neonatology

1. CASE PRESENTATION

2. Case presentation
• Baby of SELVARANI, 3 days old 2nd born male child
born to non consanguinous parents admitted in view of
respiratory distress
• The child was born on 2.9.15 at 11.45 am in RMMCH

3. Antenatal history
• Birth order : Gravida-2 ,Para-1,Live-1
• Maternal age : 32
• Age at conception : 31
• LMP: 14.12.2014
• EDD : 21.9.2015

4. Antenatal history
• Mode of conception : spontaneous
• Pregnancy confirmed by UPT at kammapuram GH at 45
days of LMP
• Booked and immunised
• Blood group : B positive

5. First trimester
• No h/o fever with rash
• No h/o bleeding per vagina
• No h/o radiation
• No h/o any drug intake
• USG scan not done IN FIRST TIRMESTER

6. Second trimester
• Quickening felt at 5 month
• No h/o GDM
H/o PIH-anti-hypertensive tab taken from 6th month
• No h/o bleeding per vagina
• TT injection taken at 5th & 7th month
• Usg revealed twin gestation – at 5 months
• Anomaly scan – done at 6 month. No anomalies
detected in both babies.
• Iron ,folic and calcium tablets taken from 4 th month..

7. Third trimester
• H/o PIH -Anti-hypertensive tab taken
• No h/o GDM
• No h/o UTI
• USG scan done found to be normal
• No bleeding pv
• No h/o any fever with rashes

8. Natal history
• EDD :21.9.2015
• Mode of delivery : LSCS
• Indication : previous LSCS with immenent eclampsia

9. Natal history
TWIN-1 TWIN-2
• Delivered a male baby of
birth weight 2.6 kg through
clear liquor with cephalic
presentation at 11.45 am on
2-8-15
APGAR 1ST min : 5
5 min : 7
• Baby cried immediately
after birth
• Delivered a male baby of
birth weight 2.5kg through
meconium stained liquor
with cephalic presentation
at 11.55 am on 2-8-15
• APGAR 1st min: 3
• 5 min : 5
• Baby didnot cry after birth;
established weak cry after
tube and bag ventilation
given for 20 min

10. neonatal history TWIN-1
• Baby [twin-1] is admitted in NICU in v/o respiratory
distress
• Passed meconium and urine at 1st day of life
• Baby was treated with nasal oxygen, IV fluids and
respiratory distress settled with in 24 hours of treatment

11. TWIN-2
• Baby was admitted in RNB in view of respiratory distress
and birth asphyxia
• Baby was treated with IV fluid ,iv antibiotic,and
mechanical ventilation were given, in spite of all the
measures baby expired at 2 am on 3-9-15

12. 40 yrs
32
yrs
4yrs

13. Family history
• History of twins in the fathers family
• No h/o any neonatal death / neonatal seizures /
developmental delay in the family

14. Socioeconomic history
• House : thatched
• No.of persons in the family 4
• Father 12th std , daily wages ,12,000 per month
• Mother 8th std. house wife
• According to modified kuppusamy scale upper middle
class

15. • Summary.
• 3 days old b/o selvarani.twin 1 delivered via lscs at
rmmch…cried imm after birth admitted in view of
respiratory distress and distress settled with in 24 hours
of admission

16. GENERAL EXAMINATION
• Age at examination:3rd day
• Posture :flexed
• Color : Pink
• Cry, Activity : GOOD
• Vital Signs
Heart Rate : 148 Beats/min
Resp. Rate : 44 /min
spo2 : 96% @ RA
CRT : < 2 secs

17. Anthropometry
• Weight : 2.5 kg
• length : 47 cm
• Head circumference : 36 cm
• Chest circumference : 33 cm

18. Head to Toe examination
• Head – normal
anterior fontanalle 3 X 3 cm
• Eyes : No discharge,no squint,no hypertelorism
• no sub-conj-hemorrhages
• Ears : no preauricular tag,no abnormal shape,external
auditory canal [patent]
• Nose : no bleeding,no flaring,patent

19. • Mouth : no cleft lip ,no cleft palate, no natal teeth,
• Neck : no swelling.
• Skin : pink
• Umblical cord : dried
• Genitals : testis descended
• Anus : patent
• Spine : normal
• Upper limb & lower limbs : normal

20. Systemic examination
• CVS
apical impulse at 4th ICS lateral to MCL
S1 & S2 normal
no murmurs
• RS
B/L air entry present
no added sounds
• Abdomen
umblicus-normal position , all quadrants moves with
respiration , no visible mass
no organomegaly

21. • CNS
AF at level pulsatile
Tone : normal
neonatal reflexes
ORAL REFLEXES:
• sucking
• Rooting
EYE REFLEXES
• Glabellar tap
• Mc Carthys reflex
• Light reflex

22. SPINE REFLEX
• Gallant’s reflex
• Perez reflex
LIMB REFLEXES
• Stepping
• Placing
• Moro’s
• Plantar and palmar grasp
• Magnet reflex

23. • 3 days old male newborn born to para -2, live-2 mother
whose gestational age is 37 weeks and 2 days/ AGA/
with respiratory distress most probable disgnosis
TRANSIENT TACHYPNEA OF NEWBORN

24. THANK YOU