Pediatric Case
August 16, 2019

Baby boy of shahad is 14 days old boy products , of SVD , uncomplicated pregnancy , no PROM , 38 weeks , BW 3 kg , GBS status unknown , no NICU admission , mother blood group is A+ , baby A – , coomb –ve discharge with his mother in a good condition with TSB 4.5

At age of 3 days came to our clinic  for routine check up TSB was done and it was 24.2 so shifted immediately to PICU and he spent in PICU only 1 day on intensive phototherapy then shifted to our Then at age of 6 days he came also for follow up in our clinic and TSB once again jumped to 23,

so for the second time he was shifted to picu for 1 day and started on intensive phototherapy then shifted to our floor with TSB 13,5 and started on double phototherapy and discharge with TSB 10,6

floor and discharge with TSB  13.7

At age of 11 days he came for follow up with TSB 19,3 and HGB dropped from 13.2 to 10.6 so he was admitted in our  floor as a case of low risk neonatal jaundice for investigation and low HGB for investigations

Systemic review:

No fever or irritability or lethargy or decrease in feeding or oral intake or sucking no skin rash or abnormal movement or cyanosis or apnea or SOB or change of urine color or smell or change in bowel habit

Natal history:

Mom was primigravida with complicated pregnancy due to oligohydrominous and placental insufficiency , she did not received any medications during pregnancy and no history of infections ,

GBS status unknown

No history of GDM or preeclampsia

Delivered SVD without any complications FT baby 38 week ,

BW 3 kg

Past surgical history

  • circumcision was done at age of 3 days minor bleeding from circumcision site was occur and dr taha khatab was consulted regarding this issue and advise to do coagulations profile and d.daimer and fibrinogen all was within normal range then no more bleeding occurred

Vaccination

Received both BCG and hip. B

Family history

Positive history  of NNJ from mother side

Physical Examination :

General / the patient looks well active alert not in distress jaundiced with yellowish discoloration of sclera with no signs of dehydrations

Vital signs /

T/36.7      HR/155     RR/44    P/140     O2/100%     BP/80/48

WT/ 3.4 kg ON 40th percentile

length/ 50 cm ON  40th percentile

HC/ 40 cm ON 50th percentile

CVS / s1 + s1 + 0      CR 2 sec

Chest / equal bilateral breath sounds no added sounds

Abd. / soft lax no organomegally

CNS /  intact    AF at level

SUMMURY :

14 days old baby boy 38 week svd no NICU admission baby blood A- , mom A +  , coomb –ve two hospital admission due to high TSB  and both of these admissions he was in picu and started only on intensive phototherapy no blood exchange or transfusion done

admitted this time with high tsb and dropping of HGB ,

as a case of/ LOW risk NNJ and dropping of HGB for investigations

Laboratory investigations :

DB TSB Date
0.6 24.2 7/3/2019
0.6 13.7 9/3/2019
0.66 23.4 10/3/2019
10.6 12/3/2019
0.74 19.0 15/3/2019

 

retics plt hgb wbc Date
4.5 291 19.0 10.5 4/3/2019
1.29   1.18 442 14.2 12.4 11/3/2019
* 502 13.7 12.5 12/3/2019
2.0 597 10.3 9.0 16/3/2019
2.8 578 10.4 10.4 17/3/2019

 

Procalcitonin / 0.05 Blood c/s / no growth  Crp/ 0,4
OSMOTIC FRAGILITY / 0.5 G6PD / 378 LDH 385
GGT/198 AST/26 ALT/14
VBG/ NORMAL BLOOD FILM/

MILD THROMBOCYTOSIS

ALP/163
PT/11.2 CREA/0.39 BUN/9.1
PYROVATE KINASE AND PARVO VIRUS B 19 / P INR/1 PTT/36