Sadunima Karunarathne,2 years & 6

months old twin baby girl from

Pasyala presented to the
developmental clinic with a delay in
walking.
She is premature
born at 30wks & 4 days by a normal
vaginal delivery.
No complications during pregnancy
but suddenly due to the rupture of the
membrane she gave birth to twins.

 Presented in breech presentation &

it has been a prolonged labour which
has taken 45mins to deliver her.
Her birth weight was 1.370gms.
Liqure clear.
Length - 35cm
OFC 28cm

 Baby was found to be in respiratory

depressed @ birth & she was
resuscitated with 2*5 inflation
breaths.
1 min
APGAR
SCORE

5mins
5

10mins
7

 Baby was kept in the SCBU for 12 days &

expressed breast milk was given 2days after the
birth.
At 20 days of age - her both eyes were
undergone a lazer treatment.
At the age of 8 months she was found to have a
herniaion @ the right inguinal area & @ 17
months it was surgically removed.
No past history of seizures.
Other baby didnt have any complications during
birth & her development is appropriate to her age.

Developmental History : Until 1 year & 3 months, the age which she has
started commander crawling parents havent
noticed any delay in her development.
Due to delayed walking in March she was taken
to Ragama Rehabilitation center &
physiotherapy was done.
After that Physiotherapy was given from a
private place in Kadawatha,but there was no
significant improvement.
Currently Baby is capable of standing with aid
but can not walk without aid.
She is capable of making simple phrases using
two or three words but doesnt say sentences
constantly. She can draw a line & plays
interactively with her sister.

 Immunizations are up to date.

Drug history At birth IV Penicillin &
Amoxillin was given for 7 days.
No known allergies.
No family history of similar conditions.
Social history :Father -37 years,Businessman,no
medical conditions, sometimes allergic
to food consuming lot of flour.
Mother-28 years,house-wife,no
medical conditions.
Income is Rs.40,000 per month.

 Living in a one story rented house.It is

close to their grandparents house so get
their support to look after the children.
Examination
Child looks alert & happy.
When walking with aid Spastic gait was
seen. Hip and the knees are flexed &
touching each other,walks from toes.
Lower limb examination
Quadriceps looks wasted, both ankles are
planter flexed,hypertonic,exaggerated
reflexes, Clones absent.
Examination of other systems including
upper limbs were unremarkable.

Investigations done : After 10 days from birth USS of the

brain,KUB,hips & a Chest X-Ray was
done.
They all appeared to be normal.
At 2 months of age another USS of
the brain was done & was reported of
having B/L periventriculer cystic
lesions & was suggested to follow up
in one month.
The next scan appeared normal.