset neonatal sepsis / Congenital pneumonia, IV antibiotics was started (Inj.TAXIM 150 mg/kg/day BD & Inj.AMIKACIN 15mg/kg OD) and upgraded to ( Inj.VANCOMYCIN and MEROPENAM)

Since mother had O- POSITIVE blood group, considering the risk of ABO incompability, Cord bilirubin was taken  which is 4.9 mg / dl. Baby blood group A- POSITIVE , DCT – Negative No family H/O suggestive of hemolytic disease

Baby Was Icteric up to thigh with serum bilirubin of 13.6mg / dl . @ 24 hrs of life which is over the phototherapy range. ( PT > 7 mg /dl @ 24 Hrs  ) , Hence Baby Was Started On Intensive phototherapy.Inspite of DS-PT,the serum bilirubin is on increasing trend. @ 43 hrs of life – 17.7 mg / dl  and @ 47 hrs of life  – 18.8mg /dl is noted [ range for PT > 11: DVET > 17 ]

Hence double volume exchange transfusion is started. Post transfusion vitals stable.

Serial values of Ser.Bilirubin are as follows;

@51 hrs of life 7.5 mg/dl

@59 hrs of life10.2 mg/dl

@68 hrs of life 13.5 mg/dl

@76 hrs of life  9.0mg/dl

@100 hrs of life 6.3 mg/dl

This is the first of its kind in the history of Trichy SRM Medical College Hospital