INTERNATIONAL HOSPITAL

“ LOTUS TOWER ”

G.S.ROAD

GUWAHATI - 5

A TERM AGA , BABY WAS BORN TO A PRIMIGRAVIDA MOTHER BY EMERGENCY LSCS (INDICATION – MSL) PRESENTED ON 2ND DAY OF LIFE WITH A HISTORY OF

BIRTH ASPHYXIASEVERE RESPIRATORY DISTRESS - MAS

REFUSAL OF FEEDING

ANURIA

GENERALIZED SEIZURE

CLINICAL FINDINGSTACHYCARDIA

TACHYPNOEASEVERE RETRACTIONSLETHARGY

PERIPHERAL CYANOSIS

POOR REFLEXES

POOR AIR ENTRY BILATERALLY ON THE CHEST SPO2 WAS MAINTAINED IN 60 – 70 % WITH O2 @ 10 LTS / MIN

LARGE CEPHALHAEMATOMA LEFT SIDE

INVESTIGATION

POSITIVE SEPSIS SCREEN CHEST X-RAY – OVER INFLATED CHEST

- INFILTRATES ELECTROLYTE IMBALANCEHIGH SERUM CREATININE – 6.8 mg / dl

( Normal – 0.5 – 1.4 mg / dl )

DIAGNOSIS

HIE STAGE II

SEPTICEMIA

MAS

ARF

MANAGEMENT

STABILIZATION AND FLUID RESUSCITATIONMECHANICAL VENTILATION STARTED IN VIEW OF DESATURATION AND INCREASED WORK OF BREATHING

I.V. ANTIBIOTICS & SUPPORTIVESPERITONEAL DIALYSIS

PERITONEAL DIALYSIS

1ST PERITONEAL DIALYSIS ON 3RD DAY OF LIFE - EACH EXCHANGE 50 ml DIALYSATE - TOTAL 58 EXCHANGES2ND PERITONEAL DIALYSIS ON 7TH DAY OF LIFE - IN VIEW OF INCREASING SERUM CREATININE LEVEL (8.6 ml / dl )

- EACH EXCHANGE 50 ml DIALYSATE

- TOTAL 30 EXCHANGES

PROGRESS

EXTUBATION DONE ON 11TH DAY OF LIFE URINE OUTPUT – .7 - .8 ml / kg / hour

CREATININE LEVEL HAS GONE DOWN TO 1.6 mg / dl

TOLERATING NASO GASTRIC FEEDING

STARTED BREAST FEEDING

SHIFTED TO MOTHER

FOLLOW UP

WEIGHT GAIN - NORMAL

RENAL FUNCTION TEST - NORMAL

BORDERLINE DELAYED MILE STONES

DISCUSSION

ARF IN NEONATE IS DEFINED AS SERUM CREATININE LEVEL > 1.5 mg / dl DESPITE NORMAL MATERNAL RENAL FUNCTION CAUSES OF ARF IN NEONATE ARE

- SEPSIS

- METABOLIC DISEASE

- PERINATAL ASPHYXIA

- PREMATURITY Cont.

INCIDENCE OF ARF IN NICU IS 3 – 10 %

MORTALITY RATE IN ARF IS 20 – 24 %

ARF NEEDS FOR DIALYSIS ALONG WITH MECHANICAL VENTILATION ARE ASSOCIATED WITH HIGH MORTALITY .

DISCUSSION