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Maternal History Gravida 2; Para 0 ( 1 Abortion) Blood group : O positive. Diabetic on glugcophage Delivered live male by emergency C/section
Born 8/2/11 @ 1931 at a private Hospital by emergency c/section due to failure to progress & CPD(cephalopelvic
disproportion)
Baby X
AFTER BIRTH Shifted to NICU HR 145 RR 74 Sats 70% - 75% 30% incubator O2 Systolic murmur heard Cardiac Echo bidirectional flow Large PDA with
Diagnosis : PPHN
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N e xt f e w h ou r s
mode. Umbilical venous catheter was inserted. ABG showed respiratory acidosis.
4 H ou r s of a g e : Fluid Resuscitation:
5 ml NaHCO3 8.4% + 5 ml NACL 0.9%. Dopamine Infusion @ 2mcg/kg/min. Dobutamine infusion @ 2mcg/kg/min. Fentanyl infusion @ 1mcg/kg/hrs
At 6 hours of age
Vitals : BP 80/33 (47) mmhg HR: 132 SpO2: 62% Temp. 36.5C Blood Gas (1 hrs after reintubation) PH: 7.31 PCO2: 44 PO2: 110 BE: -4 HCO3: 22.6
At 6 hours of age
FFP infusion. NACL 0.9% bolus. Dopamine started. Fentanyl infusion started.
At 11 hours of age
Hypotension:
Bolus NACL 0.9%. Another FFP Infusion.
At 16 hours of age
Started HFOV by 4pm: map- 18 Amp- 40 Freq-10 FiO2-100 Started muscle relaxant and sedation. Dopamine Infusion 10mcg/kg/min. Started Dobutamine 5mcg/kg/min Another FFP given. X ray done
22 hours of life
Oscillator settings increased Map: 21 Frequency: 10 Amplitude: 40 Dobutamine dose increased HFOV continued with same setting for 14 hours
10
Day 2 of life
TPN and intralipid infusion started Repeat x-ray done - small opacity in RT upper zone Urinary catheter inserted ( urine output) Platelet count < 100 - PRBC transfused Elevated temperature noted Petechial and blanching rashes noted Acyclovir started Blood immunoassay for herpes sent.
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Day 3- Day 5
Continued same treatment HFOV settings decreased gradually according to baby's blood gases. Rashes subsided.
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Day 6
HFOV weaned off conventional ventilation started with AC+VG mode Urinary catheter removed urine output good Dopamine, Fentanyl infusion tapered Dobutamine discontinued.
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Day 7
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Day 8 - 10 of life.
Fentanyl infusion tapered. X ray done Rt lower zone clearing but Rt parahilar still has opacity. Sildenafil discontinued
15
Day 11-12
Baby extubated and put on BCPAP with FiO2-40% Peep-5 Fentanyl discontinued. Cranial ultrasound done normal.
16
Day 13- 17
BCPAP discontinued nasal cannula O2 Oral feeds given as tolerated
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Day 18 - 21
10 days of antibiotics completed 14 days of acyclovir completed Baby on full feeds Vitals stable Immunization given and hearing test passed Discharged with weight of 3620grms
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