clinical meeting

1. Welcome to
clinical meeting
Dr. KANTA HALDER
Resident (MD;Phase A),
General paediartics,
BICH.

2. Particulars of the patient
 Name: Alziyan.
 Age: 9 days.
 Sex: Male.
 Address: Mirzapur, Tangail.
 Date of Admission: 25.11.2015.
 Date of Examination: 25.11.2015.

3. Chief Complaints
 Yellow colouration of skin & sclera
from 3rd day of life.

4. History of present illness
According to the statement of the mother,
baby was born normally before the expected
date of delivery at hospital with average
birth weight and cried immediately after
birth. The baby developed yellow
colouration of skin & sclera from 3rd day of
life which was increasing gradually day by
day.

5. History of present illness (cont)
With these complaints, they consulted a local
physician and did some investigations and
was referred to Dhaka Shishu Hospital for
further evaluation and better management.
On query, mother also stated that, her baby’s
blood group is A positive.

6. Birth History
Antenatal : Mother, Rumi Akter (para – 1), a 23
years old lady was on regular antenatal check
up and was normotensive & nondiabetic. She
had no h/o fever, rash or taking any offending
drug during her pregnancy period. She was
immunized against tetanus and her blood group
is O positive.

7. Birth History (cont..)
Postnatal : Baby cried immediately after birth,
needed no resuscitation.
Natal : Baby was delivered normally at 36 weeks
of gestation at hospital on 17.11.2015 at 03.40
AM due to maternal premature rupture of
membrane for 5 hours with birth weight of 2700
gm.

8. Family History
He is the 1st issue of his non-consanguineous
parents.
Socio-economic History
He came from a middle class family.
Feeding History
Breast feeding was started from 1 hour of
age and now the baby is on exclusive breast
feeding.

9. Physical Examination
o Baby was active, mildly pale, icteric up to palm
& sole.
o Weight : 2700 gm( falls above 10th centile ).
o Length : 48 cm ( falls above 10th centile ).
o OFC : 34 cm ( falls above 10th centile ).
o Temperature : 98° F.
o CRT ˂ 3 seconds.
o SPO₂ (Pulse oximeter) : 97% in room air.

10. Cont..
o Fontanelle : Normal, not bulged.
o Face : No dysmorphysm.
o Eye : Pupil size was normal, light reflex was
present.
o Ear : Formed pinna, firm and instant recoil.
o Nose : Normal.
o Oral cavity : Normal.
o Neck : Normal.

11. Cont..
o Respiratory rate : 38/min.
o No chest deformity, chest movement was
symmetrical on both side.
o Air entry was good and symmetrical in both
side, no added sound.
o Heart rate : 132/min.
o Apex beat was palpable in left 4th intercostal
space just medial to the mid clavicular line, 1st
and 2nd heart sound was audible in all 4 areas,
no murmur.

12. Cont..
o Abdomen : Soft, not distended.
o Umbillicus : Dry, healthy.
o Liver : Not palpable.
o Spleen : Not palpable.
o Kidneys : Not ballotable.
o Bowel sound : Present.
o Genitalia : Both testes are in scrotum.

13. Cont..
o Spine : Normal.
o Hip joints (both) : Normal.
o Movement of all joints : Normal.
o Muscle tone : Normal.
o Primitive reflexes : Moderate.
o No visible congenital anomaly.

14. Salient feature
Alziyan, 9 days old male neonate was
admitted with the complaints of jaundice
from 3rd day of age. Baby was born by vaginal
delivery at 36 weeks of gestational age with
birth weight of 2700 gm and cried
immediately after birth. Mother’s blood
group is O positive. Baby was active, mildly
pale, icteric up to palm & sole, primitive
reflexes were moderate with good muscle
tone. Vitals were within normal limit and his
blood group is A positive.

15. Provisional Diagnosis
Neonatal jaundice due to ABO incompatibility
in a Preterm (36 weeks) Appropriate for
Gestational Age baby.

16. Differential Diagnosis
Neonatal jaundice with sepsis in a Preterm
(36 weeks) Appropriate for Gestational Age
baby.

17. Investigations
Complete Blood Count :
• Hb%: 14.3 gm/dl
• WBC: Total count: 8,700/cumm
Differential count:
o Neutrophil: 52%
o Lymphocyte: 45%
o Monocyte: 01%
o Eosinophil: 02%
o Basophil : 00%

18. Cont.
o RBC: Normocytic with
normochromic.
o WBC: As distribution.
o Platelet: Thrombocytosis.
• Platelet : 5,44,000/cumm.
• PBF:

19. Cont..
RBC Indices :
RBC count : 4.01 m/µl.
HCT : 43.0 %.
MCV : 108.0 fl.
MCH : 36 pg
MCHC : 33.0 g/dl.
RDW : 13.0 %.

20. Cont..
Reticulocyte count: 02%.
S. Billirubin : Total – 34.20 mg/dl.
Direct – 0.70 mg/dl.
Indirect – 33.50 mg/dl.
Coomb’s test : Positive.

21. Cont..
RBS : 5.3 mmol/L.
S. Electrolytes : Na⁺ - 137.6 mmol/L.
K⁺ - 5.6 mmol/L.
Cl⁻ - 100.3 mmol/L.
S. Calcium : 2.59 mmol/L.
CRP : 2.5 mg/L.
Blood C/S : No growth of bacteria.

22. Final Diagnosis
Neonatal Jaundice due to ABO incompatibility
in a Preterm (36 weeks) Appropriate for
Gestational Age baby.

23. Management
A.Counseling.
B.Supportive:
 Maintenance of temperature.
 Maintenance of airway, breathing &
circulation.
 Maintenance of hydration and nutrition :
Breast feeding on demand along with Inf. 10%
dextrose in 0.225% NaCl (100ml/kg).
 Continuous phototherapy covering eyes and
genitalia.

24. Cont..
 Inj. Ceftazidime 100 mg/kg/day in 2 divided
doses.
 Inj. Amikacin 15 mg/kg/day in 2 divided
doses.
C.Specific:
 Exchange transfusion was done with 0 (+ ve)
blood on 26.11.2015.
D.Follow up.

25. Pre-exchange
S. Billirubin : Total – 24.5 mg/dl.
Direct – 0.5 mg/dl.
Indirect – 24.0 mg/dl.

26. Cont..
Complete Blood Count :
• Hb%: 11.5 gm/dl
• WBC: Total count: 8,800/cumm
• Platelet: 473,000/cumm.
• RBC Indices: RBC count : 3.36 m/µl.
HCT : 39.0 %.
MCV : 116.0 fl.
MCH : 34 pg
MCHC : 30.0 g/dl.
RDW : 11.0 %.

27. Post-exchange
S. Billirubin : Total – 8.3 mg/dl.
Direct – 0.3 mg/dl.
Indirect – 8.0 mg/dl.
RBS : 5.5 mmol/L.
S. Calcium : 2.2 mmol/L.
S. Electrolyte : Na⁺ - 147.8 mmol/L
K⁺ - 3.9 mmol/L
Cl⁻ - 98.7 mmol/L.

28. Cont..
Complete Blood Count :
• Hb%: 11.4 gm/dl
• WBC: Total count: 7,900/cumm
• Platelet: 303,000/cumm.
• RBC Indices: RBC count : 4.10 m/µl.
HCT : 38.0 %.
MCV : 93.0 fl.
MCH : 28 pg
MCHC : 30.0 g/dl.
RDW : 11.0 %.

29. Follow up
On 27.11.2015
S. Billirubin : Total – 16.4 mg/dl.
Direct – 0.4 mg/dl.
Indirect – 16.0 mg/dl.
On 29.11.2015
S. Billirubin : Total – 5.6 mg/dl.
Direct – 0.2 mg/dl.
Indirect – 5.4 mg/dl.

30. Thank you