Thesis

APRIL 08 MARCH 09 MAS : 21
Jan 09
Name : B/o. MANGALAM Hos.No : 399420 Age / Sex: NB/M Mrd.No :302313 Dept : Neonatology Ward : I NB NICU
D.O.A : 26.12.08 REF. BY. DR. MAHALINGAM
D.O.D : 03.01.09 PLACE: MADRUAI
DIAGNOSIS: MECONIUM ASPIRATION WITH RESPIRATORY DISTRESS CHD [MODERATE ASD WITH PPHN] THROMBOCYTOPENIA COURSE:
This Term / AGA / Male / born at private hospital by LSCS (Indication: Meconium stained liquor) on 25.12.08. Baby cried soon after birth, H/o. Meconium aspiration +, and developed respiratory distress since birth for that transferred to MMHRC on 26.12.08 for further management. H/o. Cyanosis +. No Maternal H/o. PIH, GDM & PROM. O/E. Baby activity & cry: Weak, Peripheral cyanosis +, CFT > 3 sec, dyspnoeic +, tachypnoeic +, no birth injury, CVS: S1, S2 heard, murmur +. RS: RR: >60/mt, Bilateral air entry equal, P/A: soft, CNS: NNR sluggish. External genitalia : Left Undesended testis +. Baby was investigated Peripheral smear showed
Thrombocytopenia (Platelet count 20,000). Blood sugar & serum creatinine were normal. Chest X ray showed Bilateral meconium infiltration. Echo showed moderate sized ostium secundum type of ASD, L p R shunt and Mild PHT. Baby was managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate & Syp. Digoxin. Baby had hypotension, perfusion was low Inj. Dopamine was started. With the above measures baby respiratory distress reduced, so weaned form the ventilator
31.12.08 & started on tube feeds. Now baby is taking oral feeds and discharged today with the advice to continue further follow up with the referral doctor.
INVESTIGATIONS:
Investigation HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE Result 15.2 9100 43 113 39 34 13 3.8 7.9 60 38 02 20,000 CELLS 0.7 Unit gm/dl cells/cumm % FL PG % % FL % % % Date 26/12/2008 26/12/2008 26/12/2008 26/12/2008 26/12/2008 26/12/2008 26/12/2008 26/12/2008 26/12/2008 26/12/2008 26/12/2008
MILL/Cumm 26/12/2008
Lakhs/Cumm 26/12/2008 mg /dl 27/12/2008
PERIPHERAL SMEAR SHOWED (26.12.08):
RBCs show normochromic
normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No atypical or immature cells. DC: Neutrophils: 54%, Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 40%. Platelets normal in number and morphology. THROMBOCYTOPENIA. IMPRESSION:
ECHO REPORT SHOWED (27.12.08) : SITUS SOLITUS. LEVOCARDIA. AV, VA CONCORDANCE. NORMAL RELATED GREAT VESSELS. MODERATE SIZED OSTIUM SECUNDUM OF ASD. LEFT TO RIGHT SHUNT > 2:1. TR PEAK GRADIENT = 30mm of hg. NO PDA / COARCTATION. MILD PHT. IMPRESSION : MODERATE SIZED OSTIUM SECUNDUM TYPE OF ASD, L p R SHUNT AND MILD PHT. ADVICE ON DISCHARGE : Tab. Edigra Syp. Digoxin 1/8th 0.75ml TID OD x 1 week x Till further advice
PLAN : REPEAT ECHO AFTER 1 WEEK Admission weight : 3.690 Kg Discharge Weight : 3.680 Kg
Name : B/o. Amarshanthi

Hos.No: 399328
Age/Sex : NB/ M
Mrd.No : 302215
Dept
: Neonatology
Ward : IL.NB. NICU
D.O.A : 24/12/08 D.O.D : 25/12/08 ************************************************************************ DIAGNOSIS: NEONATAL JAUNDICE / RH INCOMPATIBILITY WITH NEONATAL CONVULSION AND ? MECONIUM ASPIRATION COURSE:
This 1 days old Term / Female / AGA born at private hospital by normal vaginal delivery on 23.12.08 to RH negative mother. No H/o Birth asphyxia. H/o. respiratory
distress since birth, H/o. ? meconium aspiration +, H/o. refusal of feeds +, H/o convulsion 1 episode. No maternal H/o PIG, GDM & PROM, O/E. Babys activity & cry were weak, Tachypnoeic +, dyspnoeic +, grunting +, cyanosis +, no birth injury, no obvious external anomaly. CVS: S1, S2 heard, RS: RR > 60/min, sub costal indrawing +, P/A: distension +, CNS: NNR sluggish. Baby was investigated peripheral smear showed leukoerythroblastic blood picture (HB : 13.3m%, TC 2 lakhs, Platelet count : 70000) DCT : positive, Serum bilirubin : 18.8mg%, Serum Creatinine : 1.1 mg%, Reticulocyte count : 3.6%. Baby was managed with mechanical ventilator support, Iv fluids, Iv
antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inj. Gardenol, Baby had severe jaundice, treated with triple sided phototherapy & exchange blood transfusion. Post exchange serum bilirubin was 16.1mg%. On 25.12.08 ABG showed respiratory acidosis & hyperkalemia, Asthalin nebulization & Inj. Insulin infusion started. Babys blood sugar hourly monitored. Baby developed Hypotension, ionotropes started. Baby had desaturation, persistent cyanosis & bradycardia, CPR carried out, Inj. Adrenaline, Inj. Atropine given. Even with above measures baby could not be revived, DECLARED DEAD on 25.12.08 at 9.30pm
INVESTIGATION :
Investigation CREATININE BILIRUBIN TOTAL BILIRUBIN DIRECT DIRECT ANTI HUMAN GLOBULIN TEST (COOMBS) HAEMOGLOBIN TOTAL COUNT HAEMOGLOBIN TOTAL COUNT PCV PCV MCV MCV MCH MCH MCHC MCHC RDW RDW RBC RBC MPV MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT PLATELET COUNT RETICULOCYTE COUNT (Children) BILIRUBIN TOTAL BILIRUBIN DIRECT Result 1.1 18.8 3.4 POSITIVE 13.3 gm/dl 2.0 LAKHS cells/cumm 13.3 gm/dl 2.0 LAKSH {TWICE RPT} cells/cumm 44 % 44 % 158 FL 158 FL 47 PG 47 PG 30 % 30 % 31 % 31.0 % 2.8 MILL/Cumm 2.8 MILL/Cumm 8.8 FL 8.8 FL 30 % 68 % 02 % 30 % 68 % 02 % 70,000 CELLS Lakhs/Cumm 70,000 CELLS Lakhs/Cumm 3.6 16.1 3.8{TWICE RPT} % mg/dl mg/dl Unit mg /dl mg/dl mg/dl Date 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008 25/12/2008
PERIPHERAL SMEAR (25.12.08): RBCs show normocytes and macrocytes. Nucleated RBCs 120 /100 WBCs. WBC count shows leukocytosis with shift to left. No atypical or immature cells. DC: Neutrophils: 25%, Eosinophils: 00%, Monocytes: 02%, Lymphocytes: 73%. Platelets count diminished. IMPRESSION: LEUKOERYTHROBLASTIC BLOOD PICTURE
FEB 09
Name : B/o. SOORATH EMINA

Hos.No: 403566
Age/Sex : NB/ F
Mrd.No : 305105
Dept
: Neonatology
Ward : IL.NB. NICU
D.O.A : 02/02/09 D.O.D : 05/02/09 ************************************************************************
REF.BY.DR.KYRDUDYN DIAGNOSIS: PNEUMONITIS (EARLY ONSET OF SEPSIS) COURSE:
PLACE : RAMNAD
This 5 days old Term / AGA/ female born at private hospital by LSCS (Indication : Previous LSCS with PROM) on 28.01.09. H/o. Baby cried immediately after birth and developed respiratory distress since birth, for that referred to MMHRC on 02.02.09 for further management. Maternal H/o. PROM 8 hours +, H/o. Meconium aspiration +, H/o. vomiting 2 episodes +, H/o PIH & GDM. O/E. activity & cry were weak, dyspnoeic +, tachypnoeic +, colour : icteric, CFT < 3 sec, no birth injury, no obvious external anomaly. CVS: S1, S2 heard, RS: Bilateral crepitation +, P/A: distended +, CNS : NNR sluggish. Baby was investigated Peripheral smear, Blood sugar & Serum creatinine were normal. Serum bilirubin T : 14.9mg%, D : 0.5mg%. Chest X-ray suggestive of Pneumonitis. Echo was normal. Baby was managed with oxygen, Iv
fluids, Iv antibiotics, Inj. calcium gluconate, Inj. Rantac & Phototherapy. With the above measures babys respiration became normal, activity improved and started on small tube feeds. Now baby is taking oral feeds and discharged today with the advice to continue the further follow-up with the referral doctor. INVESTIGATION :
Investigation CREATININE BILIRUBIN TOTAL BILIRUBIN DIRECT HAEMOGLOBIN TOTAL COUNT HAEMOGLOBIN TOTAL COUNT PCV PCV MCV MCV MCH MCH MCHC MCHC RDW RDW RBC RBC MPV MPV LYMPHOCYTE EOSINOPHIL MONOCYTES NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET Result Unit 0.3 mg /dl 14.9 0.5 mg/dl mg/dl gm/dl cells/cumm gm/dl cells/cumm % % FL FL PG PG % % % % MILL/Cumm MILL/Cumm FL FL % % % % % % Lakhs/Cumm Date 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009 02/02/2009
17.1 7200 51 101 34 33 18 4.9 6.7
58 40 02
COUNT PLATELET COUNT
2.4
Lakhs/Cumm
02/02/2009
PERIPHERAL SMEAR (02.02.09): RBCs shows normochromic normocytes and macrocytes . Nucleated RBCs 2/100 WBCs. WBC count normal. immature cells. No atypical or DC: Neutrophils: 42%, Eosinophils: 02%, Monocytes: 05%,
Lymphocytes: 51%. Platelets count normal in number and morphology. IMPRESSION: NORMAL SMEAR STUDY ECHO REPORT SHOWED (02.02.09) : SITUS SOLITUS. LEVOCARDIA.
NORMAL VALVES, IAS, IVS INTACT, GREAT VESSELS NORML, NO PDA / COARCTATION, NO PHT, NORMAL LV AND RV FUNCTION. IMPRESSION : NORMAL STUDY. ADVICE ON DISCHARGE : Inj. Magnex Inj.Amikacin. 125mg 40mg IV BD IVOD x 5 days x 5 days
Admission weight : 2.715 Kg Discharge weight : 2.975 Kg
Name : B/o. KALAIARASI Hos.No : 403698
Age / Sex: NB/ M Mrd.No : 305199
Dept : Neonatology Ward : I NB NICU
D.O.A :02.02.09 D.O.D : 20.02.09 ************************************************************************ REF. BY. DR. SABARI RAJA., PLACE : SIVAGANGAI DIAGNOSIS: MECONIUM ASPIRATION SYNDROME COURSE:
This Term / AGA / Male / born at private hospital by LSCS (Indication : Fetal Bradycardia with thick meconium stained liquor) on 02.02.09. H/o. Baby cried
immediately after birth and developed respiratory distress and convulsion since birth for that referred to MMHRC on 02.02.09 for further management. Maternal H/o. PROM 6 hours +, UTI +. No Maternal H/o PIH & GDM. O/E. Baby activity : Sluggish & cry: Irritable, peripheral cyanosis +, convulsion +, dyspnoeic +, tachypnoeic +, Pallor +, no birth injury, no obvious external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest indrawing+, P/A: soft, CNS: Irritable, Convulsion +. Baby was investigated Peripheral smear showed neutrophilic leukocytosis. Blood sugar & Serum creatinine were normal. Echo within normal limits. Chest X ray showed meconium aspiration syndrome. Baby was managed with Mechanical ventilator support, Iv fluids, Iv
antibiotics, Inj. Dopamine infusion, Inj. Gardenol, Inj. Calcium gluconate, Inj. Surfactant & Domstal drops. With the above measures babys respiratory distress reduced so
weaned from the ventilator on 12.02.09 & started on small tube feeds. On 12.02.09 as baby had lower chest indrawing, suspected as CLD hence started on Tab. Aldactone and
mucolite drops. Now babys respiration became normal and is taking breast-feeds and discharged today with advice to continue further fellow up with the referral doctor.
INVESTIGATION :
Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE Result "AB" POSITIVE 18.2 [ TWICE RPT ] 33900 54 114 38 33 19 4.7 7.3 80 19 01 1.9 0.8 Date 03/02/2009 gm/dl 03/02/2009 cells/cumm 03/02/2009 % 03/02/2009 FL 03/02/2009 PG 03/02/2009 % 03/02/2009 % 03/02/2009 MILL/Cumm 03/02/2009 FL 03/02/2009 % 03/02/2009 % 03/02/2009 % 03/02/2009 Lakhs/Cumm 03/02/2009 mg /dl 05/02/2009 Unit
PERIPHERAL
SMEAR
SHOWED
(03.02.09):
RBCs
shows
normochromic
normocytes and macrocytes . Nucleated RBCs 6/100 WBCs. neutrophilic leukocytosis. number and morphology. IMPRESSION: NEUTROPHILIC LEUKOCYTOSIS. No atypical or immature cells.
WBC count shows
DC: Neutrophils: 82%,
Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 12%. Platelets count normal in
ECHO CARDIOGRAPHY REPORT (07.02.09) : SITUS SOLITUS. LEVOCARDIA. NORMAL VALVES. GREAT VESSELS NORMAL. IAS, IVS INTACT. NO PDA/ COARCTATION. NO PULMONARY HYPERTENSION. NORMAL LV AND RV FUNCITON. IMPRESSION : NORMAL STUDY.
Admission Weight : 3.250 Kg Discharge Weight : 3.320 Kg
Name : B/o. PUSHPALATHA Hos.No : 404046
D.O.A :05.02.09 D.O.D : 20.02.09 ************************************************************************ REF. BY. DR. SABARI RAJA., PLACE : SIVAGANGAI DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH THROMBOCYTOPENIA COURSE:
This Term / AGA / Male baby born at private hospital by LSCS : (Indication : Previous LSCS) on 05.02.09. H/o. Baby cried immediately after birth and developed respiratory distress and convulsion since birth, for that referred to MMHRC on 05.02.09 for further management. Maternal H/o. Pervious LSCS, H/o. Consanguinous marriage. No Maternal H/o PIH, GDM & PROM. O/E. Baby activity & cry: Weak, peripheral cyanosis +, convulsion +, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest indrawing+, P/A: soft, CNS: NNR sluggish, Convulsion +. Baby was investigated Peripheral smear showed Thrombocytopenia. Blood sugar was normal. Serum creatinine : 1.1 (07.02.09), 1.2 (10.02.09), 0.8 (13.02.09). Platelet counts : 20,000 (05.02.09), 60,000 (10.02.09). Chest X ray showed meconium aspiration syndrome. Baby was managed with
Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Dopamine infusion, Inj. Nor adrenalin, Inj. Pavlon, Inj. Calcium gluconate, Inj. Gardenol, Inj. Rantac & Domstal drops. With the above measures babys respiratory distress reduced so weaned from the ventilator on 16.02.09 & started on small tube feeds. On 16.02.09 as baby had features suggestive of CLD started on Tab. Aldactone. Now babys respiration became normal and is taking oral feeds hence discharged today with advice to continue further fellow up with the referral doctor.
INVESTIGATION :
Investigation Result BLOOD GROUP " AB " POSITIVE RH TYPING BLOOD GROUP " AB " POSITIVE RH TYPING HAEMOGLOBIN 15.5 TOTAL COUNT 18700 HAEMOGLOBIN 15.5 TOTAL COUNT 18700 PCV 44 PCV 44 MCV 107 MCV 109 MCH 37 MCH 37 MCHC 34 MCHC 34 RDW 17 RDW 17.0 RBC 4.0 RBC 4.0 MPV 10.4 MPV 10.4 RBCs: NORMOCHROMIC NORMOCYTIC. NO HAEMOPARASITES ARE SEEN. WBCs: P/S COUNT IS NORMAL. NO IMMATURE CELLS ARE SEEN. PLATELET COUNT IS DECREASED. NEUTROPHILS 80 LYMPHOCYTE 19 EOSINOPHIL 01 NEUTROPHILS 80 LYMPHOCYTE 19 EOSINOPHIL 01 PLATELET 20,000 CELLS COUNT PLATELET 20,000 CELLS COUNT IMPRESSION THROMBOCYTOPENIA CREATININE 1.1 CREATININE 1.2 PLATELET 60,000 CELLS
Unit
Date 05/02/2009 06/02/2009
gm/dl cells/cumm gm/dl cells/cumm % % FL FL PG PG % % % % MILL/Cumm MILL/Cumm FL FL
05/02/2009 05/02/2009 06/02/2009 06/02/2009 05/02/2009 06/02/2009 05/02/2009 06/02/2009 05/02/2009 06/02/2009 05/02/2009 06/02/2009 05/02/2009 06/02/2009 05/02/2009 06/02/2009 05/02/2009 06/02/2009
06/02/2009
% % % % % %
05/02/2009 05/02/2009 05/02/2009 06/02/2009 06/02/2009 06/02/2009
Lakhs/Cumm 05/02/2009 Lakhs/Cumm 06/02/2009 06/02/2009 mg /dl 07/02/2009 mg /dl 10/02/2009 Lakhs/Cumm 10/02/2009
COUNT CREATININE
0.8
mg /dl
13/02/2009
PERIPHERAL
SMEAR
SHOWED
(03.02.09):
RBCs
shows
normochromic
normocytes and macrocytes . Nucleated RBCs 6/100 WBCs. neutrophilic leukocytosis. number and morphology. IMPRESSION: NEUTROPHILIC LEUKOCYTOSIS.
Admission Weight : 3.420 Kg Discharge Weight : 3.265 Kg
WBC count shows
No atypical or immature cells.
Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 12%. Platelets count normal in
Name : B/o. Ushnara {Twin I}

Hos.No: 406170
Age/Sex : NB/ M
Dept
: Neonatology
Mrd.No : 306825
Ward : IL.NB. NICU
D.O.A : 25.02.09 D.O.D : 26.02.09 ************************************************************************
DIAGNOSIS: PRE TERM (26 WEEKS) / ELBW RESPIRATORY DISTRES SYNDROME COURSE: This Pre Term (26 weeks) / ELBW / male / Twin I born at MMHRC by Normal vaginal delivery (Breech presentation) on 25.02.09. H/o. Baby had weak cry after birth and developed grunting and respiratory distress for that baby shifted to NICU for further management. No Maternal H/o PIH, GDM & PROM. O/E. Activity & cry were weak, grunting +, Peripheral cyanosis +, dyspnoeic +, tachypnoeic +, CFT > 3 sec, no birth injury, no obvious external anomaly. CVS: S1, S2 heard, hypotension +, RS: RR : >60/mt, Lower chest indrawing +, P/A: soft, CNS : NNR sluggish. Baby was investigated HB : 16.1 gm%, TC 18,400 cells, Platelet count 2.7 lakhs. Blood sugar was normal. Baby was managed in incubator with Mechanical ventilator support, Surfactant [2 doses], Iv fluids, Iv antibiotics, Inj. calcium gluconate, Inj. Vitamin K, Inj. Aminophylline & Ionotropes. With the above measures now baby is maintaining oxygen saturation of 97% with mechanical ventilator support of FIO2 30%. Since parents were not willing for further management, Baby is discharged Against Medical Advice on 26.02.09
INVESTIGATION :
Investigation Result BLOOD GROUP RH TYPING "O" POSITIVE Unit Date 25/02/2009
HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT
16.1 18,400 49 106 35 32 17.1 4.6 7.8 61 38 01 2.7
gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm
26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009
Name : B/o. Ushnara {Twin II} Age/Sex : NB/ M

Hos.No: 406171 Mrd.No : 306826
Dept
: Neonatology
Ward : IL.NB. NICU
D.O.A : 25.02.09 D.O.D : 26.02.09 ************************************************************************
DIAGNOSIS: PRE TERM (26 WEEKS) / ELBW RESPIRATORY DISTRES SYNDROME COURSE: This Pre Term (26 weeks) / ELBW / male / Twin II born at MMHRC by Normal vaginal delivery (Breech presentation) on 25.02.09. H/o. Baby had weak cry after birth and developed grunting and respiratory distress for that baby shifted to NICU for further management. No Maternal H/o PIH, GDM & PROM. O/E. Activity & cry were weak, grunting +, Peripheral cyanosis +, dyspnoeic +, tachypnoeic +, CFT > 3 sec, no birth injury, no obvious external anomaly. CVS: S1, S2 heard, hypotension +, RS: RR : >60/mt, Lower chest indrawing +, P/A: soft, CNS : NNR sluggish. Baby was investigated HB : 19.7 gm%, TC 11,200 cells, Platelet count 2 lakhs. Blood sugar was normal. Baby was managed with Mechanical ventilator support, Surfactant [3 doses], Iv fluids, Iv antibiotics, Inj. calcium gluconate, Inj. Vitamin K, Inj. Aminophylline & Ionotropes. With the above measures now baby is maintaining oxygen saturation of 92% with mechanical ventilator support of FIO2 85%. Since parents were not willing for further management, Baby is discharged Against Medical Advice on 26.02.09
INVESTIGATION :
Investigation Result BLOOD GROUP RH TYPING "A" NEGATIVE Unit Date 25/02/2009
HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT
19.7 11,200 60 103 33 32 17.5 5.8 8.2 24 75 01 2.0
gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm
26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009 26/02/2009
Name : B/o. ANITHA BEGAM

Hos.No: 404311
Age/Sex : NB/ M
Mrd.No : 305573
Dept
: Neonatology
Ward : IL.NB. NICU
D.O.A : 09/02/09 D.O.D : 28/02/09 ************************************************************************

REF. BY: DR.PREMA PRABHAKAR., PLACE: MELUR
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME CHD (SMALL MID MUSCULAR VSD, SMALL ASD, TINY PDA) COURSE: This new born Term / AGA/ male baby born at private hospital by LSCS (Indication : PROM with failure to induction ) on 08.02.09, H/o. Baby cried immediately after birth, then developed respiratory distress, H/o. Meconium aspiration +, H/o. cord around the neck +, for that referred to MMHRC on 09.02.09. Maternal H/o. PROM + with failure to induction. No Maternal H/o PIH & GDM. O/E. Baby activity & cry were weak, dyspnoeic +, Tachypnoeic +, no cyanosis, CVS: S1, S2 heard, RS: RR > 60/mt. lower chest indrawing +, Bilateral crepitation +, P/A: soft, CNS : NNR sluggish. Baby was investigated Peripheral smear showed neutrophilic leukocytosis, Blood sugar & Serum creatinine were normal. Serum magnesium : 6.6. Chest X-ray suggestive of meconium aspiration syndrome. ECHO showed small mid, muscular VSD, Small ASD, Tiny PDA. Baby was managed with mechanical ventilator, Iv fluids, Iv antibiotics, Inj. Nor adrenaline infusion, Inj. Dopamine infusion, Inj. calcium gluconate, Inj. Rantac, Tab. Edigra & Syp. Digoxin. With the above measures babys respiratory distress reduced and weaned from mechanical ventilator on 18.02.09 and started on small tube feeds. On 18.02.09 Tab. Aldactone was started since respiratory features were suggestive
of CLD. Now baby is on breast feeds and discharged today with the advice to continue further follow up with the referral doctor.
INVESTIGATION :
Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE MAGNESIUM Result "A" POSITIVE 13.8 17200 42 94 30 32 16 4.4 6.6 80 19 01 3.0 0.9 6.6 Date 09/02/2009 gm/dl 09/02/2009 cells/cumm 09/02/2009 % 09/02/2009 FL 09/02/2009 PG 09/02/2009 % 09/02/2009 % 09/02/2009 MILL/Cumm 09/02/2009 FL 09/02/2009 % 09/02/2009 % 09/02/2009 % 09/02/2009 Lakhs/Cumm 09/02/2009 mg /dl 11/02/2009 mg/dl 14/02/2009 Unit
PERIPHERAL SMEAR SHOWED (09.02.09): RBCs show normochromic normocytes and few macrocytes. No nucleated RBCs or hemoparasites. WBC count shows neutrophilic leukocytosis. No atypical or immature cells. IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS.
ECHO REPORT SHOWED (09.02.09) : SITUS SOLITUS. LEVOCARDIA. SMALL MID MUSCULAR VSD, TINY PDA, SMALL OSTIUM SECUNDUM TYPE OF ASD, L -> R SHUNT, NO PAH, GOOD LV AND RV FUNCTION. IMPRESSION : CHD. SMALL MID MUSCULAR VSD, TINY PDA, SMALL ASD. NO PAH.
APRIL 09
Hos.No : 409759 Mrd.No : 309279 Ward : I NB NICU
D.O.A : 28.03.09 D.O.D : 08.04.09 ************************************************************************ REF. BY. DR. VIGNESHRAJ PLACE: DINDIGUL
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH THROMBOCYTOPENIA ? EARLY ONSET SEPSIS COURSE:
This pre term 36 weeks / AGA / Male / born at private hospital by LSCS (Indication: Oligohydraminios) on 28.03.08. H/o. Baby cried soon after birth, H/o. Meconium aspiration +, resuscitated at referral doctor clinic and developed respiratory distress since birth for that referred to MMHRC on 28.03.09 for further management. Maternal H/o. PROM 6hours +. No Maternal H/o. PIH & GDM. O/E. Baby activity & cry: Weak, colour : Pink, CFT < 3 sec, dysphonic +, tachypnoeic +, no birth injury, CVS: S1, S2 heard, RS: RR: >60/mt, low chest indrowing, Bilateral air entry equal, P/A: soft, CNS: NNR sluggish. Baby was investigated Peripheral smear showed leukocytosis & Thrombocytopenia (HB : 20.6%mg/dl, TC : 22,800, Platelet count 20,000). Blood sugar was normal. serum creatinine 1.1mg/dl (30.03.09), 0.7mg/dl (31.03.09). Chest X ray showed Bilateral meconium infiltration. Baby was managed with C-PAP, Iv fluids, Iv antibiotics, Inj. Calcium
gluconate & Ionodrops. Baby had persistent respiratory distress, Inj. Midazolam infusion started on 30.03.09. With the above measures baby respiratory distress reduced, so weaned form the C-PAP on 03.04.09 & started on tube feeds. Now baby is taking oral feeds and discharged today with the advice to continue further follow up with the referral doctor. INVESTIGATION :
Investigation HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE CREATININE Result Unit 20.6 [ TWICE RPT ] gm/dl 22800 cells/cumm 57 % 109 FL 38 PG 35 % 12.7 % 5.3 MILL/Cumm 7.8 FL 59 % 40 % 01 % 20,000 CELLS Lakhs/Cumm 1.1 mg /dl 0.7 mg /dl Date 29/03/2009 29/03/2009 29/03/2009 29/03/2009 29/03/2009 29/03/2009 29/03/2009 29/03/2009 29/03/2009 29/03/2009 29/03/2009 29/03/2009 29/03/2009 31/03/2009 31/03/2009
PERIPHERAL SMEAR SHOWED (30.03.09) :
normocytes and macrocytes. Nucleated RBCs 5/100 WBCs. WBC count shows leukocytosis. No atypical or immature cells. DC: Neutrophils: 49%, Eosinophils: 01%,
Monocytes: 05%, Lymphocytes: 45%. Platelet count diminished. LEUKOCYTOSIS. THROMBOCYTOPENIA.
IMPRESSION:
Name : B/o. Poomari Hos.No : 408068
Age / Sex: NB/F Mrd.No : 308130
D.O.A : 13.03.09 D.O.D : 08.04.09 ************************************************************************ REF. BY. DR. MUTHUPANDIAN PLACE: MANAMADURAI DIAGNOSIS: MECONIUM ASPIRATION SYNDROME CHD [SMALL ASD WITH MILD PAH] ACUTE RENAL FAILURE (RECOVERED) COURSE:
This Term / AGA / Female / born at private hospital by LSCS (Indication: Failure to Progress) on 13.03.09. Baby cried soon after birth, H/o. Meconium aspiration +, and developed respiratory distress since birth for that referred to MMHRC on 13.03.09 for further management. No Maternal H/o. PIH, GDM & PROM. O/E. Baby activity : Weak, cry: Irritable, Colour : Pink, CFT > 3 sec, dyspnoeic +, tachypnoeic +, no birth injury, CVS: S1, S2 heard, murmur +, RS: RR: >60/mt, lower chest indrowing +,
P/A: soft, CNS: NNR sluggish. Baby was investigated Peripheral smear & Blood sugar were normal. Serum creatinine : 1.2mg/dl (14.03.09), 1.4mg/dl (17.03.09), 0.9mg/dl (19.03.09). Chest X ray showed bilateral meconium infiltration. Echo showed
congenital heart disease, Small sized ostium secundum type of ASD (4 5mm), L p R
shunt and Mild PAH. Baby was managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Inj. Midazolam Infusion & Ionotropes. Child had ET bleed, FFB transfusion given. On 14.03.09 babys oxygen saturation not maintained & surfactant 1dose given, on 23.03.09 baby was pale, packed cell transfusion given. With the above measures baby respiratory distress reduced, so weaned form the ventilator 03.04.09 & started on tube feeds. Now baby is taking breast feeds and discharged today with the advice to continue further follow up with the referral doctor. INVESTIGATION :
Investigation Result BLOOD GROUP RH TYPING "B" POSITIVE HAEMOGLOBIN 12.9 TOTAL COUNT 13900 PCV 37 MCV 103 MCH 35 MCHC 34 RDW 17.1 RBC 3.6 MPV 6.6 NEUTROPHILS 85 LYMPHOCYTE 14 EOSINOPHIL 01 PLATELET COUNT 2.5 CREATININE 1.2 CREATININE 1.4 CREATININE 0.9 Unit gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm mg /dl mg /dl mg /dl Date 14/03/2009 13/03/2009 13/03/2009 13/03/2009 13/03/2009 13/03/2009 13/03/2009 13/03/2009 13/03/2009 13/03/2009 13/03/2009 13/03/2009 13/03/2009 13/03/2009 15/03/2009 17/03/2009 19/03/2009
normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No atypical or immature cells. DC: Neutrophils: 88%, Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 06%. Platelet count normal in number and morphology.
IMPRESSION: NORMAL SMEAR STUDY. ECHO REPORT (16.03.09) : SITUS SOLITUS, LEVOCARDIA, SMALL OSTIUM SECUNDUM TYPE OF ASD SEEN ( 4 5mm) L -> R SHUNT, IVS INTACT, RVSP ~ 35mm of HG, MV,AV,PV NORMAL, GREAT VESSELS NORMALLY ARISING, NO PERICARDIAL EFFUSION, NO PDA / COARCTATION, NORMAL LV AND RV FUNCTION. IMPRESSION : CONGENITAL HEART DISEASE. SMALL PDA. MILD PAH ADVICE ON DISCHAGRE : Syp. Deriphyllin Domstal drops Zincovit drops Evion drops 8 drops 5 drops 10 drops 5 drops TID TID OD OD x 2 weeks x 2 weeks x Till further advice x Till further advice
Name : B/o. Thanga radhika Age / Sex: NB/ F Dept : Neonatology Hos.No : 410141 Mrd.No : 309586 Ward : I NB NICU D.O.A :02.04.09 D.O.D : 16.04.09 ************************************************************************ REF. BY. DR.ANBURAJAN., PLACE : THENI DIAGNOSIS: MECONIUM ASPIRATION SYNDROME COURSE:
This Term / AGA / female / born at private hospital by LSCS (Indication : Primi with CPD) on 01.04.09. H/o. Baby did not cry immediately after birth, resuscitation was done at referral doctor clinic. Baby developed respiratory distress since birth, for that referred to MMHRC on 02.04.09, for further management. H/o. Meconium stained liquor +. No Maternal H/o PIH, PROM & GDM. O/E. Baby activity & cry were weak, Peripheral cyanosis +, poor perfusion +, grunting +, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest indrawing+, Bilateral crepitations +, P/A: soft, CNS:NNR sluggish. Baby was
investigated Peripheral smear showed neutrophilic leukocytosis. Blood sugar was : 34mg/dl (Corrected with dextrose). Serum creatinine was normal. Chest X-ray showed bilateral infiltration. Baby was managed with Mechanical ventilator support, Ionotropes,
Iv fluids, Iv antibiotics, Inj. Gardenol, Inj. Calcium gluconate and Inj. Vitamin K. With the above measures babys respiratory distress reduced so weaned from the ventilator on 08.04.09 & started on small tube feeds. Now babys respiration became normal and is
taking Oral feeds and discharged today with advice to continue further fellow up with the referral doctor.
INVESTIGATION :
Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE Result "B" POSITIVE 17.8 26,800 53 105 35 33 11.9 5.0 8.2 58 40 02 2.0 0.7 Date 02/04/2009 gm/dl 02/04/2009 cells/cumm 02/04/2009 % 02/04/2009 FL 02/04/2009 PG 02/04/2009 % 02/04/2009 % 02/04/2009 MILL/Cumm 02/04/2009 FL 02/04/2009 % 02/04/2009 % 02/04/2009 % 02/04/2009 Lakhs/Cumm 02/04/2009 mg /dl 03/04/2009 Unit
PERIPHERAL SMEAR SHOWED (02.04.09): RBCs shows normochromic normocytes and macrocytes . Nucleated RBCs 2/100 WBCs. WBC count shows neutrophilic
leukocytosis. No atypical or immature cells. DC: Neutrophils: 56%, Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 38%. Platelets count normal in number and morphology. IMPRESSION: NEUTROPHILIC LEUKOCYTOSIS.
Admission Weight : 2.825 Kg Discharge Weight : 2.72
MAY 09
Name : B/o. Kavitha

Hos.No: 414605
Age/Sex : NB/ F
Mrd.No : 312433
Dept
: Neonatology
Ward : IL.NB. NICU
D.O.A : 09.05.09 D.O.D : 09.05.09 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA MECONIUM ASPIRATION BILATERAL PNEUMOTHORAX COURSE: This Term / AGA/ Female born at private hospital by Normal vaginal delivery on 09.05.09. H/o. Baby had weak cry immediately after birth resuscitated at referral doctor clinic, H/o. Thick meconium stained liquor +, H/o. Respiratory distress since birth for that referred to MMHRC on 09.05.09 for further management. No Maternal H/o PIH, GDM & PROM. O/E. On admission baby had no spontaneous respiration, HR : 60/mt, cyanosis +, CFT > 3 sec, BP not recordable, intubated and connected to Mechanical ventilator support. CVS: S1, S2 heard, BP not recordable, RS: Bilateral air entry diminished, P/A: soft, CNS : NNR not elicitable. Baby was investigated Peripheral
smear showed neutrophilic leukocytosis. Chest X-ray showed Bilateral Pneumothorax. ICD done bilaterally. Baby was managed with Mechanical ventilator support, Ionotropes, Iv fluids, Iv antibiotics, Inj. NaHco3, Inj. calcium gluconate & Inj. Vitamin K. Even with the above measures babys O2 Saturation not maintained, had persistent bradycardia followed by cardiac arrest. CPR was carried out, Inj. Adrenaline & Atropin were given. Baby could not be revived, Declared Dead on 09.05.09 at 9.10 PM. INVESTIGATION :
Investigation HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT Result 12.7 38,700 [TWICE RPT] 39 111 35 32 19.7 3.5 7.2 74 25 01 3.7 Unit gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm Date 10/05/2009 10/05/2009 10/05/2009 10/05/2009 10/05/2009 10/05/2009 10/05/2009 10/05/2009 10/05/2009 10/05/2009 10/05/2009 10/05/2009 10/05/2009
PERIPHERAL SMEAR (21.01.09): RBCs shows normochromic normocytes and macrocytes. Nucleated RBCs 5/100 WBCs. WBC count shows neutrophilic
leukocytosis. No atypical or immature cells. DC: Neutrophils: 64%, Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 30%. Platelets count normal in number and morphology. IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS
Name : B/o. Regina Age / Sex: NB/F Dept : Neonatology Hos.No : 415649 Mrd.No :313091 Ward : I NB NICU D.O.A :18.05.09 D.O.D : 29.05.09 ************************************************************************ DIAGNOSIS: PRETERM (32 WEEKS) / LBW RESPIRATORY DISTRESS SYNDROME SURFACTANT THREAPY GIVEN
COURSE:
This Preterm (32 weeks) / LBW / male born at MMHRC by LSCS (Indication : premature labour with transverse lie) on 18.05.09. H/o. Baby cried immediately after birth, then developed respiratory distress and grunting since birth, for that admitted in NICU, for further management. Maternal H/o. PCOD +, conception after PCOD
puncturing. No Maternal H/o. PIH, GDM & PROM. O/E. Activity & cry were weak, Peripheral cyanosis +, grunting +, CFT prolonged, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anomaly. CVS : S1 & S2 heard, RS : RR > 60/mt, subcostal retraction +, Bilateral air entry equal. P/A : Soft, CNS : NNR sluggish. Baby was
investigated : Peripheral smear, Blood sugar were normal. Serum creatinine : 1.0 mg/dl. Chest x-ray showed respiratory distress syndrome. Baby was managed with mechanical ventilator support, Ionotropes, surfactant (2doses), Iv fluids, Iv antibiotics, Inj. Aminophylline, Inj. calcium gluconate, Inj. Vitamin K, FFP transfusion & Single side Phototherapy. With the above measures babys activity improved, respiration became normal & started on small tube feeds. Now baby is taking oral feeding and discharged today with the advice to continue the following. INVESTIGATION :
Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE Result "A" POSITIVE 17.0 (TWICE RPT) 6700 51 109 36 33 17.2 4.6 7.9 50 49 01 2.5 1.0 gm/dl cells/cumm % FL PG % % FL % % % mg /dl Unit Date 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 20/05/2009
MILL/Cumm 19/05/2009
Lakhs/Cumm 19/05/2009
normocytes, macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No atypical or immature cells. Lymphocytes: 49%. DC: Neutrophils: 49%, Eosinophils: 01%, Monocytes: 01%, Platelet count normal in number and morphology.
IMPRESSION: NORMAL SMEAR STUDY.
Name : B/o. Bobby Age / Sex: NB/F Dept : Neonatology Hos.No : 415669 Mrd.No :313127 Ward : I NB NICU D.O.A :18.05.09 D.O.D : 29.05.09 ************************************************************************
REF.BY.DR. RAJA GOPAL BOOMA NURSING HOME PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION PNEUMOTHORAX (RIGHT SIDE) ACUTE RENAL FAILURE (RECOVERED) ASD WITH PDA
COURSE:
This 2 days old Term / AGA / female / born at private hospital by LSCS (Indication : Meconium stained liquor) on 17.05.09. H/o. Baby cried immediately after birth and developed respiratory distress since birth. H/o. Meconium aspiration +, for that referred to MMHRC on 18.05.09 for further management. No Maternal H/o PIH, PROM & GDM. O/E. Babys activity & cry were weak, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest
indrawing+, P/A: soft, CNS: NNR sluggish, Baby was investigated HB:18gm%, TC : 4,700, Platelet count 80,000 (19.5.09) 70,000 (21.05.09), Blood sugar was normal. Serum creatinine : 1.5mg/dl(19.05.09), 1.7mg/dl(21.05.09). 1.2mg/dl( 22.05.09), 0.9mg/dl(23.05.09), Blood urea : 60mg/dl(21.05.09). 53mg/dl ( 22.05.09),
56mg/dl(23.05.09). Serum LDH was elevated. Urine routine showed albumin 2+, Urine PCR : Protein - 45, Creatinine : 13, ratio - 3.6 : 1.0. Echo showed congenital heart disease- Moderate sized ASD with PDA, Mild PAH. USG abdomen showed bilateral medical renal disease. Chest X ray showed right side pneumothorax (18.05.09). Repeat X-ray was normal (19.05.09). Nephrologist opinion was obtained. Baby was managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Midazolam infusion, Inj. Lasix, Inj. Calcium gluconate & Inj. Vitamin K. With the above measures babys
respiratory distress reduced, weaned from the ventilator on 24.05.09 & started on small tube feeds. Now babys respiration became normal, activity improved, serum creatinine became 0.9mg/dl(23.05.09) and taking breast-feeds. Baby is discharged today with
advice to continue further follow up with the referral doctor.
INVESTIGATION :
Investigation BLOOD GROUP RH TYPING CREATININE HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE UREA CREATININE PLATELET COUNT POTASSIUM SODIUM UREA LDH COLOUR TRANSPARENCY REACTION ALBUMIN SUGAR EPI CELLS PUS CELLS URINE SPOT PROTEIN URINE SPOT CREATININE URINE FOR PROTEIN CREATININE
Result "B" POSITIVE 1.5 18.0 (TWICE RPT) 4700 54 119 39 32 21 4.5 7.2 67 32 01 80,000 CELLS 1.7 60 1.2 70,000 CELLS 2.0 128 53 730 YELLOW CLEAR ACIDIC [++] NIL 2-3 2-3 45 13 3.6 : 1.0
Unit mg /dl gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm mg /dl mg/dl mg /dl Lakhs/Cumm mEq / L mEq / L mg/dl Iu/l
Date 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 19/05/2009 21/05/2009 21/05/2009 22/05/2009 21/05/2009 21/05/2009 21/05/2009 22/05/2009 21/05/2009 22/05/2009 22/05/2009 22/05/2009 22/05/2009 22/05/2009 22/05/2009 22/05/2009 22/05/2009 22/05/2009 22/05/2009
/ HPF / HPF mg/dl mg/dl
RATIO CREATININE POTASSIUM SODIUM UREA
0.9 2.1 135 56
mg /dl mEq / L mEq / L mg/dl
23/05/2009 23/05/2009 23/05/2009 23/05/2009
RBCs show normochromic No
normocytes, macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal.
atypical or immature cells. DC: Neutrophils: 67%, Eosinophils: 00%, Monocytes: 01%, Lymphocytes: 32%. Platelet count adequate.
ECHO SHOWED ON 21.05.09 : SITUS SOLITUS, LEVOCARDIA, 3MM OSTIUM SECUNDUM TYPE OF ASD SEEN, L -> R SHUNT, IVS INTACT, 1mm PDA SEEN, L -> R SHUNT, MV, AV, PV NORMAL, RVSP 30mm of hg, CHAMBERS NORMAL SIZE, NORMAL LV FUNCTION, GREAT VESSELS NORMALLY ARISING, NO COARCTATION. IMPRESSION : CONGENITAL HEART DISEASE, MODERATE SIZED ASD WITH PDA, MILD PAH. USG ABDOMEN PELVIS REPORT ON 21.05.09 : Bilateral medical renal disease. ADVICE ON DISCHARGE : Syp. Domstal drops 8 drops TID x 2 weeks
Admission weight : 2.290kg

Discharge weight : 2.195kg
JUNE 09
Name : B/o. Jothi Lakshmi Age / Sex: NB/ F Dept : Neonatology Hos.No : 415923 Mrd.No : 313278 Ward : I NB NICU D.O.A : 20.05.09 D.O.D : 01.06.09 ****************************************************************** REF. BY. DR.ARAVIND BABU., PLACE : VIRUDHUNAGAR DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERINATAL ASPHYXIA PERSISTENT PULMONARY HYPERTENSION COURSE: This Term / AGA / female born at private hospital by forceps delivery on 20.05.09 to RH negative mother. H/o. Baby cried immediately after birth and developed respiratory distress since 2 hours of life, for that referred to MMHRC on 20.05.09, for further management. H/o. Meconium Aspiration +. No H/o. Cord around the neck, convulsion. No Maternal H/o PIH, GDM & PROM. O/E. Baby activity & cry were weak, Peripheral cyanosis +, dyspnoeic +, tachypnoeic +, left club foot +, cephalhematoma +, no obvious external anomaly, CVS: S1, S2 heard, RS: RR: >60/mt, Lower chest indrawing+, Grunting +, Bilateral air entry equal, P/A: soft, CNS:NNR Absent. Baby was investigated
Peripheral smear showed neutrophilic leukocytosis. Blood sugar & Serum creatinine were normal. Serum Bilirubin : T 3.2, D 0.6. DCT was negative. Echo showed Congenital Heart disease, Tiny PDA with PFO, mild PAH (? Newborn PAH). Baby was managed with Mechanical ventilator support, Ionotropes, 1 dose of surfactant, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Rantac, Inj. Vitamin K, Tab. Edigra, Mucolite drops, Domstal Drops, & FFB transfusion. With the above measures babys Respiratory distress came down, hence weaned from ventilator on 27.05.09, then started on small tube feeds. Baby tolerated feed well and increased slowly. Now baby is on sufficient oral feeds and
discharged today with advice to continue the following. INVESTIGATION :

Investigation BLOOD GROUP RH TYPING BILIRUBIN TOTAL BILIRUBIN DIRECT DIRECT ANTI HUMAN GLOBULIN TEST (COOMBS) HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE Result Unit "B" POSITIVE 3.2 mg/dl 0.6 mg/dl "NEGATIVE" 20.5 15,500 63 105 34 32 19.9 6.0 7.4 69 30 gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % Date 21/05/2009 20/05/2009 20/05/2009 21/05/2009 20/05/2009 20/05/2009 20/05/2009 20/05/2009 20/05/2009 20/05/2009 20/05/2009 20/05/2009 20/05/2009 20/05/2009 20/05/2009
EOSINOPHIL PLATELET COUNT CREATININE CREATININE
01 2.1 0.9 0.6
% Lakhs/Cumm mg /dl mg /dl
20/05/2009 20/05/2009 21/05/2009 29/05/2009
PERIPHERAL
SMEAR
SHOWED
(02.04.09):
RBCs
shows
normochromic
normocytes and macrocytes . Nucleated RBCs 2/100 WBCs. neutrophilic leukocytosis. No atypical or immature cells.
WBC count shows
Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 32%. Platelets count normal in number and morphology. IMPRESSION: NEUTROPHILIC LEUKOCYTOSIS.
ECHO CARDIOGRAPHY REPORT (21.05.09) : SITUS SOLITUS.
LEVOCARDIA.
SMALL PFO +. L p R SHUNT. TINY PDA + (<1mm). L p R SHUNT. ALL CHAMBERS NORMAL SIZE. NORMAL LV AND RV FUNCTIN. IVS INTACT. NORMALLY ARISING. COARCTATION. IMPRESSION. CONGENITAL HEART DISEASE. TINY PDA WITH PFO MILD PAH (? NEWBORN PAH) GREAT VESSELS NO
MV, RV, PV NORMAL. RVSP $ 35 mm of hg.
ADVICE ON DISCHARGE : Tab. Edigra 50mg 1/10th BD x 2 weeks
Name : B/o. Seema Age / Sex: NB/ M Dept : Neonatology Hos.No : 418760 Mrd.No : 315274 Ward : I NB NICU D.O.A : 13.06.09 D.O.D : 17.06.09 ******************************************************************
REF. BY. DR.SARAVANAN.,

DIAGNOSIS: MECONIUM ASPIRATION SYNDROME THROMBOCYTOPENIA COURSE:
PLACE: PARAMAKUDI
This Term / AGA / male born at private hospital by LSCS (Indication : Meconium Stained Liquor and Failure to thrive) on 12.06.09, with H/o. Respiratory difficulty after 3 hours of life, hence referred to MMHRC on 13.06.9. No Maternal H/o PIH, GDM & PROM. O/E. Baby activity & cry : Moderate, Colour : Pink, CFT < 2sec, no birth injury, no obvious external anomaly, CVS: S1, S2 heard, RS: Bilateral air entry equal, P/A: soft, CNS:NNR +. Baby was investigated Peripheral smear showed neutrophilic leukocytosis with thrombocytopenia. Blood sugar & Serum creatinine were normal. Baby was
managed with CPAP, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K. With the above measures babys activity & cry : Fair, respiration became normal. Now
baby is on sufficient oral, hence discharged today with advice to continue further follow up with the referral doctor. INVESTIGATION :
Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT PLATELET COUNT CREATININE Result "A" POSITIVE 14.9 18700 44 103 34 33 19.2 4.2 9.9 85 14 01 30,000 CELLS 1.1 0.7 Date 13/06/2009 gm/dl 13/06/2009 cells/cumm 13/06/2009 % 13/06/2009 FL 13/06/2009 PG 13/06/2009 % 13/06/2009 % 13/06/2009 MILL/Cumm 13/06/2009 FL 13/06/2009 % 13/06/2009 % 13/06/2009 % 13/06/2009 Lakhs/Cumm 13/06/2009 Lakhs/Cumm 13/06/2009 mg /dl 14/06/2009 Unit
PERIPHERAL
SMEAR
SHOWED
(15.06.09):
RBCs
shows
normochromic
normocytes and macrocytes . Nucleated RBCs 2/100 WBCs. neutrophilic leukocytosis. No atypical or immature cells.
WBC count shows
Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 13%. Platelets count diminished. IMPRESSION: NEUTROPHILIC LEUKOCYTOSIS.
ECHO CARDIOGRAPHY REPORT (15.06.09) : SITUS SOLITUS. NORMAL VALVES. IAS, IVS INTACT. LEVOCARDIA. NO PDA /
GREAT CESSELS NORMAL.
COARCTATION.
NO PULMONARY HYPERTENSTION.
GOOD LV AND RV
FUNCTION. IMPRESSION : NORMAL STUDY
ADVICE ON DISCHARGE : Inj. Ceftocin 150mg IV BD x 4 days
Name : B/o. Rupavathy Age / Sex: NB/ M Dept : Neonatology Hos.No : 418894 Mrd.No : 315337 Ward : I NB NICU D.O.A : 14.06.09 D.O.D : 18.06.09 ****************************************************************** REF. BY. DR. LAKSHMI GANESH., PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION (RECOVERED) COURSE:
This Term / AGA / male born by LSCS at private hospital on 14.06.09 with H/o. Baby cried immediately after birth. H/o Respiratory distress since birth, hence referred to MMHRC for further management. No H/o. Convulsion & Cord around the neck.
Maternal H/o. LSCS (Indication : Failure the progress and meconium stained liquor). No Maternal H/o PIH, GDM, UTI, Fever, skin raches and hypothyroidism. O/E. Baby activity & cry were weak, Colour : Pink, Peripheral cyanosis +, no birth injury and no obvious external anomaly, CVS: S1, S2 heard, RS: Bilateral crepitatin +, P/A: soft, CNS:NNR Absent. Local exmination left side undescended tests +. Baby was
investigated
Peripheral smear showed normal smear study. Blood sugar
177mg/dl,
serum creatinine
1.2. chest x-ray suggestive of meconium aspiration syndrome. Baby
was managed with Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Dopamine infusion, Inj. Gardenol surfaced 2 dose given, mechanical ventilator support and Inj.
Rantac 12th hourly. ABG was done. With above measures baby s activity improved but had persistent fall in oxygen saturation. 12th hourly ABG was done, PO2 & PCO2 showed improvement but baby s parents want to continue the further management in government hospital, hence discharged AT REQUEST on 12.06.09.
INVESITGATION
Investigation HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE Result 18.0{TWICE RPT} 8600 53 111 37 33 16.5 4.8 6.6 84 15 01 1.8 1.0 Unit gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm mg /dl Date 14/06/2009 14/06/2009 14/06/2009 14/06/2009 14/06/2009 14/06/2009 14/06/2009 14/06/2009 14/06/2009 14/06/2009 14/06/2009 14/06/2009 14/06/2009 16/06/2009
PERIPHERAL SMEAR SHOWED (15.06.09): RBCs show normochromic normocytes and microcytes. No nucleated RBCs or hemoparasites. WBC count normal. No atypical or immature cells. DC: Neutrophils: 86%, Eosinophils: 01%, Monocytes: 01%,
Lymphocytes: 12%. Platelets count normal in number and morphology.
Name : B/o. Rathina Age / Sex: NB/ M Dept : Neonatology Hos.No : 418921 Mrd.No : 315361 Ward : I NB NICU D.O.A : 14.06.09 D.O.D : 22.06.09 ****************************************************************** REF. BY : DR. ANBUCHELIYAN., PLACE : BODINAYAKANUR REF. BY : DR. MAHALINGAM., PLACE : MADURAI DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH NEONATAL SEIZURE CLINICAL SEPSIS COURSE: This Term / AGA / male born at private hospital by LSCS (Indication : meconium stained liquor, Fetal distress, Failure to Progress, PIH) on 14.06.09. H/o. Baby cried immediately after birth and developed respiratory distress since birth, H/o. Meconium Aspiration +, for that referred to MMHRC on 14.06.09 for further management. Baby received with only spo2 - 40% O2 saturation, hence baby was intubated and put on mechanical ventilator support at NICU. No H/o. Cyanosis & cord around the neck.
Maternal H/o. PIH, Fever, and Bleeding PV at 3rd month of gestation. No Maternal H/o GDM, PROM & Hypothyroidism. O/E. Baby activity & cry were weak, Colour :
Peripheral cyanosis +, CFT Prolonged, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anomaly, CVS: S1, S2 heard, RS: Bilateral air entry + RR: >70/mt, sub costal retraction +, P/A: soft, CNS:NNR sluggish. Baby was investigated Peripheral smear showed normal smear study. TC : 3,200, Blood sugar was normal. Serum creatinine 1.2mg/dl (15.06.09), 1.0mg/dl (18.06.09), 0.6mg/dl (20.06.09) CRP was positive. Blood culture no growth. Chest x-ray suggestive of meconium aspiration syndrome. Baby was managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Dopamine infusion, Inj. Gardenol, Inj. Rantac, Mucolite drops & oxygen therapy. With the above measures babys Respiration became normal, hence weaned from ventilator on 16.06.09, and started on small tube feeds. Now baby is on sufficient oral feeds and discharged today with advice to continue the following.
INVESTIGATION :
Investigation HAEMOGLOBIN TOTAL COUNT PCV MCV Result 12.3 3200 (TWICE RPT) 35 111 Unit gm/dl cells/cumm % FL Date 15/06/2009 15/06/2009 15/06/2009 15/06/2009
MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE CREATININE CREATININE
38 34 18.4 3.2 8.7 70 29 01 1.5 1.2 1.0 0.6
PG % % MILL/Cumm FL % % % Lakhs/Cumm mg /dl mg /dl mg /dl
15/06/2009 15/06/2009 15/06/2009 15/06/2009 15/06/2009 15/06/2009 15/06/2009 15/06/2009 15/06/2009 15/06/2009 18/06/2009 20/06/2009
Name : B/o. Santha kumari Age / Sex: NB/ M Dept : Neonatology Hos.No : 420108 Mrd.No : 316129 Ward : I NB NICU D.O.A : 23.06.09 D.O.D : 24.06.09 ******************************************************************
REF. BY. DR.MAHALINGAM.,
PLACE: MADURAI
DIAGNOSIS: MECONIUM ASPIRATION WITH RAISED RENAL PARAMETERS COURSE: This 1 day old post dated / AGA / male born at private hospital by LSCS (Indication : post dated pregnancy) on 22.06.09. H/o. Baby cried immediately after birth and developed respiratory distress since birth. H/o. Meconium aspiration +, for that referred to MMHRC on 23.06.09 for further management. No Maternal H/o PIH, GDM & PROM. O/E. Babys activity & cry were weak. Colour : peripheral cyanosis +, CFT > 3sec, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anomaly, CVS: S1, S2 heard, RS :
RR:60/mt, Bilateral air entry equal, P/A: soft, CNS:NNR sluggish. Baby was investigated HB : 14.6gm%, TC : 21,600, Platelet count : 3.3lakhs, serum Creatinine : 1.9mg/dl. Chest x-ray showed Bilateral minimal meconium infiltration. CRP was negative. Baby was
managed with CPAP, Iv fluids, Inotropes, Iv antibiotics, Inj. Gardenol, Inj. Lasix, Inj. Calcium gluconate & Inj. Vitamin K. Now baby is maintaining SPO2 100% with CPAP Fio2 of 30%, since parents want to continue further management at Government Hospital, discharged AT REQUEST on 24.06.09.
INVESTIGATION :
Investigation BLOOD GROUP RH TYPING C-REACTIVE PROTEIN(CRP) LATEX CREATININE HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT Result "A" POSITIVE NEGATIVE 1.9 14.6 21,600 42 106 36 34 17.1 4.0 6.6 84 15 01 3.3 Unit Date 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009
mg /dl gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm
JULY 09
Name : B/o. Sankareswari Neonatology
Hos.No : 420515
Age / Sex: NB/

Mrd.No : 316382
Dept :
Ward : I NB NICU
D.O.A :26.06.09 D.O.D :03.07.09 ************************************************************************ REF. BY: DR. DEEPAN., PLACE: VIRUDHUNAGAR
DIAGNOSIS: NEONATAL ENCEPHALOPATHY, MECONIUM ASPIRATION SYNDROME
COURSE:
This term / AGA / female / born at private hospital by LSCS (Indication : CPD & Cord around the neck) on 26.06.09, H/o. Baby did not cry immediately after birth, H/o. Thick meconium stained liquor, H/o. Baby had weak cry after ambu bag & mask ventilation for 40 sec. H/o. Baby had respiratory distress with grunting since birth, hence referred to MMHRC on 26.06.09, for further management. H/o cord around the neck +. No Maternal H/o. PIH, GDM, PROM, fever and hypothyroidism. O/E. Baby s activity
& cry were weak, Colour : Pink, CFT : > 3sec, dyspnoeic +, no birth injury and no obvious external anamolies, CVS: S1, S2 heard, RS: Bilateral air entry +, Sub costal retraction and lower chest indrawing +, P/A: soft, CNS: NNR sluggish, Encephalopathy +. Baby was investigated peripheral smear showed neutrophilic leukocytosis. Blood sugar and serum Creatinine were normal. Chest x-ray showed meconium aspiration syndrome. Baby was managed with oxygen therapy, Iv fluids, Iv. Antibiotics, Inj. calcium gluconate, Inj. Dopamine infusion, Inj. Eptoin and Inj. Rantac. With above measures baby s activity & cry : fair, respiration became normal and baby is now on
breast feed, hence discharged today.
INVESTIGATION
Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV LYMPHOCYTE PLATELET COUNT CREATININE Result "O" NEGATIVE 15.4 34,900 47 98 31 32 11.2 4.8 7.4 01 2.4 1.0 Unit gm/dl cells/cumm % FL PG % % MILL/Cumm FL % Lakhs/Cumm mg /dl Date 27/06/2009 26/06/2009 26/06/2009 26/06/2009 26/06/2009 26/06/2009 26/06/2009 26/06/2009 26/06/2009 26/06/2009 26/06/2009 26/06/2009 28/06/2009
PERIPHERAL SMEAR SHOWED ON (27.06.09): RBCs shows normochromic normocytes and macrocytes. Nucleated RBCs 25/100 WBCs. WBC count shows neutrophilic leukocytosis. No atypical or immature cells. DC: Neutrophils: 70%, Eosinophils: 01%, Monocytes: 05%,
Lymphocytes: 24%. Platelets count normal in number and morphology. NEUTROPHILIC LEUKOCYTOSIS
IMPRESSION :
Name : B/o. Vimala devi Hos.No : 420145
Age / Sex: NB/ F Mrd.No : 316144
D.O.A :24.06.09 D.O.D :03.07.09 ************************************************************************ REF. BY: DR. CAPT. AUGUSTUS SAMVEL DODD., PLACE: MADURAI REF. BY : DR. THUTHESAN PAVA
PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME NEONATAL SEIZURE
COURSE:
This Term / AGA / female / born at private hospital by normal vaginal delivery on 23.06.09 with H/o. Baby cried immediately after birth, H/o. respiratory distress since birth, H/o. Thick meconium stained liquor and aspiration +, hence referred to MMHRC on 24.06.09 for further management. H/o. convulsion + after admission. No H/o. Cord around the neck and cyanosis. Maternal H/o : No Maternal H/o. PIH, GDM, PROM,
Fever, UTI and hypothyroidism. O/E. Baby
s activity & cry were weak, dyspnoeic +,
tachypnoeic +, no birth injury and no obvious external anamolies, CVS: S1, S2 heard, RS: Bilateral air entry +, lower chest indrawing & respiratory distress +, P/A: distended, CNS: NNR sluggish. Baby was investigated peripheral smear showed neutrophilic Negative, Blood
leukocytosis. Blood sugar and serum Creatinine were normal. CRP culture
no growth, Chest x-ray suggestive of meconium aspiration syndrome. Baby
was managed with mechanical ventilator support, Iv fluids, Iv. Antibiotics, Inj. calcium gluconate, Inj. Gardenol, Inj. Dopamine infusion, Mucolite drops & Domstal drops. With above measures baby s respiration became normal, hence weaned from ventilator support on 27.06.09 and started on small tube feeds. Now baby is on direct breast feeds and no further convulsion seen, hence discharged today with advice to continue the follow-up with referral doctor.
INVESTIGATION
Investigation BLOOD GROUP RH TYPING C-REACTIVE PROTEIN(CRP) LATEX CREATININE HAEMOGLOBIN Result "B" POSITIVE NEGATIVE 0.9 20.3{TWICE RPT} mg /dl gm/dl Unit Date 24/06/2009 24/06/2009 24/06/2009 24/06/2009
TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT
17000 60 108 36 33 19.4 5.5 7.3 89 10 01 2.0
cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm
24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009 24/06/2009
Name : B/o. Geetha Age / Sex: NB/M Dept : Neonatology Hos.No : 421462 Mrd.No : 316971 Ward : I NB NICU D.O.A :04.07.09 D.O.D :17.07.09 ************************************************************************ REF. BY: DR. PARATHASARATHY., PLACE: PARAMAKUDI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME SEPTICEMIA COURSE:
This term / AGA / male / born at private hospital by LSCS (Indication : Post
dated with oligohydramnios / meconium stained liquor ) on 04.07.09. H/o. Baby cried
soon after birth and developed respiratory distress since birth for that referred to
MMHRC on 04.07.09 for further management. Maternal H/o. Oligohydrmnios +. No
Maternal H/o. PIH, GDM & PROM. O/E. Baby
s activity & cry were weak, Peripheral
cyanosis +, CFT : > 3sec, dyspnoeic+, tachypnoeic +, not anemic, not icteric, no birth
injury and no obvious external anomaly, CVS: S1, S2 heard, RS: RR > 60/mt, lower
chest indrawing +, P/A: soft, CNS: NNR sluggish. Baby was investigated peripheral
smear showed neutrophilic leukocytosis. Blood sugar and serum Creatinine were normal.
Chest x-ray showed left upper lobe infiltration. Baby was managed with CPAP, Iv fluids,
Iv. Antibiotics, Inj. calcium gluconate, Inj. Aminophylline & Inj. Dopamine.
On
08.07.09 baby had brown coloured vomitus, Inj. Rantac was added. On 10.07.09, baby
had abdominal distension, ryles tube feeding was with held. On 16.07.09. Baby had
convulsion Inj. Gardenol was added. On 17.07.09 baby had desaturation with the C-PAP,
so intubated and connected to mechanical ventilator support. As baby had low perfusion
with hypotension, Ionotrophes were restarted. Now baby is on mechanical ventilator
support and maintaining O2 saturation 98% with Fio2 of 100%. Since parents were not
willing for further management, baby is discharged AGAINST MEDICAL ADVICE on
17.07.09.
INVESTIGATION :
Investigation Result BLOOD GROUP RH TYPING "O" POSITIVE HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE CREATININE Unit Date 04/07/2009 04/07/2009 04/07/2009 04/07/2009 04/07/2009 04/07/2009 04/07/2009 04/07/2009 04/07/2009 04/07/2009 04/07/2009 04/07/2009 04/07/2009 04/07/2009 05/07/2009 09/07/2009
17.6 gm/dl 23,000 [ TWICE RPT ] cells/cumm 53 % 105 FL 34 PG 32 % 13.5 % 5.1 MILL/Cumm 8.1 FL 67 % 31 % 02 % 2.5 Lakhs/Cumm 1.0 mg /dl 0.7 mg /dl
RBCs shows normochromic
normocytes and macrocytes. No nucleated RBCs 2/100 WBCs. WBC count shows neutrophillic leukocytosis. No atypical or immature cells. DC: Neutrophils: 60%,
Eosinophils: 02%, Monocytes: 05%, Lymphocytes: 33%. Platelet count normal in number and morphology. IMPRESSION: NETROPHILIC LEUKOCYTOSIS.
Name : B/o. Aruna Rani Hos.No : 422643
D.O.A : 15.07.09 D.O.D : 20.07.09 ************************************************************************ REF. BY: DR.K.K RAVISANKAR., PLACE: MADURAI DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION OF NEWBORN ACUTE RENAL FAILURE COURSE:
This Term / LBW / male baby born at private hospital by LSCS (Indication : severe oligohydramnios with fetal distress) on 14.07.09 with baby cried immediately after birth, H/o. Baby had respiratory distress since birth. Hence referred to MMHRC on 15.07.09, for further management. No H/o. cyanosis and convulsion. H/o. meconium aspiration +. Maternal H/o. white discharge +, H/o. maternal fever +, H/o. sever oligohydramnios and cord around the neck shown in the antenatal USG abdomen. O/E. Baby s activity & cry were weak, respiratory distress +, colour : pink, CFT > 3 sec, CVS : S1 S2 heard, RS : sub costal and intercostal retraction +, bilateral air entry +, P/A:
soft, CNS: NNR sluggish.
Baby was investigated peripheral smear showed mild
leukocytosis. Blood sugar 104mg/dl, serum Creatinine 1.1(15.07.09), 1.8(20.07.09) CRP was negative. Blood culture no growth. Chest x-ray suggestive of meconium aspiration syndrome. Baby was managed with mechanical ventilator support, Iv fluids, Iv. Antibiotics, Inj. Dopamine infusion, Inj. Nor aderenaline infusion, Inj.calcium gluconate, Inj. Rantac and Inj. Aminophylline. With above management babys oxygen saturation was maintained activity & cry were weak. Since babys parents were not willing for further management, baby was discharged today AGAINST MEDICAL ADVICE on 20.07.09
INVESTIGATION :
Investigation BLOOD GROUP RH TYPING C-REACTIVE PROTEIN(CRP) LATEX HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE Result "O" POSITIVE NEGATIVE 19.9 (TWUCE RPT) 15800 59 107 35 33 12.9 5.5 8.4 59 40 Date 15/07/2009 15/07/2009 gm/dl 15/07/2009 cells/cumm 15/07/2009 % 15/07/2009 FL 15/07/2009 PG 15/07/2009 % 15/07/2009 % 15/07/2009 MILL/Cumm 15/07/2009 FL 15/07/2009 % 15/07/2009 % 15/07/2009 Unit
EOSINOPHIL PLATELET COUNT CREATININE CREATININE CREATININE
01 2.0 1.1 0.8 1.8
% Lakhs/Cumm mg /dl mg /dl mg /dl
15/07/2009 15/07/2009 15/07/2009 18/07/2009 20/07/2009
Name : B/o. Haria Devi Age/Sex : NB/ F Dept : Neonatology Hos.No: 423288 Mrd.No : 318219 Ward : IL.NB. NICU D.O.A : 20.07.09 D.O.D : 21.07.09 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA THICK MECONIUM ASPIRATION
COURSE: This Pre term (35 weeks) / AGA / female born at MMHRC by normal vaginal
delivery on 20.07.09 with H/o. Baby did not cry immediately after birth, H/o. Thick
meconium stained liquor, hence immediately intubated with 3 size ET tube and
resuscitated with ambu bag ventilator, then babys activity & cry regained and shifted to
NICU for further management. No H/o. convulsion and cord around the neck. Maternal
H/o. draining PV 3 days, H/o. Hepatitis E Positive, Maternal H/o. Jaundice with
elevated LFT. O/E. Baby activity & cry weak. Colour : Pink, CFT < 3 sec, Mild
respiratory distress +, no birth injury,
no obvious external anomaly. Baby was
extubated on the same day of birth and was on oxygen therapy. CVS : S1 S2 heard, RS :
Bilateral air entry equal, mild lower chest indrawing +, P/A soft, CNS : NNR sluggish.
Baby was investigated : Peripheral smear showed Neutrophilic leukocytosis. Blood sugar
normal. CRP Negative, Blood culture report awaited. Baby was managed with
oxygen therapy, Iv fluids, Inj. Calcium gluconate and Inj. Vitamin K. With above
measures babys activity & cry - fair, no respiratory distress and baby is on sufficient
oral feeds hence discharged today with advice to continue. INVESTIGATION :

Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT Result "B" POSITIVE 12.5 23600 37 111 37 33 13.5 3.3 9.0 65 32 03 3.3 Unit gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm Date 20/07/2009 20/07/2009 20/07/2009 20/07/2009 20/07/2009 20/07/2009 20/07/2009 20/07/2009 20/07/2009 20/07/2009 20/07/2009 20/07/2009 20/07/2009 20/07/2009
PERIPHERAL SMEAR (20.07.09): RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count shows neutrophilic
leukocytosis. No atypical or immature cells. DC: Neutrophils: 63%, Eosinophils: 03%, Monocytes: 03%, Lymphocytes: 31%. Platelets count normal in number and morphology. IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS
Name : B/o. Saritha Rani Age / Sex: NB/M Dept : Neonatology Hos.No : 423715 Mrd.No : 318497 Ward : I NB NICU D.O.A : 23.07.09 D.O.D : 27.07.09 ************************************************************************ REF. BY: DR.S.N SURESH KUMAR., PLACE: MADURAI DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PULMONARY HYPERTENSION ACUTE SEPTAL DEFECT COURSE:
This Term / AGA / male baby born at private hospital by LSCS (Indication : Non progression of labour) on 21.07.09 with H/o. baby cried immediately after birth and had respiratory distress since birth, hence child was referred to MMHRC on 23.07.09 for further management. H/o. Meconium stained liquor +, H/o. Aspiration +. No H/o. cyanosis and cord around the neck. No Maternal H/o. PIH, GDM, UTI, fever and hypothyroidism. O/E. Baby s activity & cry were weak, respiratory distress +, colour : Icteric, CFT < 3 sec, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anomaly, CVS : S1 S2 heard, RS : Bilateral air entry equal, P/A: soft, CNS: NNR sluggish. Baby was investigated peripheral smear, Blood sugar & serum Creatinine were
normal. DCT was negative. Reticulocyte count 2.6%. Serum Bilirubin : T 13.3 mg/dl, D- 0.4mg/dl (23.07.09), T - 12.9mg/dl, D 0.5 mg/dl (27.07.09). Echo showed congenital heart disease, moderate sized ASD, mild PAH. Baby was managed with Oxygen, Iv fluids, Iv. Antibiotics, Inj.calcium gluconate, Inj. Vitamin K and Double side phototheraphy. With these above measures babys activity & cry moderate, ictures and respiratory distress reduced, hence started on oral feeds. Since babys parents were not willing for further management, was discharged AGAINST MEDICAL ADVICE on 27.07.09
INVESTIGATION :
Investigation CREATININE 0.9 BILIRUBIN 13.3 TOTAL BILIRUBIN 0.4 DIRECT DIRECT ANTI HUMAN "NEGATIVE" GLOBULIN TEST (COOMBS) HAEMOGLOBIN 18.0 TOTAL COUNT 7100 HAEMOGLOBIN 18.0 TOTAL COUNT 7100 HAEMOGLOBIN 18.0 TOTAL COUNT 7100 PCV 55 PCV 55 Result Unit mg /dl mg/dl mg/dl Date 24/07/2009 24/07/2009 24/07/2009
25/07/2009 gm/dl cells/cumm gm/dl cells/cumm gm/dl cells/cumm % % 24/07/2009 24/07/2009 24/07/2009 24/07/2009 24/07/2009 24/07/2009 24/07/2009 24/07/2009
PCV MCV MCV MCV MCH MCH MCH MCHC RDW RBC MPV
P/S
NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET 2.9 COUNT IMPRESSION NORMAL STUDY. RETICULOCYTE 2.6 COUNT (Children) BILIRUBIN 12.8 TOTAL BILIRUBIN 0.5 DIRECT CREATININE 0.4
55 % 94 FL 94 FL 94 FL 30 PG 30 PG 30 PG 32 % 14.1 % 5.8 MILL/Cumm 8.2 FL RBC'S: ARE NORMOCHROMIC NORMOCYTIC. NO HAEMOPARASITES ARE SEEN. WBC'S: COUNTS ARE NORMAL. NO IMMATURE CELLS ARE SEEN. PLATELETS ARE NORMAL IN COUNT AND MORPHOLOGY. 61 % 38 % 01 %
24/07/2009 24/07/2009 24/07/2009 24/07/2009 24/07/2009 24/07/2009 24/07/2009 24/07/2009 24/07/2009 24/07/2009 24/07/2009
24/07/2009
24/07/2009 24/07/2009 24/07/2009
Lakhs/Cumm 24/07/2009 24/07/2009 % mg/dl mg/dl mg /dl 24/07/2009 27/07/2009 27/07/2009 27/07/2009
ECHO CARDIOGRAPHY REPORT (27.07.09) : SITUS SOLITUS. LEVOCARDIA. SMALL OSTIUM SECUNDUM TYPE OF ASD SEEN (5mm). LpR SHUNT. IVS INTACT. RVSP $40mm of hg. OTHER VALVES NORMAL. GREAT VESSELS NORMALLY ARISING. NO PDA / COARCTATION. NORMAL LV FUNCTION.
IMPRESSION : CONGENITAL HEART DISEASE. MODERATE SIZED ASD. MILD PAH.
Name : B/o. Kamala Age / Sex: NB/M Dept : Neonatology Hos.No : 423815 Mrd.No :318543 Ward : I NB NICU D.O.A : 24.07.09 D.O.D : 28.07.09 ************************************************************************ REF. BY : DR. KARTHIKEYINI., PLACE : DEVAKOTTAI
DIAGNOSIS: PRETERM (32 34 WEEKS) RESPIRATORY DISTRESS SYNDROME PERIPHERAL CIRCULATORY FAILURE HIGH RISK FOR SEPSIS [PROM > 7 DAYS] SURFACTANT THERAPY GIVEN ON 25.07.09
COURSE :
This Pre term (32 - 34 weeks) / AGA / male born at Private hospital by Normal vaginal delivery on 24.07.09. H/o. Baby cried immediately after birth and developed respiratory distress since birth for that referred to MMHRC on 24.07.09 for further management. Maternal H/o. PROM 7 days, UTI +. No Maternal H/o. GDM and PIH. O/E. Activity & cry : weak, Peripheral cyanosis +, CFT > 3 sec, dyspnoeic +, tachypnoeic +, no obvious external anomaly. CVS : S1 & S2 heard, Hypertension +, RS
: RR > 60/mt, Lower chest indrawing +. P/A : Soft, CNS : NNR sluggish. Baby was investigated : Peripheral smear was normal smear study. CRP was negative. Chest x-ray suggestive of respiratory distress syndrome. Echo showed IAS aneurysm. Baby was managed with Mechanical ventilator support, Ionotropes, Iv fluids, Iv antibiotics, Inj. calcium gluconate, Inj. Vitamin K and 2 doses of surfactant given. On 27.07.09 baby had persistent cyanosis with hypotension, Inj. Nor adrenaline infusion was started. Baby had decreased urine output and raised renal parameters of Blood urea 81mg/dl and Serum creatinine was - 1.3mg/dl, Inj. Lasix infusion was added on 28.07.09. Now baby is in mechanical ventilator support, maintaining oxygen saturation 94% with the FIO2 of 100%. Since parents were not willing for further management, baby is discharged Against Medical Advice on 28.07.09 at 12.00 no INVESTIGATION :
Investigation BLOOD GROUP RH TYPING C-REACTIVE PROTEIN(CRP) LATEX C-REACTIVE PROTEIN(CRP) LATEX HAEMOGLOBIN TOTAL COUNT HAEMOGLOBIN Result "A" POSITIVE NEGATIVE Unit Date 24/07/2009 24/07/2009
NEGATIVE 14.5 8500 14.5 gm/dl cells/cumm gm/dl
25/07/2009 24/07/2009 24/07/2009 25/07/2009
TOTAL COUNT PCV PCV MCV MCV MCH MCH MCHC MCHC RDW RDW RBC RBC MPV MPV
P/S
NEUTROPHILS LYMPHOCYTE EOSINOPHIL NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT PLATELET COUNT IMPRESSION CREATININE
8500 cells/cumm 41 % 41 % 104 FL 104 FL 36 PG 36 PG 34 % 34 % 17.3 % 17.3 % 4.0 MILL/Cumm 4.0 MILL/Cumm 7.6 FL 7.6 FL RBC'S: NORMOCHROMIC NORMOCYTIC. NO HAEMOPARASITES ARE SEEN. WBC'S: COUNTS ARE NORMAL. NO IMMATURE CELLS ARE SEEN. PLATELETS ARE NORMAL IN COUNT AND MORPHOLGY. 65 % 34 % 01 % 65 % 34 % 01 % 2.8 2.8 NORMAL STUDY. 1.0
25/07/2009 24/07/2009 25/07/2009 24/07/2009 25/07/2009 24/07/2009 25/07/2009 24/07/2009 25/07/2009 24/07/2009 25/07/2009 24/07/2009 25/07/2009 24/07/2009 25/07/2009
25/07/2009
24/07/2009 24/07/2009 24/07/2009 25/07/2009 25/07/2009 25/07/2009
Lakhs/Cumm 24/07/2009 Lakhs/Cumm 25/07/2009 mg /dl 25/07/2009 27/07/2009
ECHO CARDIOGRAPHY REPORT (25.07.09) : SITUS SOLITUS. LEVOCARDIA. AV, VA CONCORDANCE. NORMAL RELATED GREAT VESSELS. NORMAL VALVES. CHAMBERS NORMAL. IAS, IVS INTACT. IAS ANEURYSM +. NO SHUNT. NO PDA / COARCTATION. NO PULMONARY HYPERTENSION.
IMPRESSION : IAS ANEURYSM. NO SHUNT.
AUG 09
Name : B/o. Jothi Age / Sex: NB/M Dept : Neonatology Hos.No : 425280 Mrd.No : 319549 Ward : I NB NICU D.O.A : 07.08.09 D.O.D :09.08.09 ************************************************************************ REF. BY: DR.J.AMBA BHAVANI., PLACE: MADURAI
DIAGNOSIS: PRE TERM (33 WEEKS) / AGA / MALE RESPIRATORY DISTRESS SYNDROME TO R/O EARLY ONSET OF SEPSIS PDA WITH MODERATE PAH SURFACTANT THERAPY GIVEN
COURSE:
This Pre term ( 33 weeks) / AGA / male / born at private hospital by LSCS (Indication : previous LSCS ) on 07.08.09 with H/o. Baby cried soon after birth
developed cyanosis and respiratory distress since birth, for that referred to MMHRC on 07.08.09 for further management, Maternal H/o. G5 P3 A2 L2, H/o. recurrent UTI at 7 months, treated. No Maternal H/o. PIH, GDM & PROM. O/E. Baby s activity & cry were weak, colour : Peripheral cyanosis +, CFT : > 3sec, grunting respiration +,
tachypnoeic +, Spo2 60-70% with the oxygen hood immediately intubated and connected to ventilator support. no birth injury, CVS: S1, S2 heard, RS: RR > 60/mt, chest indrawing +, Bilateral air entry equal, P/A: soft, CNS: NNR sluggish, External genitalia left undescended testis. Baby was investigated : Peripheral smear showed HB 16.5gm%, TC 13,000 cells & platelet count 2.1 lakhs, Blood sugar : 48mg/dl. Chest x-ray showed bilateral reticular pattern with air bronchogram. Echo showed small PDA 3mm with L p R shunt, PFO +, moderate pulmonary hypertension, TR moderate. Baby was managed with Mechanical ventilator support, Iv fluids, Iv. Antibiotics, Inj. calcium gluconate, Inj. Vitamin K & surfactant (3 doses). Now baby is maintaining oxygen saturation (Spo2 100%) with mechanical ventilator support of Fio2 70%. Since parents want to continue further management at some other hospital discharged AT REQUEST on 08.08.09
INVESTIGATION :
Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT Result "B" POSITIVE 16.5 13,000 48 102 34 33 17.5 4.7 7.2 40 58 02 2.1 Unit gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm Date 07/08/2009 08/08/2009 08/08/2009 08/08/2009 08/08/2009 08/08/2009 08/08/2009 08/08/2009 08/08/2009 08/08/2009 08/08/2009 08/08/2009 08/08/2009 08/08/2009
GLUCOMETER SUGAR
9PM:48mg/dl
08/08/2009
ECHO SHOWED ON 08.08.09 : SITUS SOLITUS, LEVOCARDIA, SMALL PDA SEEN (3 MM), L p R SHUNT, NORMAL RELATED GREAT VESSELS, PFO +, NO COARCTATION, MODERATE PULMONARY HYPERTENSION,
IMPRESSION : CONGENITAL HEART DISEASE, SMALL PDA, PFO, MODERATE TR, MODERATE PULMONARY HYPERTENSION. Name : B/o. Suba Age/Sex : NB/ F Dept : Neonatology
Hos.No: 426283 Mrd.No : 320146 Ward: IL.NB. NICU D.O.A : 14.08.09 D.O.D : 20.08.09 ************************************************************************
DIAGNOSIS: TERM / IUGR

MECONIUM ASPIRATION WITH RESPIRATORY DISTRESS
COURSE:
This Term / IUGR / female baby born at MMHRC on 14.08.09 by LSCS (Indication : Primi with Oligohydramnios) with H/o. baby cried immediately after birth and had poor activity and feeding, hence admitted at NICU for further management, H/o. Thick meconium stained liquor +. No maternal H/o. PIH, GDM, PROM, Fever, UTI & Hypothyroidism. O/E. Babys activity & cry were weak. Colour : Pink, CFT < 3 sec, dyspnoeic, tachypnoeic, no birth injury, no obvious external anomaly. CVS: S1 & S2 heard, RS: RR 66 / min Bilateral air entry equal. P/A: soft, CNS : NNR sluggish. Baby was investigated : HB 19.8mg/dl, TC : 22,600, platelet count 3.1 lakhs, Blood sugar & serum creatinine were normal. Baby was managed with oxygen, Iv fluids, Iv antibiotics, Inj. Calcium gluconate & single sided phototherapy. With above measures
baby became active and had no respiratory distress. Now baby is on breast feeds, hence discharged today.
INVESTIGATION :
Investigation HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE
Result 19.8 [TWICE RPT] 22,600 58 102 34 33 17 5.7 7.4 78 20 02 3.1 0.4
Unit gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm mg /dl
Date 15/08/2009 15/08/2009 15/08/2009 15/08/2009 15/08/2009 15/08/2009 15/08/2009 15/08/2009 15/08/2009 15/08/2009 15/08/2009 15/08/2009 15/08/2009 15/08/2009
Name : B/o. Kasiammal Hos.No : 427217
Age / Sex: NB/M Mrd.No : 320747
Name : B/o. Kasiammal Age / Sex: NB/M Dept : Neonatology Hos.No : 427217 Mrd.No : 320747 Ward : I NB NICU D.O.A :23.08.09 D.O.D :26.08.09 ************************************************************************
DIAGNOSIS: THICK MECONIUM ASPIRATION RESPIRATORY DISTRESS
COURSE:
This Term / AGA / female / born at MMHRC by LSCS (Indication : Fetal distress with thick meconium stained liquor ) on 23.08.09. H/o. Baby cried soon after birth & developed respiratory distress since birth for that admitted at NICU for further
management.
H/o.
Thick
meconium
stained
liquor
+.
No
maternal
H/o.
PIH/GDM/PROM & Hypothyroidism. O/E. Baby
s activity & cry were weak, Colour :
pink, CFT : < 3sec, Tachypnoeic +, no birth injury, no obvious external anamoly. CVS: S1, S2 heard, RS: RR : 60/mt, Mild lower chest indrawing +, P/A: soft, CNS: NNR sluggish. Baby was investigated peripheral smear showed Neutrophilic leukocytosis. Blood sugar was normal. Baby was managed with oxygen, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate & Inj. Vitamin K. With these above measures babys respiration became normal and started on small tube feeds. Now baby is taking breast feeds & discharged today with advice to continue following.
INVESTIGATION :
Investigation HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT Result 17.0 [TWICE RPT] 21,100 50 106 35 33 16.7 4.7 8.1 83 15 02 2.9 Unit gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm Date 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009
PERIPHERAL SMEAR SHOWED ON (24.08.09): RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count shows
neutrophilic leukocytosis. No atypical or immature cells.
Eosinophils: 02%, Monocytes: 05%, Lymphocytes: 17%. Platelets count normal in number and morphology. IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS Admission weight : 3.145kg Discharge weight : 3.050kg
Name : B/o. Eluvakkal Age/Sex : NB/ F Dept : Neonatology Hos.No: 426224 Mrd.No : 320132 Ward: IL.NB. NICU D.O.A : 14.08.09 D.O.D : 29.08.09 ************************************************************************
DIAGNOSIS: TERM / IUGR / BIRTH ASPHYXIA THIN MECONIUM ASPIRATION COURSE:
This Term / IUGR / female baby born at MMHRC by normal vaginal delivery on 14.08.09. H/o. baby had weak cry at birth, resuscitated with one cycle of ambu mask ventilation & had respiratory distress since birth. H/o. Cord around the neck +, H/o.
Thick meconium stained liquor +. For that admitted at NICU for further management. Antenatally USG abdomen showed cadiomegaly, hepatomegaly & ascites. Maternal H/o. severe Oligohydraminios +, G4 P1 L1 A2, 1st child had CHD. No maternal H/o. PIH, GDM & PROM. O/E. Babys activity & cry were weak. Colour : cyanosis, CFT < 3 sec, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anomaly. CVS: S1 & S2 +, RS: RR 60/mint, inter costal retraction +, P/A: soft, CNS : NNR sluggish. Baby was investigated peripheral smear showed leukocytosis. Blood sugar was normal. Serum creatinine 1.7mg/dl, 0.8mg/dl (17.08.09), karyotyping sent, report awaited. Baby was managed with mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K and Ionotrophic support. ET tip culture showed coagulase negative staphycococus, antibiotics were changed according to culture sensitivity. With these above measures, babys respiration became normal, activity improved so weaned from the ventilator on 24.08.09 & tapering of Ionotropes done. Baby was started on small tube feeds & tolerating feeds well. Now baby is taking breast feeds & discharged today with the advice to continue the following. INVESTIGATION :
Investigation BLOOD GROUP RH TYPING
Result "B" POSITIVE
Unit
Date 14/08/2009
HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE CREATININE
14.1 21,400 42 99 33 33 15.4 4.2 8.7 62 37 01 1.8 1.7 0.8
gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm mg /dl mg /dl
14/08/2009 14/08/2009 14/08/2009 14/08/2009 14/08/2009 14/08/2009 14/08/2009 14/08/2009 14/08/2009 14/08/2009 14/08/2009 14/08/2009 14/08/2009 15/08/2009 17/08/2009
PERIPHERAL SMEAR SHOWED ON (14.08.09): RBCs shows normochromic normocytes and macrocytes. Nucleated RBCs 4/100 WBCs. WBC count shows leukocytosis. No atypical or immature cells. DC: Neutrophils: 59%, Eosinophils: 01%, Monocytes: 03%, Lymphocytes: 37%. Platelets count normal in number and morphology. IMPRESSION : LEUKOCYTOSIS
Name : B/o. Sorna Gowri Age/Sex : NB/ F Dept : Neonatology Hos.No: 427884 Mrd.No : 321209 Ward: IL.NB. NICU D.O.A : 28.08.09 D.O.D : 30.08.09 ************************************************************************
DIAGNOSIS: MECONIUM ASPIRATION

NEONATAL SEIZURE BILATERAL PNEUMOTHORAX
COURSE: This Boderline Term / IUGR / female born at private hospital by normal vaginal delivery on 28.08.09. H/o. Birth asphyxia +, Thick meconium stained, Liquor +, Resuscitated, intubated, ambu bag, ventilation given, then & referred to MMHRC on 28.08.09 for further management. Maternal H/o. Polyhydramnios +. Maternal H/o. Fetal
distress +. Antenatal USG abdomen showed ? Reversal of diastolic flow. No maternal H/o. PIH, GDM. O/E. Babys activity & cry : weak. Colour : Pink, peripheral cyanosis +, CFT < 3 sec, tachypnoeic +, lower chest indrawing +, low set of ears +, cleft palate +, no birth injury, CVS: S1 & S2 heard, RS: RR >60/mt, LCI +, P/A : Soft, CNS : NNR sluggish. Baby was investigated peripheral smear showed HB : 17.9gm%, TC : 19,300 cells & Platelet count : 1.1 lakhs, Blood sugar & serum creatinine were normal. Baby was managed with mechanical ventilator support, Iv. Fluids, Iv antibiotics, Inj. Calcium gluconate & Inj. Vitamin K. As baby had hypotension, Inj. Dopamine infusion was started. On 29.08.09. baby had convulsion, Inj. Gardenol was added. Baby had recurrent seizures, not controlled with Inj. Gardenol, so Inj. Eptoin was added. On 30.08.09. Baby had desaturation. Chest X-ray was taken, which showed Bilateral pneumothorax - ICD was done, on both sides. Even with these above measures, baby had desaturation followed by bradycardia, Inj. Atropine and Inj. Adrenaline were given. CPR was carried out. But baby could not be revived & DECLARED DEAD on 30.08.09. INVESTIGATION :
Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT
Result "B" POSITIVE 17.9 19300
Unit gm/dl cells/cumm
Date 29/08/2009 29/08/2009 29/08/2009
PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE
54 109 36 33 21.6 4.9 8.2 80 19 01 1.1 0.5
% FL PG % % MILL/Cumm FL % % % Lakhs/Cumm mg /dl
29/08/2009 29/08/2009 29/08/2009 29/08/2009 29/08/2009 29/08/2009 29/08/2009 29/08/2009 29/08/2009 29/08/2009 29/08/2009 29/08/2009
PERIPHERAL SMEAR SHOWED ON (28.08.09): RBCs show normocytes and macrocytes. Nucleated RBCs 5/100 WBCs. WBC count shows neutrophilic leukocytosis. No atypical or immature cells. DC: Neutrophils: 86%, Eosinophils: 01%, Monocytes: 03%, Lymphocytes: 10%. Platelets count just adequate. IMPRESSION :
NEUTROPHILIC LEUKOCYTOSIS
SEP 09
Hos.No : 426693 D.O.A :19.08.09 Mrd.No : 320442 Ward : I NB NICU D.O.D :01.09.09 PLACE : MADURAI
************************************************************************
REF.BY.DR. SABITHA SRIDHARAN
DIAGNOSIS: PRETERM (30 - 32 WEEKS) / LBW / FEMALE / TWIN - I RESPIRATORY DISTRESS SYNDROME
SURFACTANT THERAPY GIVEN ON 19.08.09 CONGENITAL HEART DISEASE, (SMALL PDA(1 mm) / SMALL ASD (3 mm) & SEVERE PAH)
COURSE:
This pre term (30 - 32 weeks) / LBW / female / Twin I born at private hospital by normal vaginal delivery on 19.08.09. H/o. Baby cried immediately after birth for that
referred to MMHRC on 19.08.09 for further management. No H/o. PIH / GDM / PROM. O/E. Babys activity & cry were weak. Colour : Pink, peripheral cyanosis +, CFT > 3sec, dyspnoeic+, tachypnoeic +, no birth injury, no obvious external anamoly, CVS: S1, S2 heard, RS: RR > 60/mt. Bilateral air entry equal, P/A: soft, CNS: NNR sluggish. Baby was investigated peripheral smear, blood sugar & serum creatinine were normal. ECHO showed CHD, Small ASD (3 mm), small PDA (1mm) & severe PAH. Chest x-ray suggestive of RDS. Baby was managed with mechanical ventilator support, Iv fluids, Inj. Calcium gluconate, Inj. Vitamin K, Ionotrophic support and 1 dose of Inj. Surfactant. Three dose of Syp. Brufen was given for PDA closure. With these above measures, babys respiration became normal. So weaned from the ventilator on 26.08.09 and started on small tube feeds. Baby was slowly weaned from oxygen theraphy. ET Tip culture showed Enterobactor growth. Antibiotics were changed according to culture sensitivity. Now babys activity improved & taking breast feeds well & discharged today with the advice to continue further follow-up with the referral doctor. INVESTIGATION
Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC Result "B" POSITIVE 18.4 [TWICE RPT] 6900 53 107 37 34 Unit gm/dl cells/cumm % FL PG % Date 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009
RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE
15.6 4.9 6.8 48 50 02 2.9 0.4
% MILL/Cumm FL % % % Lakhs/Cumm mg /dl
19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 22/08/2009
PERIPHERAL SMEAR SHOWED ON (19.08.09): RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count normal. No atypical or immature cells. DC: Neutrophils: 40%, Eosinophils: 02%, Monocytes: 05%, Lymphocytes: 53%. Platelets count normal in number and morphology. ECHO SHOWED ON 21.08.09 : SITUS SOLITUS, LEVOCARDIA, 3 mm OSTIUM SECUNDUM TYPE OF ASD SEEN, L p R SHUNT, IVS INTACT, MV, AV, PV NORMAL, GREAT VESSELS NORMALLY ARISING, SMALL 1mm PDA SEEN, L p R SHUNT ONLY DURING SYSTOLE, NO COARCTATION, NO PERICARDIAL EFFUSION, NORMAL LV AND RV FUNCTION. IMPRESSION : CONGENTIAL HEART DISEASE, SMALL ASD, SMALL PDA, SEVERE PAH.
Name : B/o. Vanitha Rex Age/Sex : NB/ F Dept : Neonatology Hos.No: 427202 Mrd.No : 320734 Ward: IL.NB. NICU D.O.A : 22.08.09 D.O.D : 08.09.09 ************************************************************************
REF.BY.DR.NANDHINI PANDIYAN., PLACE : MADURAI
DIAGNOSIS: PRETERM ( 32 34 WEEKS) WITH RESPIRATORY DISTRESS SURFACTANT THERAPHY GIVEN ON 24.08.09 CHD [SMALL ASD (2mm)] COURSE: This Pre term (34 35 weeks) / AGA / female born at private hospital by LSCS ( Ind : previous LSCS with Oligohydramnios) on 22.08.09. H/o. Baby cried immediately after birth. baby had respiratory distress since birth, for that referred to MMHRC on 22.08.09 for further management. Maternal H/o. Decreased fetal movements +,
Oligohydramnios +. No maternal H/o. PIH & PROM. O/E. Babys activity & cry weak, peripheral cyanosis +, CFT < 3 sec, grunting +, tachypnoeic, no birth injury, no obvious external anamoly, CVS: S1 & S2 heard, RS: RR > 60/mt, lower chest indrawing +, P/A: soft, CNS : NNR sluggish. Baby was investigated : Peripheral smear showed neutrophilic leukocytosis. Blood sugar was normal. Serum creatinine 1.3mg/dl (23.08.09) & 0.7mg/dl (27.08.09). ECHO showed CHD, Small ASD (2mm) with left to right shunt. Baby was managed with mechanical ventilator support, Iv fluids, Iv
antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inj. Dopamine infusion. With these above measures babys respiratory distress reduced & weaned from the ventilator on 01.09.09. Baby was started on small tube feeds. Baby was slowly weaned from the oxygen therapy. ET Tip culture showed non fermenting gram Negative Bacilli, antibiotics were changed according to culture sensitivity. Now babys activity improved, respiration became normal and taking breast feeds well. Baby is discharged today with the advice to continue further follow-up with the referral doctor. INVESTIGATION :
Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC Result "O" POSITIVE 15.5 19,000 [TWICE RPT] 46 97 32 33 Unit gm/dl cells/cumm % FL PG % Date 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009
RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE CREATININE
15.6 4.8 7.7 77 20 03 3.1 1.3 0.7
% MILL/Cumm FL % % % Lakhs/Cumm mg /dl mg /dl
23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 23/08/2009 24/08/2009 27/08/2009
PERIPHERAL SMEAR SHOWED ON 240.08.09 :
RBCs show normochromic shows
normocytes and macrocytes, Nucleated RBCs 2/100 WBCs. WBC count
neutrophilic leukocytosis. No atypical or immature cells. Neutrophilic : 60%, Eosinophils : 03%, Monocytes : 05%, Lymphocytes : 32%. Platelets count normal in number and morphology. IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS
ECHO SHOWED ON 28.08.09 : SITUS SOLITUS, LEVOCARDIA, SMALL OSTIUM SECUNDUM TYPE OF ASD SEEN (2mm), L pR, IVS INTACT, MV, AV, PV NORMAL, NO PDA / COARCTATION, NORMAL LV FUNCTION, NO PAH.
IMPRESSION : CONGENITAL HEART DISEASE, SMALL ASD, L p R SHUNT, NO PAH
Name : B/o. Rajeswari Age/Sex : NB/ M Dept : Neonatology Hos.No: 426692 Mrd.No : 320441 Ward: IL.NB. NICU D.O.A : 19.09.09 D.O.D : 24.09.09 ************************************************************************
REF. BY : DR. SABITHA SRIDHARAN.,
PLACE : MADURAI
DIAGNOSIS: PRETERM (30-32 WEEKS) / LBW / MALE / TWIN II RESPIRATORY DISTRESS SYNDROME SURFACTANT THERAPY GIVEN ON 19.08.09 & 20.08.09 CONGENITAL HEART DISEASE SMALL PDA (2mm) / MODERATE ASD (3mm) / ? COARCATION
COURSE: This Pre term (30-32 weeks) / LBW / Male / Twin II born at Private Hospital by normal vaginal delivery on 19.08.09. H/o. Baby did not cry immediately after birth for that referred to MMHRC on 19.08.09 for further management. No Maternal H/o PIH,
GDM & PROM. O/E. Babys activity & cry : weak, colour : pink, peripheral cyanosis +, CFT > 3 sec, tachypnoeic +, dyspnoeic +, no birth injury, no obvious external anomaly. CVS: S1 & S2 heard, RS: RR > 70/mt, Bilateral decreased air entry, P/A: soft, CNS : NNR sluggish. Baby was investigated : Peripheral smear and Blood sugar were normal. ECHO showed CHD, moderate sized ASD and small PDA, ? Coarctation. Chest x-ray suggestive of RDS. Baby was managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Ionotrophic support & 2 doses of Surfactant . on 19.08.09 and 20.08.09. 3 doses of Syp. Brufan was given for PDA closure. Baby icteric on day of life and was managed with single side phototherapy. Serum creatinine 1.2mg% (22.08.09) and repeat serum creatinine 0.9mg% (24.08.09). Baby developed rashes over genitalia. Dermatologists opinion was obtained. With these above measures babys respiration became normal, so weaning from ventilator was attempted on 29.05.09 and was put on T-piece O2 on flow. Baby had apnoeic spells, hence was put on ventilator again on 08.09.09. Repeat HB done showed 11.9mg/dl (02.09.09) and 10.6mg/dl (08.09.09) respectively. 30ml of whole fresh blood was transfused on 08.09.09, intra and post transfusion period are uneventful. ET tip culture showed enterobactor growth. Antibiotics were changed according to culture sensitivity. With these above measures respiration improved, so weaned from ventilator on 11.09.09 and started on small tube
feeds. Baby was slowly weaned from oxygen therapy, now babys activity improved and taking breast feeds well, hence discharged today with advice to continue the following.
INVESTIGATION :
Investigation BLOOD GROUP RH TYPING HAEMOGLOBIN TOTAL COUNT PCV MCV MCH MCHC RDW RBC MPV NEUTROPHILS LYMPHOCYTE EOSINOPHIL PLATELET COUNT CREATININE CREATININE
Result "B" POSITIVE 15.9 11,300 46 110 37 34 14.6 4.2 6.8 64 35 01 3.7 1.2 0.9
Unit gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm mg /dl mg /dl
Date 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 19/08/2009 22/08/2009 24/08/2009
PERIPHERAL SMEAR SHOWED ON (19.08.09): RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100 WBCs. WBC count high normal.
No atypical or immature cells. DC: Neutrophils: 47%, Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 47%. Platelets count normal in number and morphology.
ECHO SHOWED ON 28.08.09 : SITUS SOLITUS, LEVOCARDIA, 3mm OSTIUM SECUNDUM TYPE OF ASD SEEN, L p R SHUNT, IVS INTACT, 2mm PDA SEEN, L p R SHUNT, MV,, AV, PV NORMAL, RVSP = 25 mm of hg, NRMAL LV AND RV FUNCTION, ? COARCTATION (POST DUCTAL), GRADIENT = 25mm of hg, IMPRESSION : CONGENITAL HEART DISEASE, MODERATE SIZED ASD AND SMALL PDA, ? COARCTATION
ADVICE ON DISCHARGE : Domstal drops Syp. Deriphylline Tab. Aldactone Axbex drops Evion drops 8 drops 6 drops 1/6 th 5 drops 5 TID TID OD OD OD x x x x x 2 weeks 2 weeks 2 weeks Till further advice Till further advice
Name : B/o. Selva Rajeswari Age/Sex : NB/ M Dept : Neonatology Hos.No: 432985 Mrd.No : 324667 Ward: IL.NB. NICU D.O.A : 12.10.09 D.O.D : 17.10.09 ************************************************************************
REF.BY.DR. NITHIYA DEVI PLACE : BODINAYAKKANUR
DIAGNOSIS: SEPTICEMIA WITH MECONIUM ASPIRATION SYNDROME CHD WITH PULMONARY HYPERTENSION COURSE:
This term male baby was referred to MMHRC on 12/10/2009 H/o. Respiratory Distress since birth. Maternal History: G4 P1 L1 A2mother with 39 weeks gestation, LSCS done on 12/10/09 at 2.45 p.m., (Ind: Thick Meconium stained liquor / non progression of labour) Baby cried after resuscitation and had
respiratory distress since birth. No maternal H/o. PIH, GDM & PROM. O/E. Babys activity & cry weak, peripheral cyanosis+, CRT > 3 sec, Spo2 83% with O2, CVS: S1 & S2 heard, RS: RR > 70/mt, lower chest indrawing +, subcostal retraction+, tachypnoea +, dyspnea+. P/A: soft, no organomegaly, CNS : NNR sluggish. Child was immediately intubated and connected to mechanical ventilator support. Baby was investigated HB 17.7gm%, TC : 14800, platelets 50,000, CRP +ve. Chest X ray, showed Bilateral infiltrates. Echo showed: ASD with pul Hypertension. Baby was treated with Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Dopamine infusion and pulmonary vasodilators. ABG 12th hourly monitored. As baby continued to have respiratory distress and high Pco2, surfactant therapy given on 15/10/09. As the baby parents were not willing for further management, baby is discharged AGAINST MEDICAL ADVICE on 17.10.09.
INVESTIGATION :
PERIPHERAL BLOOD SMEAR STUDY RBC HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC 48 49 01 02 00 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 13-10-2009 13-10-2009 13-10-2009 13-10-2009 13-10-2009 4.7 Cells/cumm 17.7 14800 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 13-10-2009 13-10-2009 13-10-2009
50000
51
150000 to 450000 Cells/cumm 13-10-2009 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 13-10-2009 13-10-2009 13-10-2009 13-10-2009
109 37
34
RDW MPV
12.4
7.0
20 to 42 % 6 to 10.2 Fl
13-10-2009 13-10-2009
BIO CHEMISTRY CREATININE (Jaffe Kinetic) MICROBIOLOGY CRP-C REACTIVE PROTEIN PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100WBCs. WBC count shows neutrophilic leukocytosis. No atypical or immature cells. DIFFERENTIAL COUNT NeutroPhils :38% : Eosinophils :01% Monocytes :05% Lymphocytes :56% Platelets Count diminished IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. THROMBOCYTOPENIA. 13-10-2009 POSITIVE 24 MICROGRAM /ML 13-10-2009 0.8 0.4 to 1.4 mg/dL 14-10-2009
13-10-2009
13-10-2009 13-10-2009
ECHO SHOWED ON 14.10.09 : SITUS SOLITUS, LEVOCARDIA, 6 mm OSTIUM SECUNDUM TYPE OF ASD SEEN,(MODERATE SIZED) L p R SHUNT, NO
COARCTATION,
PULMONARY
HYPERTENSION
IMPRESSION
: L p R
CONGENTIAL HEART DISEASE, OS ASD (MODERATE SIZED) SHUNT, WITH PULMONARY HYPERTENSION.
OCT 09
Name : B/o. Priya Age/Sex : NB/ F Dept : Neonatology Hos.No: 430666 Mrd.No : 323082 Ward: IL.NB. NICU D.O.A : 23.09.09 D.O.D : 02.10.09 ************************************************************************
REF. BY : DR. GOMATHI.,
PLACE : THIRUMANGALAM
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION COURSE:
This term female baby delivered by LSCS (Ind : Fetal distress with thick meconium stained liquor) said to have cried immediately after birth but soon developed respiratory distress and referred to MMHRC for further management. H/o. grunting +. No maternal H/o. PIH, GDM, Fever with rash or hypothyroidism. O/E. Baby cry and activity poor with severe respiratory distress. Peripheries cyanosis, CFT > 3 sec, no birth injury, no obvious external anomaly. CVS: S1 & S2 +, RS: Grunting +, SCR +, ICR +, Bilateral air entry, Bilateral occasional crepitations, P/A: soft, CNS : NNR weak. Baby was investigated : Hb : 17.0, TC : 23,200, platelet count 2.8 lakhs, CRP Positive, Blood sugar 30mg/dl, serum
creatinine 0.9. Baby was managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Gardenol & Domstal drops. With above measures baby cry and activity poor. Since parents were not willing for further management, baby is discharged AGAINST MEDICAL ADVICE on 02.10.09.
PERIPHERAL SMEAR (23.09.09): RBCs Normal
WBCs Normal DC: Neutrophils: 61%, Eosinophils: 01%, Myleocytes : 01%, Lymphocytes: 37%. Platelets count normal in number and morphology.
IMPRESSION : NORMAL SMEAR STUDY
Name : B/o. Dorkas Suganya
Age/Sex : NB/ F
Dept
: Neonatology
Hos.No: 431128 Mrd.No : 323377 Ward: IL.NB. NICU D.O.A : 27.09.09 D.O.D : 03.10.09 ************************************************************************
DIAGNOSIS: PRETERM (30-32 WEEKS)/ LBW / FEMALE RESPIRATORY DISTRESS WITH BIRTH ASPHYXIA (SURFACTANT THERAPY ON 27.09.09) COURSE:
This preterm IUGR female baby delivered by LSCS (Ind: Severe PIH with reversal of diastolic flow in fetus) at MMHRC on 27.09.09. Baby cried after stimulation admitted for respiratory distress. Maternal H/o. PIH+ on
antihypertensives. No H/o. GDM / UTI / hypothyroidism / fever with rash. USG done showed IUGR and Reversal of diastolic flow. O/E. Baby cry and activity: weak, peripheral cyanosis+, no icterus, respiratory distress+ SpO2 94% with O2, no obvious external congenital anomaly. CVS: HR 148 / min, S1, S2+, no murmur, RS : RR 74/min, SCR+, ICR+, BAE, no added sounds, P/A: soft, CNS: Tone decreased, NNR sluggish. Baby was investigated, HB: 17.5g%, TC: 12,400 cells/cu.mm, platelets count 1.6 lakhs, Blood Sugar : 54 mg%, serum creatinine : 1.4mg% repeat 0.9 (02.10.09) Chest x-ray suggestive of Hyaline Membrane
Disease. Baby was managed with nasal C-PAP ventilation, surfacant therapy, Iv fluids, Iv antibiotics, Iv Aminophylline, Iv Calcium gluconate and Inj. Vitamin K. Baby continued to have mild distress and had icterus on 3rd day, started on phototherapy. FFP transfusion given on 01/10/09. On 03/10/09 baby developed severe respiratory distress and had desaturation. Baby was intubated and connected to mechanical ventilator support. Dopamine infusion was started. Baby had ET tube bleeding hence WFB transfusion given. Inspite of all the above measures, babys condition deteriorated and went into apnea, cardiac arrest and could not be revived. Hence DECLARED DEAD on 03/10/09 at 5.00 am.
Name : B/o. Mahalakshmi Age/Sex : NB/ M Dept : Neonatology Hos.No: 428869 Mrd.No : 321846 Ward: IL.NB. NICU D.O.A : 06.09.09 D.O.D : 22.10.09 ************************************************************************
DIAGNOSIS: PRETERM (29 WEEKS) / VLBW /

RESPIRATORY DISTRESS SYNDROME
SURFACTANT THERAPHY GIVEN ON 06.09.09 NEONATAL SEIZURE COURSE:
This Pre term (29-30 weeks) / VLBW / male born at MMHRC by LSCS ( Ind : HELLP Syndrome / Hypothyroidism / ISCI conception) to RH negative mother on 06.09.09 at 7.50pm. H/o. Baby cried soon after birth and had respiratory distress since birth. H/o. Baby had recurrent apnoea, intubated and connected to mechanical ventilator support. Baby was admitted at NICU for further management. Maternal H/o. Elderly primi, Maternal H/o. PIH + on anti hypertensives. Maternal H/o. hypothyroid + an Tab. Eltroxin 50gm 1OD. No maternal H/o. GDM. O/E. Babys activity & cry weak, colour : pink, peripheral cyanosis +, abnormal cyclic movement of four limbs+, CFT < 3 sec, lower chest indrawing +, tachypnoeic +, no birth injury, no obvious external anamoly, CVS: S1 & S2 heard, RS: Bilateral air entry equal, LCI +, P/A: soft, CNS : NNR sluggish. Mother blood group : B ve. Babys Blood group : O +ve. Baby was investigated peripheral smear, blood sugar, serum creatinine & seurm bilirubin were normal.
DCT Negative. TSH : 5.31 uIU/ml. ECHO was normal. ET tip culture on 12.09.09 showed no growth. Chest x-ray suggestive of respiratory distress syndrome. Baby was managed with mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Inj. Gardenol, Inj. Aminophylline, Inj. Dopamine and 1 dose of Inj. Surfactant. Series of ABGs were done & ventilator settings were adjusted according to that. Baby was stated on small ryles tube feeds on 10.09.09. As baby had vomiting, Domstal drops was added. Baby had GI bleed, Inj. Rantac was added and FFP transfusion was given on 11.09.09. Baby had ET bleed with GI bleed -> FFP transfusion was given on 16.09.09 & 17.09.09. As baby had abdominal distension. USG abdomen was done which showed distended stomach with no organomegaly. Babys ryles tube feed was slowly raised. On 25.09.09 baby was pale, HB : 10.2mg%, packed cell transfusion was given. As baby had difficultly in weaning from the ventilator for more than 30 days, suspected Bronchopulmonary, dysplasia & started on diuretics & steroids. With these above management baby was slowly weaned from the ventilator. Baby was extubated on 09.10.09 and kept in oxygen hood. Et culture showed Enterobactor growth on 13.10.09. antibiotics were added according to culture sensitivity.
Name : B/o. Thilagavathy Age/Sex : NB/ M Dept : Neonatology Hos.No: 434949 Mrd.No : 325905 Ward: IL.NB. NICU D.O.A : 28.10.09 D.O.D : 29.10.09 ************************************************************************
DIAGNOSIS: PERINATAL ASPHYXIA THICK MECONIUM STAINED LIQUOR MECONIUM ASPIRATION SYNDROME COURSE:
This term male / AGA / baby referred to MMHRC as a case of meconium stained liquor with respiratory distress. H/o. baby delivered by labour naturale on 28.10.09 at 6am. Birth weight : 3.2kg. H/o. Baby cried soon after birth but baby then developed respiratory distress and cyanosis +. No Maternal H/o. PIH, GDM, Hypothyroidism, UTI, drug intake. H/o. Cord around the neck once +. O/E. Baby cry and activity : nil, severe respiratory distress +, no birth injury, no obvious external congenital anomaly, cyanosis +, peripheral cold, CFT > 3sec, Spo2 : 42% with oxygen. CVS: HR 146/min, S1, S2 +, no murmur, RS : RR : 88/min, ICR +, SCR +, Bilateral air entry +, Bilateral crepitation +, P/A : Soft, no organomegaly, CNS : Drowsy, NNR absent. Baby was investigated showed Hb :
14.7g%, Tc : 17,400cells, platelets : 2.47 lakhs, CRP : Positive. Chest x-ray showed Bilateral infiltrate. ABG showed metabolic acidosis ( HCO3 : 8.8mm) for which bicarb correction given. Baby was immediately intubated and connected to mechanical ventilator. Baby was managed with Iv. fluids, Iv. antibiotics, Iv. Inotropes, Inj. Vitamin K and Inj. Calcium gluconate. Inspite of above measures baby had desaturation condition of the baby continuously detoriated and went into cardiac arrest. Baby was resuscitated with CPR and adrenaline, atropine. Inspite of that baby could not be revived and DECLARED DEAD on 29.10.09 at 1.45am.
INVESTIGATION :
BLOOD BANK BLOOD GROUPING & Rh TYPING B POSITIVE RBC 4.13 HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC RDW MPV CRP-C REACTIVE PROTEIN C- Reactive Protein POSITIVE 89 Mg/l 29-10-2009 / 00:13 85.0 10 04 01 00 247000 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 02:08 14.7 17400 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 02:08 29-10-2009 / 10:54
43 106 35
33
17.6
6.2
Name : B/o. Revathy Age/Sex : NB/ F Dept : Neonatology Hos.No: 435212 Mrd.No : 326113 Ward: IL.NB. NICU D.O.A : 30.10.09 D.O.D : 02.11.09 ************************************************************************
REF. BY : DR. SABARIRAJA.,
PLACE : SIVAGANGAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISTENT PULMONARY HYPERTENSION OF NEWBORN COURSE:
This term / IUGR / female baby was born at private hospital by LSCS (Ind : Previous LSCS with scar tenderness) on 30.10.09 at 7.45pm. H/o. Thick meconium stained liquor +. Baby did not cry immediately after birth had weak cry after resuscitation. Baby had respiratory distress with cyanosis. Since birth for that referred to MMHRC on 30.10.09 for further management. No Maternal H/o. PIH, GDM & PROM. O/E. Baby activitys & cry weak. Peripheral cyanosis +, CFT > 3 sec, dyspnoeic +, tachypnoeic +, grunting +, no birth injury, no obvious external anomaly. CVS: S1 & S2 +, RS: RS : RR @70/mt, lower chest indrawing +, supraclavicuar indrawing +, Bilateral crepitations +. P/A: soft, CNS : NNR sluggish. Baby was investigated peripheral smear showed : Hb : 18.3gms%, TC :
18,000cells/mm3, platelet count 1.1 lakhs. Blood sugar was normal. chest x-ray suggestive of Bilateral meconium infiltration. serum creatinine : 1.2mg/dl. Baby was managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate & Inj. Vitamin K & Ionotrophic support. series of ABGs were done and ventilator settings were adjusted according to that. On 01.11.09, baby had desaturation with the ventilator support, ABG taken which showed (PCO2 : 86, Po2 : 63.5 & Hco3 : 30) Ventilator settings were raised. With these above measures babys saturation maintained. Now baby is maintaining oxygen saturation (Spo2 : 98%) with Fio2 of 100%. Since parents were not willing for further management. Baby is discharged AGAINST MEDICAL ADVICE on 02.11.09 at 2.30pm.
INVESTIGATION
BLOOD BANK BLOOD GROUPING & Rh TYPING B POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC 5.0 Cells/cumm HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC RDW MPV BIO CHEMISTRY CREATININE (Jaffe Kinetic) MICROBIOLOGY CRP-C REACTIVE PROTEIN 1.2 0.4 to 1.4 mg/dL 01-11-2009 / 18:54 44 47 08 01 00 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 17:42 18.3 18000 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 17:42 31-10-2009 / 10:07
110000
56
112 36
32
12.4
7.8
C- Reactive Protein PATHOLOGY
POSITIVE 35 MG/L
01-11-2009 / 08:42
PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 5/100WBCs. WBC count shows leukocytosis. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :35% Eosinophils :01% Monocytes :05% Lymphocytes :59% Platelets Count slightly diminished IMPRESSION : -31-10-2009 / 17:42
31-10-2009 / 17:42
31-10-2009 / 17:42 31-10-2009 / 17:42
NOV 09
Name : B/o. Nalini Age/Sex : NB/ M Dept : Neonatology Hos.No: 435995 Mrd.No : 326588 Ward: IL.NB. NICU D.O.A : 05.11.09 D.O.D : 06.11.09 ************************************************************************
REF. BY : DR. ANBURAJAN.,
PLACE : THENI
This term / AGA / male baby was born at private hospital by LSCS ( Ind : Multipara with fibroid / maternal fever ) on 05.11.09. H/o. Meconium stained liquor +. Baby had weak cry after birth & baby had respiratory distress since birth and had apnoea for that referred to MMHRC on 05.11.09 for further management. Maternal H/o. fever with rigor 1 day. No H/o. PIH, GDM & PROM. O/E. Babys activity & cry : nil, cyanosed, CFT : prolonged, peripheral pulses : weak. Hypotension +, tachypnoeic +, Spo2 : 40% with O2 hood, immediately intubated and with tube & bag ventilation Spo2 : 58%, no birth injury, no obvious external anamoly, CVS : S1 S2 heard, RS : RR : 78/mt, Bilateral crepitations +, lower chest
indrawing +, P/A : soft, CNS : NNR not elicitable. Hypotonia +. Baby was investigated, ABG initially showed acidosis. (High Pco2 : 92.8 with Hco3 : 11.3) corrected with Hco3. babys peripheral smear showed HB : 13.4gms%, TC : 17,400cells and platelet count : 1.9 lakhs. Blood sugar were normal. Chest x-ray showed Bilateral meconium infiltration. CRP was negative. Blood culture was sent, report awaited. Baby was managed with Mechanical Ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Inj. Dopamine & Inj. Surfactant. As baby had persistent cyanosis with hypotension, Inj. Nor adrenaline infusion was started. As ABGs showed high Pco2 ventilator mode changed as HFV ventilator settings were raised. Even with these above measures, baby had desaturaion with the ventilator support. Grave prognosis was explained to the parents. Since parents were not willing for further management, baby is discharged AGAINST MEDICAL ADVICE on 06.11.09 at 11.30am.
INVESTIGATION :
BLOOD BANK BLOOD GROUPING & Rh TYPING B NEGATIVE PERIPHERAL BLOOD SMEAR STUDY RBC 3.88 HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC RDW MPV CRP-C REACTIVE PROTEIN C- Reactive Protein NEGATIVE 05-11-2009 / 23:24 75 20 04 01 00 192000 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 03:04 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 06-11-2009 / 03:04 06-11-2009 / 03:04 06-11-2009 / 12:11
13.4
17400
41 105 34
32
18.2
7.1
Name : B/o. Thilleswari Age/Sex : NB/ M Dept : Neonatology Hos.No: 435817 Mrd.No : 326483 Ward: IL.NB. NICU D.O.A : 04.11.09 D.O.D : 08.11.09 ************************************************************************
DIAGNOSIS: PRETERM ( 32 34 WEEKS) / VLBW WITH RESPIRATORY DISTRESS

SURFACANT THERAPHY GIVEN ON 04/11/2009 ? IVH
COURSE:
This preterm (32 34 weeks) VLBW (B.W 1.195kg) / Male baby was born at MMHRC on 04/11/2009 by Normal vaginal delivery. H/o. Baby had weak cry after birth with Apgar score 7/10 at 1 min and 8/10 at 5 min. Baby had Respiratory distress since birth for that admitted at NICU for further management. Maternal H/o. GDM & PROM. O/E: Babys activity & cry weak, colour: pink, CFT < 3 sec, dyspnoeic+, tachypnoeic+, no birth injury, no obvious external anamoly. CVS: S1, S2 heard, RS RR > 60/mt, lower Chest Indrawing+, SCR+, P/A: soft, CNS: NNR sluggish. Baby was investigated peripheral smear, Blood sugar & serum creatinine were normal. Chest X-ray suggestive of RDS. Baby was managed with CPAP, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & one dose of Inj. Surfactant on 07/11/2009. Baby had peripheral cyanosis followed by desaturation, Soda bi carbonate given had Apnoea
connected to mechanical Ventilator support and started on Ionotropes. Even with these above measures babys had desaturation followed by Bradycardia. Resuscitated with 3 doses Inj. Atropine & Inj. Adenaline. CPR was carried out. But could not be revived & DECLARED DEAD ON 08/11/2009 at 2.45 P.M.
Name : B/o. Bhavani Twin II Age/Sex : NB/ F Dept : Neonatology Hos.No: 436129 Mrd.No : 326678 Ward: IL.NB. NICU D.O.A : 06.11.09 D.O.D : 13.11.09 ********************************************************** ************** DIAGNOSIS: PRETERM (30 32 WEEKS) / LBW / PERINATAL ASPHYXIA/ RESPIRATORY DISTRESS / RECURRENT APNEA SURFACTANT THERAPY GIVEN ON 06.11.09
Name : B/o. Indumathi Age/Sex : NB/ F Dept : Neonatology Hos.No: 435109 Mrd.No : 326045 Ward: IL.NB. NICU D.O.A : 29.10.09 D.O.D : 12.11.09 ************************************************************************
REF. BY : DR. LATHA MURUGAN.,
PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERINATAL ASPHYXIA MILD PPHN COURSE:
This term / AGA / female baby was referred to MMHRC on 29.10.09 as a case of Meconium aspiration syndrome. Baby born at private hospital on 29.10.09 at 9.15pm by normal vaginal delivery. H/o. thick meconium stained liquor. Baby did not cry immediately, had weak cry after stimulation. H/o. resuscitation with bag and mask ventilation. Maternal H/o. Fever 1 week, 15 days before delivery. O/E. Babys activity and cry weak, peripheral cyanosis +, CRT > 3sec, RS : RR : 70/min, tachypnoeic +, lower chest indrawing +, P/A : Soft, CVS: S1 & S2 +, murmur +, CNS : NNR, not elicitable. Baby had Spo2 of 60% with O2 hood. Baby was intubated and connected to mechanical ventilator. Baby was investigated with HB : 19gm%, TC : 12,800, platelet 2 lakhs, Blood sugar : 384mg/dl, CRP :
Positive, serum creatinine : 0.9. ET culture and blood culture showed no growth. Chest x-ray showed Meconium aspiration syndrome. Baby was managed with Mechanical ventilator, Iv fluids, Inj. Ronem, Inj. Aztreonem, Syp. Osteocalcium, Domstal drops. Inj. Gardenol, Inj. Pavlon, Inj. Dopamine and mucolite drops. With these above measures baby respiration improved, activity improved and tolerating RTF. Baby was weaned form ventilator on 09.11.09 and was maintaining on CPAP. Since baby attenders not willing to continue treatment baby was discharged AGAINST MEDICAL ADVICE on 12.11.09.
INVESTIGATION :
HAEMATOLOGY & CLINICAL PATHOLOGY TOTAL WBC COUNT BLOOD BANK BLOOD GROUPING & Rh TYPING O POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC 3.38 HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC RDW MPV BIO CHEMISTRY CREATININE (Jaffe Kinetic) MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein PATHOLOGY POSITIVE 48 MICROGRAM/ML 31-10-2009 / 07:38 0.9 0.4 to 1.4 mg/dL 31-10-2009 / 22:40 70.0 20.0 6.0 2.0 1.0 242000 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 31-10-2009 / 16:05 31-10-2009 / 16:05 31-10-2009 / 16:05 31-10-2009 / 16:05 31-10-2009 / 16:05 31-10-2009 / 16:05 31-10-2009 / 16:05 31-10-2009 / 16:05 31-10-2009 / 16:05 31-10-2009 / 16:05 31-10-2009 / 16:05 31-10-2009 / 16:05 31-10-2009 / 16:05 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 31-10-2009 / 16:05 31-10-2009 / 16:05 30-10-2009 / 11:28 8900 6000 to 18000 Cells/cumm 12-11-2009 / 15:09
12.1
19800
36 107 35
33
17.3
7.7
PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 6/100WBCs. WBC count shows neutrophilic leukocytosis. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :70% Eosinophils :02% Monocytes :05% Lymphocytes :23% Platelets Count normal in Number and morphology IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 31-10-2009 / 16:05
31-10-2009 / 16:05
31-10-2009 / 16:05 31-10-2009 / 16:05
ECHO SHOWED ON 05.11.09 : SITUS SOLITUS, LEVOCARIDA, SMALL

MUSCULAR VSD, L R SHUNT, IAS ANEURYSM +, NO SHUNT, NO PDA /
COARCTATION. IMPROESSION : CONGENITAL HEART DISEASE, SMALL MUSCULAR VSD, L SHUNT, IAS ANEURYSM, MILD PAH
DR. A. KANNAN., MD., DCH., SR. CONSULTANT.
Name : B/o. Abirami Age/Sex : NB/ F Dept : Neonatology Hos.No: 436179 Mrd.No : 326727 Ward: IL.NB. NICU D.O.A : 07.11.09 D.O.D : 14.11.09 ************************************************************************
REF. BY : DR. JEYA CHITRA, DIAGNOSIS: THICK MECONIUM ASPIRATION PERINATAL ASPHYXIA COURSE:
PLACE : MADURAI
This term / AGA / female baby was born at private hospital by LSCS ( IND : Postdated with maternal fever ) on 07.11.09 at 6.28am. H/o. Thick meconium stained liquor +, resuscitated with ET tube suctioning & after with ambu bag ventilation, babys respiration was established, baby had respiratory distress since birth, for that referred to MMHRC on 07.11.09 for further management. Maternal H/o. High grade fever with thrombocytopenia + at the time of delivery. No Maternal H/o. PIH, GDM & PROM. O/E. Babys activity sluggish, cry : irritable, colour : pink, CFT < 3sec, tachypnoeic +, no birth injury, no obvious external anamoly, CVS: S1 & S2 +, RS: RR @ 60/mt, lower chest indrawing +, P/A : soft, CNS : Irritable. Baby was investigated : peripheral smear showed Neutrophilic leukocytosis. Blood sugar & serum creatinine were normal. CRP was Negative.
Blood culture showed no growth. Chest x-ray showed Bilateral meconium infiltration. Baby was managed with C-PAP, Iv. Fluids, Iv. antibiotics, Inj. Calcium gluconate & Inj. Vitamin K. With these above measures babys respiration became normal, weaned from the C-PAP on 11.11.09 and started on small tube feeds. Now baby is active, taking oral feeds, had no vomiting and discharged today with the advice to continue further follow-up with the referral doctor.
INVESTIGATION :
BLOOD BANK BLOOD GROUPING & Rh TYPING AB POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC 5.11 HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC RDW MPV BIO CHEMISTRY CREATININE (Jaffe Kinetic) 0.9 0.4 to 1.4 mg/dL 08-11-2009 / 20:10 75 15 06 04 00 287000 55 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 19:24 18.0 25000 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 19:24 07-11-2009 / 14:32
108 35
32
18.2
8.0
MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100WBCs. WBC count shows neutrophilic leukocytosis. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :75% Eosinophils :03% Monocytes :05% Lymphocytes :17% Platelets Count normal in Number and morphology IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 07-11-2009 / 19:24 NEGATIVE 07-11-2009 / 14:38
07-11-2009 / 19:24
07-11-2009 / 19:24 07-11-2009 / 19:24
ADVICE ON DISCHARGE
Domstal drops
8 drops
TID x
2 weeks
Name : B/o. Shajitha Banu Age/Sex : NB/ M Dept : Neonatology Hos.No: 434937 Mrd.No : 325899 Ward: IL.NB. NICU D.O.A : 28.10.09 D.O.D : 25.11.09 ************************************************************************
REF. BY : DR. VENKATESAN.,
PLACE : KARAIKUDI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME CHD-MODERATE SIZE ASD MILD VALVULAR PS BRONCHOPULMONARY DYSPLASIA COURSE:
This term / AGA / male baby was born at private hospital by normal vaginal delivery on 28.10.09. H/o. Thin meconium stained liquor +. H/o. Baby cried soon after birth. H/o. Respiratory distress since birth for that referred to MMHRC on 28.10.09 for further management. Mother is on Antipsychiatric drugs Tab. Olenzepine, Tab. Lorazepam & Tab. Oxycarbaine. No H/o. PIH, GDM & Hypothyroidism. O/E. Baby activity & cry : weak, peripheral cynanosis +, CFT > 3 sec, dyspnoeic +, tachypnoeic +, no birth injury & no obvious external anomaly. CVS: S1 & S2 heard, RS:RR @ 72/min, ICR +, SCR +. P/A: soft, CNS : NNR sluggish. Baby was investigated : Peripheral smear, Blood sugar & serum creatinine were normal. Chest x-ray (28.10.09) showed Bilateral meconium
infiltration. ECHO done which showed moderate size ASD with Mild Valvular PS. Baby was managed with Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Ionotrophic support. As baby had raised Respiratory distress, connected to mechnical ventilator support on 29.10.09. with these above measures, babys respiratory distress reduced, weaned from the ventilator on 02.11.09 & started on small tube feeds. As baby had desaturation on 05.11.09, again connected to mechanical ventilator support. Baby had difficulty in weaning from the ventilator, Repeat chest x-ray done - which suggestive of Bronchopulmonary dysplasia. Baby was started on diuretics & steroids. With these above management, babys respiration improved so weaned form the ventilator on 11.11.09 & ryles tube was gradually raised. Baby was slowly weaned from the oxygen. Now babys activity improved, respiration became normal & taking oral
feeds. Baby is discharged today with the advice to conitnue further follow-up with the referral doctor.
INVESTIGATION :
BLOOD BANK BLOOD GROUPING & Rh TYPING O POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC 4.5 HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC RDW MPV BIO CHEMISTRY 89 07 03 01 00 150000 49 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 16.6 21600 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 09:51
110 36
33
18.3
7.7
CREATININE (Jaffe Kinetic) PATHOLOGY
0.6
0.4 to 1.4 mg/dL
30-10-2009 / 16:32
PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes and macrocytes. No nucleated RBCs or hemoparasites. WBC count shows leukocytosis. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :88% Eosinophils :01% Monocytes :03% Lymphocytes :08% Platelets Count normal in Number and morphology IMPRESSION : -29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07 29-10-2009 / 15:07
ADVICE ON DISCHARGE
Tab. Aldarline
25mg
1/5 th OD
2 weeks
Syp. Deriphylline
8 drops
TID
2weeks
C-Pink drops
4 drops
OD
2 weeks
REVIEW AFTER 2 WEEKS
DR. A. KANNAN., MD., DCH., SR. CONSULTANT
Name : B/o. Tamilarasi Age/Sex : NB/ M Dept : Neonatology Hos.No: 438175 Mrd.No : 328083 Ward: IL.NB. NICU D.O.A : 24.11.09 D.O.D : 01.12.09 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA ( CORD AROUND THE NECK) MECONIUM ASPIRATION ACUTE RENAL FAILURE COURSE:
This term / AGA / male baby was born at MMHRC by normal vaginal delivery on 24.11.09 at 3.45am. H/o. Baby did not cried immedietly after birth. H/o. Baby had weak cry after suctioning and tactle stimulation. H/o. Cord around the neck +. H/o. Meconium stained liquor +. H/o. Baby had respiratory distress & cyanosis after birth for that admitted at NICU for further management. M H/o. Hypothyroidism +, on Tab. Eltroxin 100mg OD. No M h/o. PIH, GDM, PROM & Maternal fever. O/E. Babys activity & cry weak. Peripheral cyanosis +, CFT < sec, dyspnoeic +, tachypnoeic +, no birth injury & no obvious external abamoly, CVS : S1, S2 heard, RS : RR @ 70/mt, Inter costal & Sub constal retractions +, P/A : Soft, CNS : NNR sluggish. Baby was investigated peripheral smear, Blood sugar and serum creatinine (26.11.09) were normal. TSH : 1.29uu/ml. CRP :
Positive (24.11.09). Et tip culture showed no growth. Blood culture report awaited. Baby was managed with mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Ionotrophic support. On 30.11.09. baby had convulsion, Inj. Gardenol was added. With these above measures, babys respiratory ditress reduced weaned from the ventilator on 25.11.09 & was extubated on 27.11.09. baby had again developed respiratory distress with desaturation, intubated and connected to mechnical ventilator support on 30.11.09. As baby had decreased urine output, serum creatinine checked which was 1.9mg/dl so managed with Lasix infusion & fluid was restricted. Baby had GI bleed,
platelet count was only : 20,000 on 30.11.09, PRP transfusion was given. As babys ABG showed acidosis (Hco3 13), corrected with Inj. NaHco3. Now baby is in mechanical ventilator support, with Fio2 : 100%, maintaining Spo2 : 98%. Since parents were not willing for further management, baby is discharged AGAINST MEDICAL ADVICE on 01.12.09 @ 1pm.
INVESTIGATION :
HAEMATOLOGY & CLINICAL PATHOLOGY PLATELET COUNT BLOOD BANK BLOOD GROUPING & Rh TYPING B POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC 4.2 HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC RDW MPV BIO CHEMISTRY 75 18 05 02 00 264000 46 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 18:36 15.7 18000 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 18:36 24-11-2009 / 13:44
20000
150000 to 450000 Cells/cumm
01-12-2009 / 10:22
108 37
34
18.4
6.8
CREATININE (Jaffe Kinetic) CREATININE (Jaffe Kinetic) TSH (CLIA) MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein C- Reactive Protein PATHOLOGY
0.7
0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.34 to 5.6 U/mL
26-11-2009 / 10:21 30-11-2009 / 18:23 24-11-2009 / 13:13
1.9
1.29
NEGATIVE POSITIVE 48 MICROGRAM / ML
24-11-2009 / 11:08 30-11-2009 / 22:19
PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes. No nucleated RBCs or hemoparasites. WBC count shows mild neutrophilic leukocytosis. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :75% Eosinophils :02% Monocytes :05% Lymphocytes :18% Platelets Count normal in Number and morphology IMPRESSION : -24-11-2009 / 18:36
24-11-2009 / 18:36
24-11-2009 / 18:36 24-11-2009 / 18:36
Name : B/o. Annalakshmi Age/Sex : NB/ M Dept : Neonatology Hos.No: 437982 Mrd.No : 327931 Ward: IL.NB. NICU D.O.A : 22.11.09 D.O.D : 03.12.09 ************************************************************************
REF. BY : DR. ARIVALAHAN., DIAGNOSIS: MECONIUM ASPIRATION NEONATAL SEPSIS THROMBOCYTOPENIA COURSE:
PLACE : KARAIKUDI
This term / AGA / male baby was born at private hospital by LSCS (Ind : Mother had polioattak over legs) on 22.11.09. H/o. Meconium stained liquor +. Ho. Baby cried soon after birth. H/o. Baby had respiratory distress & cyanosis. since birth baby was referred to MMHRC on 22.11.09 as a case of ? cyanosis heart disease for further management. No H/o. Cord around the neck. No MH/o. PIH, GDM & Fever. O/E. Babys activity sliuggish, cry : weak, peripheral cyanosis +, CFT > 3 sec, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anomaly. CVS: S1 & S2 +, RS: RR @ 72 / mt, SCR +, ICR +, Bilateral air entry equal, P/A : soft, CNS : Irritable, NNR sluggish. Baby was investigated peripheral smear & Blood sugar were normal. Serum creatinine : 1.2mg/dl, (22.11.09), 0.7mg/dl (27.11.09). blood culture showed klebsiella growth. ECHO showed small
PFO, otherwise normal study. Baby was managed with Mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Ionotrophic support. With these above measures babys respiratory distress reduced with the ventilator support. Ryles tube feeds started. Baby developed icterus with petechial spots over the abdomen, serum bilirubin checked T : 20.1mg/dl, & D : 6.4mg/dl. At that time platelet count was only 20,000. Baby was managed with FFP & PRP transfusion. As baby had abdominal distension, RTF was gradually raised. Repeat blood culture sent, report awited. On 02.12.09, baby had decreased urine output, fluid restricted & Inj. Lasix infusion was started. On 02.12.09 baby was pale, HB checked, it was 6.7gms%, managed with whole fresh blood transfusion. Now baby is in mechanical ventilator support with Fio2 : 35%, maintaining oxygen saturation of 98-100% & tolerating tube feeds. Since parents were not willing for further management, baby is discharged AGAINST MEDICAL ADVICE on 03.12.09 @ 5pm. INVESTIGATION :
HAEMATOLOGY & CLINICAL PATHOLOGY
PLATELET COUNT PLATELET COUNT PLATELET COUNT PLATELET COUNT PLATELET COUNT PLATELET COUNT PLATELET COUNT PLATELET COUNT PLATELET COUNT PLATELET COUNT PLATELET COUNT BLOOD BANK
20000 20000 20000 20000 20000 20000 20000 20000 20000 20000 20000
150000 to 450000 Cells/cumm 150000 to 450000 Cells/cumm 150000 to 450000 Cells/cumm 150000 to 450000 Cells/cumm 150000 to 450000 Cells/cumm 150000 to 450000 Cells/cumm 150000 to 450000 Cells/cumm 150000 to 450000 Cells/cumm 150000 to 450000 Cells/cumm 150000 to 450000 Cells/cumm 150000 to 450000 Cells/cumm
28-11-2009 / 15:42 29-11-2009 / 09:26 29-11-2009 / 20:04 30-11-2009 / 09:39 30-11-2009 / 19:56 01-12-2009 / 10:24 01-12-2009 / 21:29 02-12-2009 / 09:54 02-12-2009 / 20:13 03-12-2009 / 07:36 03-12-2009 / 09:32
BLOOD GROUPING & Rh TYPING A POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC 4.12 HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC RDW MPV BIO CHEMISTRY CREATININE (Jaffe Kinetic) CREATININE (Jaffe Kinetic) 1.2 1.1 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 22-11-2009 / 18:45 25-11-2009 / 16:00 70 19 10 01 00 381000 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 14.2 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 09:58
26600
41 99 34
34
16.1
6.7
CREATININE (Jaffe Kinetic) BILIRUBIN - TOTAL & DIRECT BILIRUBIN - TOTAL (Diazo) BILIRUBIN - DIRECT (Diazo) MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein PATHOLOGY
0.7
0.4 to 1.4 mg/dL
27-11-2009 / 09:47
20.1 6.4
0.5 to 1.1 mg/dL 0.2 to 0.5 mg/dL
30-11-2009 / 18:32 30-11-2009 / 18:32
NEGATIVE
23-11-2009 / 12:39
PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes. No nucleated RBCs or hemoparasites. WBC count shows neutrophilic leukocytosis. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :70% Eosinophils :01% Monocytes :05% Lymphocytes :24% Platelets Count normal in Number and morphology IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16 23-11-2009 / 17:16
ECHO SHOWED ON 24.11.09 : SITUS SOLITUS, LEVOCARDIA, PFO +, GOOD LV FUNCTION, NO PDA / COARCTATION, NO PULMONARY HYPERTENSION. IMPRESSION : PFO +, OTHERWISE NORMAL STUDY.
Name : B/o. Dhanalakshmi Age/Sex : NB/ F Dept : Neonatology Hos.No: 439857 Mrd.No : 329084 Ward: IL.NB. NICU D.O.A : 05.12.09 D.O.D : 11.12.09 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA MECONIUM ASPIRATION SYNDROME NEONATAL SEIZURE ACUTE RENAL FAILURE
COURSE:
This term / AGA / female baby was born at Private hospital by normal vaginal delivery on 05.12.09. H/o. Birth asphyxia +, H/o. Baby developed respiratory distress since birth. H/o. Meconium stained liquor +. Baby was referred to MMHRC on 05.12.09 for further management, MH/o. Fever 5 days before delivery +. No MH/o. PIH & GDM. O/E Babys activitys & cry weak, CFT > 3sec, peripheral cyanosis +, dyspnoeic +, tachypnoeic +, no birth injury, no obvious external anamoly. CVS: S1 & S2 heard, RS: RR @62/mt, Bilateral crepitations +, SCR +. P/A: soft, CNS: NNR sluggish. Baby was investigated peripheral smear showed HB : 17.4gms%, TC : 34,800cells & Platelet count : 2.3 lakhs. CRP : Positive. Serum creatinine : 1mg/dl, Blood culture showed no growth (06.12.09). Repeat blood sugar sent, report awaited. Baby was managed with CPAP, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Dopamine infusion. As baby had persisitent cyanosis. ECHO done shich showed IAS
Aneurysm, Small os ASD with L-> R shunt, No PAH. Baby had distress, connected to ventilator support on 07.12.09. As baby had decreased urine output, Repeat serum creatinine on 10.12.09, showed 1.7mg/dl, managed with Inj. Lasix infusion. As baby had hypotension with low perfusion, Inj. Nor adrenaline infusion was started on 10.11.09. Even with these above measures baby developed bradycarida, followed by cardiac arrest. 3 deses of Inj. Atropine and Inj. Adrenaline were given. CPR was carried out. But could not be revived & DECLARED DEAD on 11.12.09 @ 10.25am.
INVESTIGATION :
BLOOD BANK BLOOD GROUPING & Rh TYPING A NEGATIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC 4.7 Cells/cumm HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC RDW MPV BIO CHEMISTRY CREATININE (Jaffe Kinetic) CREATININE (Jaffe Kinetic) MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes and 07-12-2009 / 16:54 POSITIVE 48microgram/ml 06-12-2009 / 01:48 1.0 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 07-12-2009 / 05:55 10-12-2009 / 13:17 85 11 03 01 00 230000 51 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 07-12-2009 / 16:54 07-12-2009 / 16:54 07-12-2009 / 16:54 07-12-2009 / 16:54 07-12-2009 / 16:54 07-12-2009 / 16:54 07-12-2009 / 16:54 07-12-2009 / 16:54 07-12-2009 / 16:54 07-12-2009 / 16:54 07-12-2009 / 16:54 07-12-2009 / 16:54 17.4 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 07-12-2009 / 16:54 07-12-2009 / 16:54 07-12-2009 / 16:54 06-12-2009 / 13:22
34800
106 34 18.3 7.4

7.4
1.7
macrocytes. Nucleated RBCs 2/100WBCs. WBC count shows neutrophilic leukocytosis with shift to left. No atypical cells. DIFFERENTIAL COUNT : Myelocytes : 02% Stab : 04% NeutroPhils :78% Eosinophils :01% Monocytes :05% Lymphocytes :10% Platelets Count normal in Number and morphology IMPRESSION : TO LEFT. 07-12-2009 / 16:54
07-12-2009 / 16:54
NEUTROPHILIC LEUKOCYTOSIS WITH SHIFT 07-12-2009 / 16:54
Name : B/o. Malar vizhi Age/Sex : NB/ M Dept : Neonatology Hos.No: 441935 Mrd.No : 330591 Ward: IL.NB. NICU D.O.A : 23.12.09 D.O.D : 26.12.09 ************************************************************************
REF. BY : DR. GAYATHREE.,
PLACE : THENI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME COURSE:
This 1 day male baby referred to MMHRC on 23.12.09 with respiratory distress. Baby delivered by outlet forceps. H/o. Thick meconium stained liquor + H/o. Baby cried soon after birth but soon developed grunting and respiratory distress. Maternal History : H/o. Severe vaginal candidiasis - 1 week before delivery. No Maternal H/o. GDM, PIH, PROM, Fever with rash. O/E. Babys cry & activity moderate, CFT < 3 sec, no pallor, not icteric, no cyanosis, no clubbing, no edema, no generalized lymphadenopathy. RS : tachypnoeia + (RR : 66/min) mild LCI +, CVS : S1 S2 +, no murmur, P/A : soft, CNS : Intact. Baby was investigated : Hb : 20%, TC : 16,400, Platelet count : 2.5lakhs, CRP : Positive, serum creatinine : 0.7, Blood culture report awaited. Baby was managed with Iv fluids, Iv antibiotics, Inj. Taxim, Inj. Amikacin and Inj. Fluconazole. With these above measures baby activity and cry good, respiratory distress decreased hence discharged today with advice to continue the further follow-up with the referral doctor.
INVESTIGATION
BLOOD BANK BLOOD GROUPING & Rh TYPING
B POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC 5.72 HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC RDW MPV BIO CHEMISTRY CREATININE (Jaffe Kinetic) MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100WBCs. WBC count shows neutrophilic leukocytosis. No atypical or immature cells. POSITIVE 24 MICROGRAM / ML 0.7 0.4 to 1.4 mg/dL 80 10 08 02 00 250000 62 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl
23-12-2009 / 10:07
23-12-2009 / 17:39 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 23-12-2009 / 17:39 23-12-2009 / 17:39
20.1
16400
23-12-2009 / 17:39 23-12-2009 / 17:39 23-12-2009 / 17:39 23-12-2009 / 17:39 23-12-2009 / 17:39 23-12-2009 / 17:39 23-12-2009 / 17:39 23-12-2009 / 17:39 23-12-2009 / 17:39 23-12-2009 / 17:39 23-12-2009 / 17:39 23-12-2009 / 17:39
109 35
32
17.5
8.1
24-12-2009 / 13:47
24-12-2009 / 10:54
23-12-2009 / 17:39
DIFFERENTIAL COUNT :
NeutroPhils :80% Eosinophils :02% Monocytes :05% Lymphocytes :13% Platelets Count normal in Number and morphology
23-12-2009 / 17:39
23-12-2009 / 17:39 23-12-2009 / 17:39
IMPRESSION :
--
ADVICE ON DISCHARGE Inj. Taxim Inj. Amikacin Inj. Fluconazole 150mg 40mg 18mg IV BD IV OD IV OD x x x 6 days 6 days 14 days
Name : B/o. Ayisha Banu Age/Sex : NB/ F Dept : Neonatology Hos.No: 442898 Mrd.No : 331137 Ward: IL.NB. NICU D.O.A : 29.12.09 D.O.D : 31.12.09 ************************************************************************
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERSISITENT PULMONARY HYPERTENSION (PPHN) COURSE:
This Term / AGA female baby referred to MMHRC on 31.12.09 as a case of respiratory distress, who delivered on 29.12.09 at 8.20am by normal vaginal delivery. H/o. Meconium stained liquor +. No H/o. Cord around the neck and baby cried immediately after birth but developed respiratory distress and cyanosis about 2 hours after birth. No H/o. Vomiting, convulsion. O/E : Cry and activity moderate, CRT > 3 sec, cyanosis +, no pallor, no icterus, lymphadenopathy, pedal edema. RS : 78/mnt, ICR +, SCR +, tachypnoeic, CVS : S1, S2 +, P/A : Soft, CNS : intact. Baby was investigated HB : 19.5, TC : 18,200, Platelet count : 1.2 lakhs, CRP : Negative. Repeat CRP done on 31.12.09 : Positive, TC : 15,600 (31.12.09), serum creaitinine : 1.0. Chest x-ray showed MAS Meconium infiltrates. Baby was managed with Mechanical ventilator support,
Ionotropes, Iv. Antibiotics, Inj. Taxim, Inj. Ampicillin, Inj. Calcium gluconate, Inj. Vitamin K and Tab. Sildenotil. Blood culture and sent report awaited. Even with above measures babys general condition continuously deteriorated, baby went into brady cardia & cardiac arrest on 31.12.09 at 2.10pm. baby was started on all cardiac resuscitation, measures but could not be revived, so baby was DECLARED DEAD on 31.12.09 at 2.30am.
INVESTIGATION
HAEMATOLOGY & CLINICAL PATHOLOGY TOTAL WBC COUNT BLOOD BANK BLOOD GROUPING & Rh TYPING A POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC 5.06 HAEMOGLOBIN TOTAL WBC COUNT DIFFERENTIAL COUNT Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT PCV (HEMATOCRIT) MCV MCH MCHC RDW MPV BIO CHEMISTRY CREATININE (Jaffe Kinetic) MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein C- Reactive Protein PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY . NEGATIVE POSITIVE 12 MG / L 29-12-2009 / 22:56 31-12-2009 / 13:14 1.0 0.4 to 1.4 mg/dL 31-12-2009 / 01:00 83 10 06 01 00 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 17:37 19.5 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 17:37 30-12-2009 / 10:27 15600 6000 to 18000 Cells/cumm 31-12-2009 / 13:03
8200
122000
57
113 38
33 21.5 8.0
RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100WBCs. WBC count normal. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :83% Eosinophils :01% Monocytes :05% Lymphocytes :11% Platelets Count normal in Number and morphology IMPRESSION : --
30-12-2009 / 17:37
30-12-2009 / 17:37
30-12-2009 / 17:37 30-12-2009 / 17:37
JAN 10
Name : B/o. Kavitha Age/Sex : NB/ M Dept : Neonatology Hos.No: 442241 Mrd.No : 330772 Ward: IL.NB. NICU D.O.A : 25.12.09 D.O.D : 13.01.10 ************************************************************************
REF. BY : DR. ILAYARAJA.,
PLACE : ARANTHANGIE
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME NEONATAL SEIZURE COURSE:
This term / AGA / male baby born at private hospital by normal vaginal delivery on 25.12.09 at 3.05am with H/o. baby not cried immediately after birth, and severe respiratory distress, and irritable cry since birth after resuscitation. No convulsion. Maternal History of Thick meconium stained liquor. No maternal H/o. PIH, GDM, Fever with rashes, recurrent UTI, PROM & Cord around the neck. O/E. Babys activity & cry : weak, colour : cyanosis, CFT > 3sec, severe respiratory distress +, no pallor, not icteric, no clubbing, no generalized edema, no obvious external congenital anamolies and no birth injury. Spo2 : 60% with oxygen therapy, CVS : S1 S2 Heard. No murmur, Rs : Bilateral air entry equal, crepts +, P/A : Soft, no organomegaly, CNS : NNR sluggish. hence baby was intubated and was shifted to NICU for mechanical ventilator support. Baby was investigated HB: 17.8gms%, TC : 24,500, Platelet count : 2.6 lakhs, CRP :
Negative. Blood sugar & serum creatinine were normal. Serum potassium : 4.5, Blood culture no growth, ET Tip Culture sent on (25.12.09) : no growth. Chest xray suggestive of meconium aspiration syndrome. Baby was managed with Mechanical ventilator support, Ionodropes, Iv fluids, Iv antibiotics, ionodropes, Inj. Rantac, Inj. Gardenol, Inj. Calcium gluconate, Domstal drops, Mucolite drops and chest physiotherapy. With these above measures baby respiration became normal and was weaned from ventilator on 09.01.09 and started on small tube feeds. Baby tolerate feed well. Baby is on direct breast feeds, hence discharged today with advice to continue the follow-up with the referral doctor.
INVESTIGATION
HAEMATOLOGY & CLINICAL PATHOLOGY TOTAL WBC COUNT (Coulter Principle) BLOOD BANK BLOOD GROUPING & Rh TYPING O POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC (Coulter Principle) 4.94 HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) DIFFERENTIAL COUNT (VCS Technology) Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) BIO CHEMISTRY Plasma CREATININE (Jaffe Kinetic) POTASSIUM (ISE) MICROBIOLOGY CRP-C REACTIVE PROTEIN 0.8 4.5 0.4 to 1.4 mg/dL 3.5 to 5 mEq/L 27-12-2009 / 07:28 25-12-2009 / 13:14 80 15 04 01 00 261000 53 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:10 17.8 24500 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:10 25-12-2009 / 14:38
21100
6000 to 18000 Cells/cumm
05-01-2010 / 13:34
107 36
33
17.7
7.4
C- Reactive Protein
NEGATIVE
25-12-2009 / 15:57
ADVICE ON DISCHARGE Tab. Gardenol Domstal drops Mucolite drops 20mg 8 drops 5 drops HS TID TID x x x Till further advice 2 weeks 2 weeks
Name : B/o. Ponnulakshmi Age/Sex : NB/ M Dept : Neonatology Hos.No: 443456 Mrd.No : 331480 Ward: IL.NB. NICU D.O.A : 03.01.10 D.O.D : 12.01.10 ************************************************************************
REF.BY.DR.SUNITHA.,
PLACE : MADURAI
DIAGNOSIS: PRETERM (30-32 WEEKS) WITH RDS (SURFACTANT GIVEN) NEONATAL ENCEPHALOPATHY WITH SEIZURE
Name : B/o. Deepa Age/Sex : NB/ M Dept : Neonatology Hos.No: 444326 Mrd.No : 332105 Ward: IL.NB. NICU D.O.A : 11.11.10 D.O.D : 11.01.10 ************************************************************************
REF. BY : DR. SUNITHA.,
PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION CONGENITAL HEART DISEASE SMALL ASD, SMALL PDA, PPHN ACUTE RENAL FAILURE COURSE:
This postdated /AGA/ baby referred to MMHRC as a case of meconium aspiration syndrome, baby delivered by LSCS (Indication : post dated preganacy) on 10.01.10 at 10.35pm. H/o. baby resuscitated at birth. No H/o. convulsions, No Maternal H/o. PIH, GDM, Hypothyroid, fever with rash. O/E. Babys activity & cry : weak, no obvious external congenital anamolies, CVS : S1 S2 +, RS : Nasal flaring +, SCR +, ICR +, Bilateral air entry +, bilateral crepts +, P/A : Soft, CNS : NNR sluggish. Baby was intubated and connected to mechanical ventilator. Baby was investigated HB : 17.8, Tc : 21,600, platelets : 1.3 lakhs, CRP : Negative. Blood sugar : 68mg/dl, serum creatinine : 1.3 lakhs (11.01.10), serum creatinine : 1.2. blood urea : 39 (14.01.10), TC : 11,800 (15.01.10). serum creatinine : 2.8 (16.01.10). Blood culture and ET aspiration culture showed no growth. ECHO showed CHD, Small ASD, Mild PAH, Small PDA. Babys Pco2 ventilator
settings changed accordingly. Baby had hypotension and was managed with
Inotropes. Depite treatment baby had persistent hypoglycemia. Blood sugar monitored 6th hourly and correction given. Baby was planned for dialysis as babys attenders not willing to continue treatment baby is discharge AT REQUEST on 10.01.10.
Name : B/o. Patchaiammal Age/Sex : NB/ F Dept : Neonatology Hos.No: 445995 Mrd.No : 333193 Ward: IL.NB. NICU D.O.A : 24.01.10 D.O.D : 25.01.10 ************************************************************************
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME BIRTH ASPHYXIA COURSE:
This term / AGA / female baby was born at MMHRC by normal vaginal delivery on 24.01.10. H/o. Thick meconium stained liquor + ( foul smelling). H/o. Baby did not cry immedietly after birth. Baby cried after tactle stimulation & suctioning. H/o. Baby developed respiratory distress since birth for that admitted at NICU for further management. H/o. Peripheral cyanosis +. MH/o. Eclampsia + on MgSo4 therapy. Unhealthy placenta +. No MH/o. GDM. O/E. After
resuscitation, babys activity & cry : weak, peripheral cyanosis +, CFT > 3sec, dyspnoeic +, tachypnoeic +, grunting +, not anaemic, not icteric, no birth injury, no obvious external anomaly. CVS: S1 & S2 heard, RS: RR @ 68 / mt, Lower chest indrawing +, SCR +, P/A : soft, CNS : NNR sluggish. Baby was investigated peripheral smear showed HB : 17.1gms%, TC : 10,300cells & platelet count 2.2 lakhs. CRP : Positive. Blood culture sent, report awaited. Chest x-ray suggestive of Bilateral meconium infiltration. Baby was managed with mechanical ventilator support, Iv fluids, Iv antibiotics, Inj. Calcium gluconate, Inj. Vitamin K &
Ionotrophic support. ABGs done which showed (Pco2 50, Po2 : 35 with Hyperkalemia), ventilator settings were adjusted & corrected with calcium gluconate & asthalin nebulization. serum K+ : 3.9 (25.01.10). Now baby is in mechanical ventilator support with Fio2 : 100%, with maintaining oxygen saturation (Spo2 : 99%). Since parents were not willing for further management, baby is discharged AGAINST MEDICAL ADVICE on 25.01.10 at 8pm.
INVESTIGATION
BLOOD BANK BLOOD GROUPING & Rh TYPING O POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC (Coulter Principle) 4.4 HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) DIFFERENTIAL COUNT (VCS Technology) Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) BIO CHEMISTRY POTASSIUM (ISE) MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY . RBCs show macrocytic normochromic. Nucleated RBCs+ Hemoparasites Nil. WBC count shows neutrophilic shift to left +. 25-01-2010 / 11:42 POSITIVE 24 MICROGRAM /ML 24-01-2010 / 22:30 3.9 3.5 to 5 mEq/L 25-01-2010 / 08:43 63 33 03 01 00 225000 48 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 11:42 17.1 10300 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 11:42 25-01-2010 / 09:55
107 38
35
16.6
6.7
No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :63% Eosinophils :01% Monocytes :03% Lymphocytes :33% Platelets Count Adequate IMPRESSION : --25-01-2010 / 11:42
25-01-2010 / 11:42 25-01-2010 / 11:42
FEB 10
Name : B/o. MuthuMari Age/Sex : NB/ F Dept : Neonatology Hos.No: 448623 Mrd.No : 334770 Ward: IL.NB. NICU D.O.A : 13.02.10 D.O.D : 17.02.10 ************************************************************************
REF.BY.DR.PRABAKAR NAVAMANI.,
PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH PERSISTENT PULMONARY HYPERTENSION ? SEPTICEMIA COURSE:
This term / AGA / female baby born at private hospital on 13.02.10 at 6.15am by normal vaginal delivery with H/o. Cried immediately after birth and developed respiratory distress after 2 hours and was sent to the referral doctor hospital. Since baby had increased respiratory distress, was referred to MMHRC for further management. No H/o. Cord around the neck and convulsion. Maternal H/o: Mother had fever at 32 weeks of gestation. H/o. Meconiums stained liquor +. No H/o. UTI, PIH, GDM, Bronchial Asthma and hypothyroidism. O/E : Babys activity and cry : weak, CFT > 3sec, Respiratory distress +, Tachypnoea +, Nasal flaring +, no pallor, no birth injury, no cyanosis, no clubbing, no obvious external anomaly. CVS : S1 S2 heard, RS : Bilateral air entry +, dysnoea +, sub costal retraction +, P/A : Soft, CNS : NNR sluggish. Since baby had a weak cry / activity with increased respiratory distress. Baby was investigated HB : 19gms%, Tc : 37,300, Platelet count : 2.2 lakhs, CRP : Negative. Micro ESR : 1mm, Blood sugar was normal, serum creaitnine : 1.1 (15.02.10) 1 (16.02.10). serum potassium : 5.2 (15.02.10), 4.4 (17.02.10). Blood culture showed no growth. ET aspiration culture showed Klebseila growth. According to the culture and sensitivity Iv. Antibiotics changed. Planned for ECHO but babys parents were not willing. Baby was managed with mechanical ventilator support, Iv. Flduis, Iv. Antibitoics, Inj. Dopamine infusion, Inj. Gardenol started since baby had convulsion after admission, Inj. Rantac and Syp. Osteocalcium & Inj. Vitamin K. Since baby had tachypnoea planned for ECHO but babys parents were not willing for further management and baby was discharged today AGAINST MEDICAL ADVICE on 17.02.10.
INVESTIGATION
BLOOD BANK BLOOD GROUPING & Rh TYPING
A POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC (Coulter Principle) 5.34 HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) BIO CHEMISTRY Plasma CREATININE (Jaffe Kinetic) Plasma CREATININE (Jaffe Kinetic) POTASSIUM (ISE) POTASSIUM (ISE) MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY . RBCs show macrocytic normochromic. No nucleated RBCs or hemoparasites. WBC count neutrophilic leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :68% Eosinophils :01% Monocytes :05% Lymphocytes :26% Platelets count Adequate. IMPRESSION : -NEGATIVE 1.1 1.0 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 3.5 to 5 mEq/L 3.5 to 5 mEq/L 19.0 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl
14-02-2010 / 15:41
15-02-2010 / 13:18 15-02-2010 / 13:18 15-02-2010 / 13:18 15-02-2010 / 13:18 15-02-2010 / 13:18 15-02-2010 / 13:18 15-02-2010 / 13:18 15-02-2010 / 13:18 15-02-2010 / 13:18 15-02-2010 / 13:18
37300
220000 58
108 35.5
32 23.3 8.4
15-02-2010 / 13:44 16-02-2010 / 17:43 15-02-2010 / 16:15 17-02-2010 / 11:32
5.2
4.4
14-02-2010 / 07:42
15-02-2010 / 13:18
15-02-2010 / 13:18
15-02-2010 / 13:18 15-02-2010 / 13:18
INVESTIGATION
HAEMATOLOGY & CLINICAL PATHOLOGY TOTAL WBC COUNT (Coulter Principle) DIFFERENTIAL COUNT (VCS Technology) Polymorphs Lymphocytes Monocytes Eosinophils Basophils PERIPHERAL BLOOD SMEAR STUDY RBC (Coulter Principle) 4.8 HAEMOGLOBIN (Photometric Measurement) 17.9 TOTAL WBC COUNT (Coulter Principle) DIFFERENTIAL COUNT (VCS Technology) Polymorphs Lymphocytes Monocytes Eosinophils Basophils PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) 67 22 10 01 00 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 150000 to 450000 Cells/cumm 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl 11-01-2010 / 21:26 11-01-2010 / 21:26 11-01-2010 / 21:26 11-01-2010 / 21:26 11-01-2010 / 21:26 11-01-2010 / 21:26 11-01-2010 / 21:26 11-01-2010 / 21:26 11-01-2010 / 21:26 11-01-2010 / 21:26 11-01-2010 / 21:26 11-01-2010 / 21:26 21600 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 11-01-2010 / 21:26 11-01-2010 / 21:26 11-01-2010 / 21:26 65 20 14 01 00 40 - 70 % 25 - 50 % 01 - 06 % 01 - 10 % 00 - 01 % 15-01-2010 / 13:50 15-01-2010 / 13:50 15-01-2010 / 13:50 15-01-2010 / 13:50 15-01-2010 / 13:50 11800 6000 to 18000 Cells/cumm 15-01-2010 / 13:50
138000
54
112 36
32
18.8
6.9
BLOOD UREA (Urease GLDH ) Plasma CREATININE (Jaffe Kinetic) Plasma CREATININE (Jaffe Kinetic) Plasma CREATININE (Jaffe Kinetic) Plasma CREATININE (Jaffe Kinetic) MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein
39 1.3 1.2
15 to 40 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL
14-01-2010 / 09:20 13-01-2010 / 06:11 14-01-2010 / 09:20 15-01-2010 / 10:26 16-01-2010 / 08:18
2.1 2.8
NEGATIVE
11-01-2010 / 20:35
RBCs show normochromic normocytes and macrocytes. 11-01-2010 / 21:26 Nucleated RBCs 2/100WBCs. WBC count shows neutrophilic leukocytosis. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :67% Eosinophils :01% Monocytes :05% Lymphocytes :27% Platelets Count normal in Number and morphology IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 11-01-2010 / 21:26
11-01-2010 / 21:26 11-01-2010 / 21:26
TREATMENT GIVEN : Weight : 2.675kg Mechanical ventilator (IMV + HEV + IRV ) Iv. Fluids Inj. Dopamine 48mg in 50ml IVF - 2/min Inj. Lasix Inj. Taxim 130mg IV BD
Inj. Ampicillin 130mg IV BD RTF 5ml Q12 hourly
Name : B/o. Sabeela Banu Age/Sex : NB/ M Dept : Neonatology Hos.No: 446597 Mrd.No : 333598 Ward: IL.NB. NICU D.O.A : 29.01.2010 D.O.D : 19.02.2010 ******************************************************************************
REF.BY.DR.PUSHPALATHA GOKULNATH.,
PLACE : MADURAI
DIAGNOSIS: PRETERM (30 WEEKS) / SURFACTANT GIVEN ON 29.01.10/ CHD : OS ASD, L-> R SHUNT 2:1, MILD TR, MILD PAH NEONATAL SEIZURE
M AR 10
Name : B/o. Shanthi Age/Sex : NB/ M Dept : Neonatology Hos.No: 452750 Mrd.No : 337266 Ward: IL.NB. NICU D.O.A : 15.03.10 D.O.D : 16.03.10 ************************************************************************
REF.BY.DR. JAYA LAKSHMI.,
PLACE : THIRUMANGALAM
DIAGNOSIS: PERINATAL ASPHYXIA WITH MECONIUM ASPIRATION SYNDROME
COURSE:
This Term male baby was referred to MMHRC on 15.03.10 with H/o. severe respiratory distress since birth. Maternal History : 22 years, Primi, No H/o. PIH, GDM, hypothyroidism UTI. H/o. Fever 2 days before delivery lasted for 1 day took Iv. Antibiotics. Delivered by LSCS (Ind: Poor progression of labour) No H/o. PROM, Cord around the neck. H/o. Thick Meconium stained liquor +. Baby did not cry after birth and developed severe respiratory distress soon after birth and referred here for further management. O/E: Baby cry and activity weak, severe respiratory distress +, cyanosis of both palms & soles +, CFT > 3sec, HR : 130/m, RR : 70/m, Temp : 98.6oF, no pallor, not icteric, no external anomalies seen, CVS : S1 S2 heard, systolic murmur in pulm area +, RS : Tachypnea +, dyspnea +, ICR, SCR, supra sternal retractions +, P/A : soft, hepatomegaly +, BS +, CNS : AF : Normal, NNR : Sluggish. baby was intubated and connected to mechanical
ventilator and investigated HB : 14.9gm%, TC : 31,000cells/mm, Platelet count : 1.4 lakhs, CRP : Negative, Blood culture sent, ABG showed severe metabolic acidosis, Hco3 correction given, ventilator settings changed accordingly baby was managed with IV. Fluids, Iv. Antibiotics, Inj. Dopamine infusion, Inj. Vitamin K, Inj. Gardenol. As baby continued to have hypotension, Inj. Noradrenaline started. ECHO done showed normal study. Repeat ABG taken also showed severe metabolic acidosis for which correction given Inspite of above measures baby continued to have cyanosis. Prognosis of the condition was well explained to the parents. Since they are not willing for further management, baby was discharged AGAINST MEDICAL ADVICE on 16.03.10.
INVESTIGATION
BLOOD BANK BLOOD GROUPING & Rh TYPING B POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC (Coulter Principle) 4.53 HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY . RBCs show macrocytic normochromic . Nucleated RBCs+ Hemoparasites Nil. WBC count neutrophilic leukocytosis with shift to left No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :67% Eosinophils :04% 16-03-2010 / 13:21 NEGATIVE 16-03-2010 / 03:16 14.9 13.6 to 19.6 g/dL 16-03-2010 / 13:21 16-03-2010 / 13:21 16-03-2010 / 13:21 16-03-2010 / 13:21 16-03-2010 / 13:21 16-03-2010 / 13:21 16-03-2010 / 13:21 16-03-2010 / 13:21 16-03-2010 / 13:21 16-03-2010 / 13:21 16-03-2010 / 10:16
31000 10000 to 25000 Cells/cumm 141000 150000 to 450000 Cells/cumm

47 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl
103
32
31 17.1
7.2
16-03-2010 / 13:21
Monocytes :05% Lymphocytes :24% Platelets Count Adequate IMPRESSION : -16-03-2010 / 13:21 16-03-2010 / 13:21
Name : B/o. Devi Age/Sex : NB/ M Dept : Neonatology Hos.No: 453050 Mrd.No : 337403 Ward: IL.NB. NICU D.O.A : 17.03.10 D.O.D : 20.03.10 ************************************************************************
REF.BY.DR.MUTHU PANDIAN.,
PLACE : MANAMADURAI
DIAGNOSIS: PERINATAL ASPHYXIA WITH MECONIUM ASPIRATION SYNDROME WITH SEVERE PULMONARY HYPERTENSION COURSE:
This Term new born male baby delivered by LSCS (Ind : Fetal distress) on 17.03.10 at 2.45pm referred to MMHRC with H/o. baby did not cry soon after birth and developed severe respiratory distress since birth. Maternal history : Primi, 23 years. No H/o. PIH, GDM, recurrent UTI, fever with rash, bleeding PV. H/o. Thick Meconium staining of liquor +. O/E : Baby cry & activity weak, colour : peripherial cyanosis +, CFT < 3sec, severe respiratory distress +, (Nasal flaring, sub costal & intercostal indrawing +), no external congenital anomalies seen. HR : 148/m, RR : 68/m, Temp : 98.6oF, Spo2 : 75% with 5 liters of Oxygen, RS : Bilateral crepts +, CVS : S1 S2 +, no murmurs +, P/A : Soft, CNS : NNR sluggish. Baby was intubated and connected to mechanical ventilator support and investigated HB : 17gms%, TC : 23,000cells, Platelet count : 2.6 lakhs, CRP : negative, serum creatinine : 0.9mg%. ECHO showed severe TR with severe PAH. Baby was started on Iv. Fluids, Iv. Antibiotics, Iv. Inotropes, Inj. Calcium
gluconate, Pulmonary vasodilators. ABG showed severe respiratory acidosis and hypercarbia, hence treated with high frequency ventilation. Since baby had fresh bleeding from ET Tube FFP transfusion given. But baby continued to have desaturation. Condition of the baby was well explained to the parents. As they are not willing for further management, discharged AGAINST MEDICAL ADVICE on 20.03.10.
INVESTIGATION
BLOOD BANK BLOOD GROUPING & Rh TYPING O POSITIVE HAEMATOLOGY & CLINICAL PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY RBC (Coulter Principle) 4.6 HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) BIO CHEMISTRY Plasma CREATININE (Jaffe Kinetic) MICROBIOLOGY CRP-C REACTIVE PROTEIN C- Reactive Protein PATHOLOGY PERIPHERAL BLOOD SMEAR STUDY . RBCs show microcytic normochromic . Nucleated RBCs+ Hemoparasites Nil . WBC count neutrophilic leukocytosis with shift to left . No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :81% Eosinophils :01% Monocytes :3% Lymphocytes :15% Platelets Count Adequate IMPRESSION : -18-03-2010 / 12:42 NEGATIVE 17-03-2010 / 21:51 0.9 0.4 to 1.4 mg/dL 19-03-2010 / 18:50 17.0 23400 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 18-03-2010 / 12:42 18-03-2010 / 12:42 18-03-2010 / 12:42 18-03-2010 / 12:42 18-03-2010 / 12:42 18-03-2010 / 12:42 18-03-2010 / 12:42 18-03-2010 / 12:42 18-03-2010 / 12:42 18-03-2010 / 12:42 18-03-2010 / 10:53
260000 150000 to 450000 Cells/cumm 53 44 to 62 % 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 20 to 42 % 6 to 10.2 Fl
115 36 31 19.3
6.9
18-03-2010 / 12:42
18-03-2010 / 12:42 18-03-2010 / 12:42
Name : B/o. Bagavidhya Age/Sex : NB/ M Dept : Neonatology Hos.No: 451650 Mrd.No : 336564 Ward: IL.NB. NICU D.O.A : 08.03.2010 D.O.D : 24.03.2010 *****************************************************************************
DIAGNOSIS: PRETERM (33 34 WEEKS) WITH RESPIRATORY DISTRESS SYNDROME

SURFACTANT II DOSES GIVEN ON 08.03.10
Name : B/o. Suguna devi Age/Sex : NB/ M Dept : Neonatology Hos.No: 453027 Mrd.No : 337394 Ward: IL.NB. NICU D.O.A : 17.03.2010 D.O.D : 23.03.2010 ************************************************************************
DIAGNOSIS: PRETERM WITH RESPRIATORY DISTRESS SYNDROME (SURFACTANT THERAPY GIVEN) SEPTICEMIA
APR 10
Name : B/o. Karthiga Age/Sex : NB/ M Dept : Neonatology Hos.No: 456014 Mrd.No : 339461 Ward: IL.NB. NICU D.O.A : 12.04.10 D.O.D : 18.04.10 ************************************************************************
DIAGNOSIS: PERINATAL ASPHYXIA NEONATAL SEIZURE MECONIUM ASPIRATION SYNDROME RIGHT SIDED PNEUMOTHORAX CHD (OS ASD WITH PULMONARY HYPERTENSION) ACUTE RENAL FAILURE COURSE:
This Term / AGA / male baby was born at private hospital by LSCS (Ind: Cord around the neck with fetal distress) on 10th April 2010 @ 11p.m. Baby was said to have cried soon after birth but developed poor activity and had cyanosis followed by respiratory distress and convulsion on 1st day of life and hence referred to MMHRC for further management. H/o. Cord around the neck and thick meconium staining of liquor+. O/E: No cry or activity, CRT > 3 sec, cyanosis+. No pallor / icterus / edema. No obvious external congenital anomalies seen. HR: 160/min, regular, Resp. rate: 74/min, Afebrile. RS: Tachypneic. ICR and SCR+. Air entry diminished on right side. No adventitious sounds. CVS : S1 & S2+,
Normal. No murmurs. P/A: Soft, No organomegaly. CNS: Neonatal reflexes could not be elicited. Anterior fontanelle Normal. Baby was investigated Hb: 14.8gm%, TC: 22,700cells/mm3. Platelet count: 2.9 lakhs/mm3. CRP Positive (48mg/dl). Chest X ray right sided Pneumothorax. Blood Culture revealed No growth of Organisms. Baby was endrotracheally intubated, connected to Mechanical Ventilator. Chest tube was placed on right side on 12th April 2010. 2D ECHO was suggestive of small OS ASD with L R shunt and moderate pulmonary hypertension (on 17 April 2010). Baby was managed with Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, Inj. Gardenal, Inj. Eptoin and Tab. Cavetra. Inj. Aminophyllin and Inj. Lasix infusion was given to treat acute renal failure. Even with these above management, general condition of baby kept deteriorating and on 18 April, 2010, baby developed cardiac arrest was resuscitated as per latest guidelines but couldnt be reviewed and was DECLARED DEAD on 18 April 2010 at 5.45a.m.
INVESTIGATION:
BLOOD BANK
BLOOD GROUPING & Rh TYPING O POSITIVE 13-04-2010 / 09:37

PERIPHERAL BLOOD SMEAR STUDY HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) 14.8 11.2 to 19.6 g/dL 13-04-2010 / 11:25 13-04-2010 / 11:25
22700 6000 to 18000 Cells/cumm
290000 150000 to 450000 Cells/cumm 13-04-2010 / 11:25 45 4.5 101 32 32 15.7 6.8 35 to 62 % 4.9 to 5.6 Mill/Cumm 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 11 to 15 % 6 to 10.2 Fl 13-04-2010 / 11:25 13-04-2010 / 11:25 13-04-2010 / 11:25 13-04-2010 / 11:25 13-04-2010 / 11:25 13-04-2010 / 11:25 13-04-2010 / 11:25
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) Plasma CREATININE (Jaffe Kinetic) Plasma CREATININE (Jaffe Kinetic) 1.8 1.5 0.6 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 13-04-2010 / 00:26 14-04-2010 / 09:28 16-04-2010 / 10:26
MICROBIOLOGY
CRP-C REACTIVE PROTEIN C- Reactive Protein POSITIVE 48 MICROGRAM / ML 12-04-2010 / 17:29
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBCs show macrocytic normochromic. No nucleated RBCs or hemoparasites. WBC count neutrophilic leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :76% Eosinophils :01% 13-04-2010 / 11:25
13-04-2010 / 11:25
Name : B/o. Gomathi Age/Sex : NB/ M Dept : Neonatology Hos.No: 455561 Mrd.No : 339172 Ward: IL.NB. NICU D.O.A : 08.04.10 D.O.D : 18.04.10 ************************************************************************
DIAGNOSIS: PRETERM (32 WEEKS) / LBW / MALE RESPIRATORY DISTRESS SYNDROME / SURFACTANT 1 DOSE GIVEN ON 08.04.10 BIRTH ASPHYXIA ? SEPTICEMIA
Name : B/o. Jeyaleela Age/Sex : NB/ F Dept : Neonatology Hos.No: 456647 Mrd.No : 339837 Ward: IL.NB. NICU D.O.A : 16.04.2010 D.O.D : 24.04.2010 *****************************************************************************
REF.BY.DR.JOSPHINE CHANDRAKALA., DIAGNOSIS:PRETERM WITH BIRTH ASPHYXIA RESPIRATORY DISTRESS SYNDROME (SURFACTANT 2 DOSES GIVEN) ACUTE RENAL FAILURE
PLACE : MADURAI
Name : B/o. Vajila Banu Age/Sex : NB/ F Dept : Neonatology Hos.No: 458208 Mrd.No : 340972 Ward: IL.NB. NICU D.O.A : 28.04.2010 D.O.D : 29.04..2010 ************************************************************************
DIAGNOSIS: RESPIRATORY DISTRESS SYNDROME WITH HYPOTENSION

SURFACTANT 1ST DOSE GIVEN ON 28.04.10
MAY 10
Name : B/o. Anandhavalli Age/Sex : NB/ M Dept : Neonatology Hos.No: 457491 Mrd.No : 340495 Ward: IL.NB. NICU D.O.A : 23.04.10 D.O.D : 03.05.10 ************************************************************************
DIAGNOSIS: PRETERM WITH RESPIRATORY DISTRESS SYNDORME

(33-34 WEEKS) SEPTICEMIA SURFACTANT THERAPHY GIVEN ON 23.04.10
JUNE 10
Name : B/o. Nithya Age/Sex : NB/ F Dept : Neonatology Hos.No: 464105 Mrd.No : 344685 Ward: IL.NB. NICU D.O.A : 08.06.10 D.O.D : 09.06.10 ************************************************************************
REF.BY.DR. REVATHI JANAKIRAM.,
PLACE : MADURAI
DIAGNOSIS: PRETERM (27-28 WEEKS) / ELBW / TWIN II RESPIRATORY DISTRESS SYNDORME SURFACTANT GIVEN ON 08.06.10
Name : B/o. Selvi Age / Sex: NB/M Dept : Neonatology Hos.No : 462757 Mrd.No : 343880 Ward : I NB NICU D.O.A : 30.05.10 D.O.D :17.06.10 ************************************************************************ REF.BY.DR. MANIMEGALAI., PLACE : KARAIKUDI
DIAGNOSIS: TERM / MALE / BIRTH ASPHYXIA MECONIUM ASPIRATION SYNDROME
COURSE:
This Term two days old Male baby was referred to MMHRC on 30.05.10 as a case of ? Meconium aspiration syndrome. Baby delivery by emergency LSCS (Ind: MSAF with fetal bradycardia) on 29.05.2010 @ 5.35p.m., H/o. Baby didnt cry immediately after birth, cried after initial resuscitation. H/o. Baby developed respiratory distress since birth. H/o. Meconium aspiration+. No H/o. cyanosis, convulsions, jaundice. No Maternal H/o. PIH, GDM, PROM, fever with rash, UTI, Hypothyroidism. Baby was initially managed with oxygen in the referral hospital, but respiratory distress increased with cyanosis baby was referred here for further management. O/E: Baby cry and activity weak, peripheral cyanosis+, CFT > 3 sec, no pallor, no icterus, no birth injury, no obvious external anamoly. CVS: S1 S2 heard, no murmurs, RS: Dyspnoea+, RR @ 70/mt, Bilateral air entry reduced, SCR+, ICR+, P/A: Soft, no organomegaly, CNS : NNR +. Baby was investigated peripheral smear showed HB : 14.1mg/dl, TC : 19,200 cells/mm3 & Platelet count :
2.5 lakhs. CRP : Positive. Blood culture no growth. ET aspiration culture no growth. Serum creatinine 0.6 mg/dl (31.05.10), Serum Bilirubin T: 5.1mg%, D: 0.6mg%. Chest x ray showed features of MAS. ECHO showed normal study. Baby was intubated and connected to mechanical ventilator support, series of ABG taken, ventilator settings changed accordingly. Baby was managed with Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K, Deriphylline drops and single side phototheraphy. Baby was weaned from the ventilator, managed with oxygen. With these above measures babys respiratory distress settled. Baby was started on ryles tube feeds, initially not tolerating the feeds, had vomiting managed with Anti emetic drops. Now baby is active tolerating the feeds, hence baby is discharged today with advice to continue the further follow-up with the referral doctor.
INVESTIGATION:
TOTAL WBC COUNT (Coulter Principle) 13300 6000 to 18000 Cells/cumm 04-06-2010 / 17:46
BLOOD BANK
BLOOD GROUPING & Rh TYPING AB POSITIVE 31-05-2010 / 11:26

PERIPHERAL BLOOD SMEAR STUDY HAEMOGLOBIN (Photometric Measurement) 14.1 TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) 19200 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 31-05-2010 / 11:12 31-05-2010 / 11:12
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) POTASSIUM (ISE) BILIRUBIN - TOTAL & DIRECT Plasma BILIRUBIN - TOTAL (Diazo) Plasma BILIRUBIN - DIRECT (Diazo) 5.1 0.6 0.4 to 1.1 mg/dL 0.1 to 0.5 mg/dL 30-05-2010 / 22:46 30-05-2010 / 22:46 0.6 3.9 0.4 to 1.4 mg/dL 3.5 to 5 mEq/L 31-05-2010 / 22:36 04-06-2010 / 08:03
MICROBIOLOGY
CRP-C REACTIVE PROTEIN C- Reactive Protein POSITIVE 48 MICRO GRAM/ML 30-05-2010 / 22:32
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBCs show macrocytic normochromic . No nucleated RBCs or hemoparasites. WBC count neutrophilic leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :88% Eosinophils :00% Monocytes :03% Lymphocytes :09% Platelets Count Adequate IMPRESSION : -31-05-2010 / 11:12
31-05-2010 / 11:12
31-05-2010 / 11:12 31-05-2010 / 11:12
ADVICE ON DISCHARGE Inj. Ronem 125mg IV BD x 5 days
Tab. Caverta Deriphylline drops
25mg 8 drops
1/5 BD TID
x x
5 days 1 week
Admission weight : Discharge weight :
2.900 kg 2.825 kg
Name : B/o. Malathy Age/Sex : NB/ F Dept : Neonatology Hos.No: 464931 Mrd.No : 345118 Ward: IL.NB. NICU D.O.A : 14.06.10 D.O.D : 25.06.10 ************************************************************************
REF.BY.DR. RAJINI PREMATLATHA.,
PLACE : MADURAI
DIAGNOSIS: TERM / FEMALE / MECONIUM ASPIRATION SYNDROME CONGENITAL HEART DISEASE (OS ASD) COURSE:
This term female baby was referred to MMHRC on 14.06.10 with H/o. Respiratory distress since birth. Baby born by normal vaginal delivery on 14.06.10 at 5.30am. H/o. Baby didnt cry immediately after birth, cried after tactile stimulation, H/o. Baby developed respiratory distress since birth. H/o. Meconium aspiration +. No H/o. cord around the neck, cyanosis, convulsions. Maternal H/o. GDM, 3rd month of gestation., treated with insulin. Maternal H/o. PIH, treated with drugs. No maternal H/o. Hypothyroidism, fever with rash / UTI. Baby was initially managed in referral hospital, as respiratory distress increased, referred here for further management. O/E : Babys activity & cry : weak, CFT > 3sec, CVS : S1 S2 +, RS : RR @ 68/min, grunting, dyspnoea +, SCR +, ICR +, P/a : Soft, CNS : NNR +. Baby was intubated and connected to mechanical ventilator support. Series of
ABG taken, ventilator settings changed accordingly. Baby was investigated showed HB : 15.5gms%, TC : 19,200 cells/mm3 & Platelet count : 3 lakhs. CRP : Negative. ECHO showed congenital heart disease, OS ASD (5-6mm). Baby was managed with Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, antiemetics drops, ionotropes. Baby was slowly weaned from ventilator & started on ryles tube feeds. With these above measures, babys active, respiratory distress settled, tolerating feeds well and discharged today with advice to continue further follow-up with the referral doctor.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING
B POSITIVE
14-06-2010 / 17:02

BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) Plasma CREATININE (Jaffe Kinetic) BILIRUBIN - TOTAL & DIRECT Plasma BILIRUBIN - TOTAL (Diazo) Plasma BILIRUBIN - DIRECT (Diazo) 9.6 0.5 0.4 to 1.1 mg/dL 0.1 to 0.5 mg/dL 16-06-2010 / 17:37 16-06-2010 / 17:37 0.8 0.4 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 16-06-2010 / 08:19 18-06-2010 / 08:33
MICROBIOLOGY
CRP-C REACTIVE PROTEIN C- Reactive Protein NEGATIVE 14-06-2010 / 17:03
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBCs show macrocytic normochromic . No nucleated RBCs or hemoparasites. WBC count neutrophilic leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :79% Eosinophils :00% Monocytes :05% Lymphocytes :16% Platelets Count Adequate IMPRESSION : -15-06-2010 / 09:52
15-06-2010 / 09:52
15-06-2010 / 09:52 15-06-2010 / 09:52
ADVICE ON DISCHARGE Domstal drops Mucolite drops 8 drops 5 drops TID TID x x 2 weeks 2 weeks
Admission weight : 3.6 kg Discharge weight : 3.6 kg
JULY 10
Name : B/o. Fathu munisha Age/Sex : NB/ M Dept : Neonatology Hos.No: 467629 Mrd.No : 346802 Ward: IL.NB. NICU D.O.A : 03.07.10 D.O.D : 03.07.10 ************************************************************************
DIAGNOSIS: TERM / BIRTH ASPHYXIA / MECONIUM ASPIRATION SYNDROME / (L) CTEV ? ARTHROGRYPOSIS COURSE:
This term male baby was born by emergency LSCS (Ind : PIH with oligohydraminos with breech presentation) on 02.07.10 @ 10.23 pm (EDD : 23.07.10) H/o. Baby didnt cry after birth, H/o. Meconium aspiration +. Baby was intubated and aspiration of meconium done. Apgar of 5min 6/10, after these initial resuscitation measures, baby developed spontaneous respiration, but had severe distress. Baby was reintubated and connected to mechanical ventilator. H/o. thick meconium stained liquor +. Maternal H/o. PIH. Past 3 months. H/o. PROM for 7hrs. No maternal H/o. GDM, fever with rash UTI. O/E : Babys on ventilator support. Peripheries cold, peripheral cyanosis +, not icteric, not anaemic, webbing of neck + restricted movement of right and left elbow joint, knee joints (L) CTEV with over lapping of 2nd digit over thumb. CVS : S1 S2 +, no murmurs, RS :
Bilateral air entry +, P/A : Soft, CNS : NNR absent. Baby was managed with ventilator support, (series of ABG taken, ventilator settings changed accordingly), Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, ionotropes. Condition of the baby and prognosis was well explained to parents. Since parents were not willing for further management, baby is discharged AGAINST MEDICAL ADVICE on 03.07.10.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING B POSITIVE 03-07-2010 / 10:05

PERIPHERAL BLOOD SMEAR STUDY HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) 14.6 23000 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 03-07-2010 / 13:04 03-07-2010 / 13:04
PATHOLOGY
. RBCs show macrocytic normochromic . No nucleated RBCs or hemoparasites. WBC count neutrophilic leukocytosis. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :74% Eosinophils :00% Monocytes :05% Lymphocytes :21% Plalets Count adequate ( seen in clumps). IMPRESSION : -03-07-2010 / 13:04 03-07-2010 / 13:04 03-07-2010 / 13:04
03-07-2010 / 13:04
Name : B/o. Sathiya Age/Sex : NB/ M Dept : Neonatology Hos.No: 467798 Mrd.No : 346877 Ward: IL.NB. NICU D.O.A : 03.07.10 D.O.D : 05.07.10 ************************************************************************
REF.BY.DR.MURUGADASS.,
PLACE : MADURAI
DIAGNOSIS: TERM / MECONIUM ASPIRATION SYNDROME / SEVERE PERSISTENT PULMONARY HYPERTENSION OF NEWBORN COURSE:
This term male baby was referred to MMHRC on 03.07.10 as a case of meconium aspiration with birth asphyxia. Baby born by normal vaginal delivery on 03.07.10 at 8.40pm. H/o. Baby didnt cry after birth (resuscitation details not known). H/o. Thick Meconium stained liquor and aspiration +. H/o. Baby
developed respiratory distress since birth. No H/o. cyanosis, convulsions, cord around the neck. No Maternal H/o. PIH, GDM, Hypothyroidism, fever with rash. O/E : Babys cry and activity : weak, CFT > 3 sec, peripheral cyanosis +, not icteric, not anaemic, no external anamoly, CVS : S1 S2 +, no murmurs, RS : Bilateral air entry equal, RR : 90/mt, SCR +, ICR +, grunting +, P/A : Soft, CNS : NNR sluggish. Baby was intubated & connected to mechanical ventilator support. ABG showed progressive, hypercarbia with hypoxia. ventilator settings changed
accordingly. Baby was investigated showed Hb : 18.7gm%, TC : 26,000, platelet : 2.3 lakhs. Chest x-ray showed features of meconium aspiration. Baby was
managed with ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, inotropes & pulmonary vasodilators. Since parents wants to continue the further treatment in Government Hospital, baby is discharged AT REQUEST on 05.07.10
INVESTIGATION
BLOOD BANK

PERIPHERAL BLOOD SMEAR STUDY HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) 18.7 26600 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 05-07-2010 / 12:25 05-07-2010 / 12:25 05-07-2010 / 12:25 05-07-2010 / 12:25 05-07-2010 / 12:25 05-07-2010 / 12:25 05-07-2010 / 12:25 05-07-2010 / 12:25 05-07-2010 / 12:25 05-07-2010 / 12:25
230000 150000 to 450000 Cells/cumm 56 5.3 106 35 33 17.7 7.4 44 to 62 % 4.9 to 5.6 Mill/Cumm 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 11 to 15 % 6 to 10.2 Fl
PATHOLOGY
. RBCs show macrocytic normochromic. Nucleated RBCs 3/100WBCs. Hemoparasites Nil. WBC count neutrophilic leukocytosis. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :60% Eosinophils :04% Monocytes :02% Lymphocytes :34% Platelets Count Adequate IMPRESSION : -05-07-2010 / 12:25 05-07-2010 / 12:25 05-07-2010 / 12:25 05-07-2010 / 12:25
AUGUST 10
Name : B/o. Sathya Priya Age/Sex : NB/ M Dept : Neonatology Hos.No: 473753 Mrd.No : 350618 Ward: IL.NB. NICU D.O.A : 12.08.10 D.O.D : 14.08.10 ************************************************************************
REF.BY.DR. SAVITHRI.,
PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PPHN ? CONGENITAL HEART DISEASE COURSE:
This term AGA,
male baby was born by normal vaginal delivery on
12.08.2010 at 10.45p.m., H/o. Baby cried soon after birth, developed respiratory distress since birth. H/o. Thick meconium stained liquor +. No H/o. convulsion / cyanosis at birth. Maternal history: Primi, 25 years. H/o. Fever 2 days back before delivery. No H/o. GDM / PIH / Hypothyroidism / fever with rash / eclampsia. O/E: Baby cry weak, activity weak, colour pale, CFT > 2 sec. Severe respiratory distress +. Saturation was 70% with 5 liters of O2, tachypnea +, dyspnea +. CVS: S1 S2 heard, no murmur, RS : Tachypnea +, ICR, SCR +, Bilateral crept +. P/A: Soft, CNS: NNR. Sluggish. Baby was immediately intubated and connected to mechanical ventilator. Baby was investigated HB: 13.7gm%, TC: 20,500cells/mm, Platelet count: 2.5lakhs. Chest x ray was showing bilateral infiltrates. ABG taken, showed severe respiratory acidosis,
ventilator settings changed accordingly. Baby was treated with Iv Fluids, Iv. Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K. Baby developed 2 episodes of convulsions managed with anticonvulsants. As baby had hypotension, inotropes were started. ABG periodically monitored showed persistently high PcO2, low PO2 inspite of maximum ventilator support. Baby had persistent hypotension, Noradrenaline infusion started. PPHN was suspected hence pulmonary vasodilators were started and planned for Echo to rule out CHD. Now baby is on high frequency ventilatory support maintained Spo2 of 85% only. The condition of the baby and the prognosis were explained to the parents. They were not willing for further management, baby was discharged AGAINST MEDICAL ADVICE on 14.08.10.
INVESTIGATION:
BLOOD BANK
BLOOD GROUPING & Rh TYPING A POSITIVE 13-08-2010 / 15:54

PATHOLOGY
RBCs show normochromic normocytes and 13-08-2010 / 18:31 macrocytes. Nucleated RBCs 7/100WBCs. WBC count shows leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :76% Eosinophils :02% Monocytes :03% Lymphocytes :19% Platelets Count normal in Number and morphology IMPRESSION : 13-08-2010 / 18:31
13-08-2010 / 18:31
LEUKOERYTHROBLASTIC BLOOD PICTURE. 13-08-2010 / 18:31
Name : B/o. Prabavathy Age/Sex : NB/ M Dept : Neonatology Hos.No: 474061 Mrd.No : 350824 Ward: IL.NB. NICU D.O.A : 16.08.2010 D.O.D : 17.08.2010 ************************************************************************
REF.BY. DR.UMAMAHESWARI.,
PLACE : SINGAMPUNARI
DIAGNOSIS: PRETERM (31 32 WEEKS) VERY LOW BIRTH WEIGHT RESPIRATORY DISTRESS SYNDROME
( ONE DOSE OF SURFACTANT GIVEN)
Name : B/o. Shanthi Age/Sex : NB/ M Dept : Neonatology Hos.No: 470943 Mrd.No : 348818 Ward: IL.NB. NICU D.O.A : 24.07.10 D.O.D : 10.08.10 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA WITH SEIZURE HIE STAGE II MECONIUM ASPIRATION SYNDORME
COURSE:
This Term / AGA / male baby born on 23.07.10 at 9.50am via labour naturalis was referred to MMHRC with H/o. Baby didnt cry after birth and H/o. Meconium stained liquor. Mother is a primi para with no H/o. PIH, GDM, Recurrent UTI or fever with rash. H/o. Difficult second stage of labour. Baby didnt cry soon after birth and was resuscitated with O2 and suctioning. Baby had weak cry after that. H/o. meconium staining of liquor with ? aspiration. No H/o. cyanosis, cord around the neck. Baby had 2-3 episodes of convulsions at referral hospital. O/E : Baby had poor activity and no cry. Colour : Pink, CFT < 3 sec, HR : 156/min, regular RR : 68/min, Spo2 : 96% with O2, No Pallor, cyanosis, edema, no birth injuries, no external congenital anomalies, CVS : S1 S2 +, normal, no murmurs, RS : Distress + (ICR, SCR and nasal flaring +), Tachypnea +, Bilateral
air entry equal, No adventitious sounds, P/A : soft, no organomegaly, CNS : Sluggish reflexes and hypotonia suggestive of encephalopathy. In emergency department baby had apnea with Spo2 falling to 55% with cyanosis. Baby was first given ambu mask ventilation and then intubated and connected to mechanical ventilator. Baby had one more episode of convulsion there. Baby was managed with Iv. Fluid, Iv. Antibiotics, anticonvulsants and other supportive and symptomatic treatment measures. With these babys general condition improved, started on oral feeds and discharged with following advice.
INVESTIGATION
Glucometer
GLUCOMETER SUGAR
10am 115 mg/dl 10pm 95 mg/dl 10am 99 mg/dl 10PM 88 mg/dl 10AM 86mg/dl 10AM 84 mg/dl 10PM 102 mg/dl
06-08-2010 / 14:54 06-08-2010 / 14:55 06-08-2010 / 14:57 11-08-2010 / 09:30 11-08-2010 / 12:13 11-08-2010 / 13:00 11-08-2010 / 13:01
BLOOD BANK
BLOOD GROUPING & Rh TYPING APOSITIVE 25-07-2010 / 12:28

BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) Plasma CREATININE (Jaffe Kinetic) POTASSIUM (ISE) POTASSIUM (ISE) 1.7 0.8 2.6 4.5 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 3.5 to 5 mEq/L 3.5 to 5 mEq/L 24-07-2010 / 20:46 27-07-2010 / 07:43 29-07-2010 / 09:10 30-07-2010 / 16:20
MICROBIOLOGY
CRP-C REACTIVE PROTEIN C- Reactive Protein POSITIVE 12 MICRO GRAM/ML 24-07-2010 / 21:02
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBCs show macrocytic normochromic. Nucleated RBCs+. Hemoparasites Nil. WBC count normal in number morphology with neutrophilic preponderance. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :87% 26-07-2010 / 11:50
26-07-2010 / 11:50
Eosinophils :01% Monocytes :02% Lymphocytes :10% Platelets Count Adequate IMPRESSION : -26-07-2010 / 11:50 26-07-2010 / 11:50
ADVICE ON DISCHARGE Tab. Gardenol 20mg HS OD x x Till further advice 7 days
Tab. Fluconazole 50mg
DR. A. KANNAN., MD., DCH., SR. CONSULTANT
Name : B/o.Kaladevi Age/Sex : NB/ M Dept : Neonatology Hos.No: 472829 Mrd.No : 350061 Ward: IL.NB. NICU D.O.A : 07.08.10 D.O.D : 15.08.10 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA WITH SEIZURE MECONIUM ASPIRATION SYNDORME ACUTE RENAL FAILURE HIE STAGE 2
COURSE:
This 2 days old Term / AGA / Male baby was born at private hospital by LSCS (Ind : Previous LSCS) on 05.08.10 @ 10.30am. H/o. Birth asphyxia +. H/o. Baby had respiratory distress since birth. H/o. Poor feeding, fever & drowsiness since 2nd day of life. H/o. Convulsion 5 episodes on 2nd day of life. H/o. Meconium aspiration +. Baby was treated as meconium aspiration syndrome / septicemia / meningitis at GH (Paramakudi) & brought to MMHRC on 07.08.10 for further management. MH/o. Typhoid in fever 2nd trimester +. No MH/o. PIH, GDM & PROM. O/E : Babys activity & cry : poor, grunting respiration +, dyspnoeic +, CFT > 3 sec, peripheral cyanosis, tachypneia +, no obvious external anomaly, CVS : S1 S2 heard, RS : RR @ 72/mt, LCI +, Grunting +, P/A : Liver 3 cm palpable, spleen 1cm +, CNS : Hypotonia +, NNR sluggish. Baby was investigated peripheral smear showed Hb : 14.4gms%, TC : 33,100 cells/mm3 & platelet count : 2.2 lakhs, PCV : 44. Serum creatinine : 1.3mg/dl (07.08.10), 0.8mg/dl (09.08.10) & 0.4mg/dl (14.08.10). CRP : Positive. Serum K+ : 2.9mg/dl. Blood culture showed no growth. Chest x-ray suggestive of bilateral infiltrations. Baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, Inj. Dopamine infusion & Inj. Gardenol. As baby had
decreased urine output with increased renal parameters managed with Inj. Lasix & Hypokalemia was corrected with oral KCl. Series of ABGs were done, ventilator settings were adjusted accordingly to that. Baby was started on small ryles tube feeds, but had abdominal distension so feeding withheld. Babys repeat serum creatinine became normal & urine output improved. Now baby is in mechanical ventilator support with Fio2 70%, maintaining Spo2 98% & in NPO. Since parents were not willing for further management, baby is discharged AGAINST MEDICAL ADVICE on 15.08.10 @ 9pm.
INVESTIGATION
Glucometer
GLUCOMETER SUGAR 6AM 41mg/dl 12PM HI 2PM HI 5PM 329mg/dl 11-08-2010 / 12:26 11-08-2010 / 12:27 11-08-2010 / 12:27 11-08-2010 / 12:28
BLOOD BANK

PERIPHERAL BLOOD SMEAR STUDY HAEMOGLOBIN (Photometric Measurement) 14.4 11.2 to 19.6 g/dL 07-08-2010 / 10:17
TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram)
33100 6000 to 18000 Cells/cumm
07-08-2010 / 10:17
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) Plasma CREATININE (Jaffe Kinetic) Plasma CREATININE (Jaffe Kinetic) POTASSIUM (ISE) POTASSIUM (ISE) 1.3 0.8 0.4 2.9 7.7 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 3.5 to 5 mEq/L 3.5 to 5 mEq/L 07-08-2010 / 08:01 09-08-2010 / 13:18 14-08-2010 / 21:30 09-08-2010 / 13:35 15-08-2010 / 15:28
MICROBIOLOGY
CRP-C REACTIVE PROTEIN C- Reactive Protein POSITIVE 12 MICROGRAM/ML 07-08-2010 / 08:44
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBCs show macrocytic normochromic. Nucleated RBCs+ Hemoparasites Nil. WBC count neutrophilic leukocytosis with shift to left . No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :80% Eosinophils :01% Monocytes :03% Lymphocytes :16% Platelets Count Adequate IMPRESSION : -07-08-2010 / 10:17
07-08-2010 / 10:17
07-08-2010 / 10:17 07-08-2010 / 10:17
Name : B/o. Kavitha Age/Sex : NB/ M Dept : Neonatology Hos.No: 473705 Mrd.No : 350602 Ward: IL.NB. NICU D.O.A : 13.08.10 D.O.D : 17.08.10 ************************************************************************
REF.BY.DR. BASKAR.,
PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH HIE
COURSE:
This term male new born baby was referred to MMHRC an 13.08.10 as a case of birth asphyxia with respiratory distress. Baby was born by normal vaginal delivery on 11.08.10 @ 4.30 a.m. H/o. Meconium staining of liquor (thick) +. No H/o. PROM, cord around the neck. Baby had weak cry after birth with H/o. meconium aspiration.. H/o. respiratory distress since birth. Hence referred to MMHRC for further management. No H/o. cyanosis, convulsion, jaundice, bleeding manifestations. Maternal history: 23 years. No H/o. PIH, GDM, fever with rash, seizure, hypothyroidism in antenatal period. O/E: Baby cry & activity weak, CFT < 3sec, colour: central cyanosis+, SpO2 : 70% with O2 5lit//min. severe respiratory distress +, tachypnea with RR of 80/min. IC and SC retractions +. No signs of dehydration / No external congenital anamolies. HR : 146/min, regular, BP : 71 mmHg, CVS : S1 S2 heard, no murmur, RS : Bilateral air entry equal, severe respiratory distress +, P/A : soft, no organomegaly, CNS : encephalopathy +, NNR sluggish. Baby was investigated Hb : 21.8mg%, Tc :
14,900cells, Platelet count : 1.6 lakhs, PCV : 60, CRP : Negative. Serum creatinine : 0.4mg%. Peripheral smear showed neutrophilic preponderance with shift to left. Baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate and Inj. Vit K. ABG was periodically monitored, ventilator settings changed accordingly. Babys continued to be dusky and cyanosis, BP was falling, Inotropes were started and planned for ECHO. The condition of the baby and prognosis were explained to the attenders. As they were not willing for the further management, child discharged AGAINST MEDICAL ADVICE on 17.08.10 @ 3.p.m.
INVESTIGATION
BLOOD BANK

PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram)
21.8 14900
11.2 to 19.6 g/dL 6000 to 18000 Cells/cumm
13-08-2010 / 10:32 13-08-2010 / 10:32 13-08-2010 / 10:32 13-08-2010 / 10:32 13-08-2010 / 10:32 13-08-2010 / 10:32 13-08-2010 / 10:32 13-08-2010 / 10:32 13-08-2010 / 10:32 13-08-2010 / 10:32
BIO CHEMISTRY
Plasma CREATININE (Jaffe Kinetic) POTASSIUM (ISE) 0.4 4.4 0.4 to 1.4 mg/dL 3.5 to 5 mEq/L 13-08-2010 / 11:56 13-08-2010 / 11:56
MICROBIOLOGY
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBCs show erthrocytosis.Macrocytic 13-08-2010 / 10:32 normochromic . No nucleated RBCs or hemoparasites. WBC count neutrophilic prepondrance shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :75% Eosinophils :00% Monocytes :01% Lymphocytes :24% Platelets Count Adequate IMPRESSION : -13-08-2010 / 10:32
13-08-2010 / 10:32 13-08-2010 / 10:32
Name : B/o. Sonia Age/Sex : NB/ F Dept : Neonatology Hos.No: 473335 Mrd.No : 350386 Ward: IL.NB. NICU D.O.A : 11.08.10 D.O.D : 19.08.10 ************************************************************************
REF.BY.DR.GURUSUNDAR.,
PLACE : MADURAI
DIAGNOSIS: TERM / AGA / BIRTH ASPHYXIA MECONIUM ASPIRATON SYNDROME COURSE:
This Term / AGA / female baby was referred to MMHRC on 11.08.10 as a case of birth asphyxia with meconium aspiration syndrome. Baby was born by normal vaginal delivery on 10.08.10 at 3.26am. H/o. baby didnt cry immediately after birth, cried after 10 mints of resuscitation with O2, tactile stimulation, baby and mask ventilation. H/o. Respiratory distress +. Baby was treated with Iv. Fluids, Inj. Vitamin K, Inj. Gardenol and referred here for further management. No H/o. cyanosis, convulsion at admission. Maternal History : Primi, 24 years. No Maternal H/o. GDM, PIH, Hypothyroidism, fever with rash. No H/o. PROM, Cord around the neck. H/o. Meconium stained liquor. O/E : Babys cry irritable, activity : moderate, CFT < 3 sec, HR : 150/m, RR : 76/min. No pallor, not icteric, no cyanosis, no external anomaly, CVS : S1 S2 heard, RS : dyspnoea +, tachypnoea +, Bilateral air entry +, Bilateral crepts +, P/A : Soft, CNS : NNR sluggish. Baby was
admitted at NICU investigated which showed normal haemogram, CRP : Positive. (12 meq), serum creatinine : 0.8mg/dl. Blood culture showed no growth. Chest xray showed bilateral infiltrations. ECHO showed 2-3 mm PDA. No pulmonary hypertension. Baby was started on treatment with Nasal C-PAP with 5 liters of O2, Iv. Fluids, Iv. Antibiotics, Iv. Anticonvulsants. Babys respiratory distress was increasing, hence intubated and connected to mechanical ventilator after 4hrs of admission. ABG showed metabolic acidosis. Bicarbonate correction given. On 13.08.10, baby had poor perfusion with hypotension, hence Inotropic support started. ABG taken showed severe respiratory acidosis, ventilatory settings changed accordingly, and ABG periodically recorded. Baby was having persistently high PCO2 with high frequency ventilation, baby
respiratory distress mildly decreased. Baby was started on RTF and gradually increased, tolerating well. Now baby is on SIMV mode of ventilation with FIO2 :
35%, Freq: 50, P max 25, PeeP : 6. As the parents were not willing for further management discharged AGAINST MEDICAL ADVICE on 19.08.10. INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING AB POSITIVE 11-08-2010 / 09:58

PERIPHERAL BLOOD SMEAR STUDY HAEMOGLOBIN (Photometric Measurement) 21.4 TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) 13.6 to 19.6 g/dL 11-08-2010 / 12:31 11-08-2010 / 12:31
27500 10000 to 25000 Cells/cumm
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) POTASSIUM (ISE) 0.7 3.9 0.4 to 1.4 mg/dL 3.5 to 5 mEq/L 12-08-2010 / 14:07 15-08-2010 / 09:42
MICROBIOLOGY
CRP-C REACTIVE PROTEIN C- Reactive Protein POSITIVE 12 MICROGRAM / ML 12-08-2010 / 15:24
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBCs show erythrocytosis with poorly preserved morphology. No nucleated RBCs or hemoparasites. WBC count neutrophilic leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :83% Eosinophils :01% 11-08-2010 / 12:31
11-08-2010 / 12:31
Name : B/o. Karpagam Age/Sex : NB/ F Dept : Neonatology Hos.No: 472617 Mrd.No : 349874 Ward: IL.NB. NICU D.O.A : 05.08.10 D.O.D : 20.08.10 ************************************************************************
REF.BY.DR. AMUTHAKALAVALLI.,
PLACE : MELUR
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME BIRTH ASPHYXIA HIE STAGE 2 COURSE:
This term (4 days post dated) / AGA / female baby / delivered by LSCS (Ind : Post dated with fetal distress) on 05.08.10 at 7.34am in a private hospital was admitted with H/o. respiratory distress since birth. Mother is 28 years old, para 2, second degree consanguinously married with no significant antenatal
conmplications. Baby had 3 rounds of cord around the neck and liquor was meconium stained with ? aspiration of meconium. Baby cried soon after birth. H/o. Respiratory distress since birth that increased gradually, hence baby was referred here for further management. No H/o. Convulsion, cyanosis, jaundice. After admission, baby had one episode of convulsion. O/E: Babys cry & activity weak, severe respiratory distress +, CFT > 3 sec, peripheral cyanosis +. No pallor, icterus, edema, no external anomalies seen. CVS : S1 S2 +, normal, no murmurs. RS : Severe respiratory distress +, ICR, SCR, Nasal flaring +, Tachypnea +, Bilateral air entry equal, NVBS heard, no adventitious sounds, SpO2 : 84% without O2 P/A : Soft, no organomegaly, CNS : NNR sluggish. Features of
encephalopathy +. Baby was immediately intubated and connected to mechanical ventilator. On investigation Total WBC count was elevated 42,400/mm3. Hb was normal. Serum creatinine was 1.2 but improved to 0.6mg% with treatment CRP was negative. Baby was managed with Iv. Fluid, Iv. Antibiotics, anticonvulsant, mechanical ventilator and other symptomatic and supportive therapeutic measures. Babys general condition improved. Baby was weaned from the ventilator and feeds introduced gradually. Baby was discharged in stable condition with following advice.
INVESTIGATION
Glucometer
GLUCOMETER SUGAR 1AM 136 mg/dl 11-08-2010 / 14:40
4AM 169 mg/dl 7AM 156 mg/dl 1PM 130 mg/dl 7PM 110 mg/dl 2AM 145 mg/dl 8AM 127 mg/dl 4PM 125 mg/dl 10PM 136 mg/dl 4AM 164 mg/dl 12PM 108 mg/dl 8PM 112mg/dl
11-08-2010 / 14:41 11-08-2010 / 14:41 11-08-2010 / 14:42 11-08-2010 / 14:44 11-08-2010 / 14:44 11-08-2010 / 14:45 11-08-2010 / 14:45 11-08-2010 / 14:46 11-08-2010 / 14:46 11-08-2010 / 14:47 11-08-2010 / 14:47
BLOOD BANK

BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) POTASSIUM (ISE) POTASSIUM (ISE) 1.2 0.6 4.1 3.0 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 3.5 to 5 mEq/L 3.5 to 5 mEq/L 07-08-2010 / 10:52 09-08-2010 / 16:03 06-08-2010 / 10:08 08-08-2010 / 07:55
MICROBIOLOGY
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes and 06-08-2010 / 18:30 macrocytes.NRBCs 15/100 WBCs. No nucleated RBCs or hemoparasites.
WBC count neutrophilic leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : Myelocytes :02% NeutroPhils :70% Stab :04% Eosinophils :00% Monocytes :03% Lymphocytes :21% Platelets Count normal in Number and morphology IMPRESSION : LEUKOERTHROBLASTIC BLOOD PICTURE. 06-08-2010 / 18:30
06-08-2010 / 18:30 06-08-2010 / 18:30
ADVICE ON DISCHARGE Inj. Ronem Domstal drops Tab. Gardenal 100mg 6 drops 15mg HS IV BD TID x x x 5 days 1 week
3 months
Name : B/o. Benazir Begam Age/Sex : NB/ F Dept : Neonatology Hos.No: 472663 Mrd.No : 349954 Ward: IL.NB. NICU D.O.A : 06.08.10 D.O.D : 20.08.10 ************************************************************************
REF.BY.DR.PEER MOHAMED.,
PLACE : MADURAI
DIAGNOSIS: BIRTH ASPHYXIA WITH NEONATAL SEIZURE HIE STAGE 2 MECONIUM ASPIRATION SYNDROME COURSE:
This Pre term (34-36 weeks) / AGA / female baby deliverd by LSCS (Ind : fetal distress) was referred to MMHRC for respiratory distress since birth. Mother is 23 years / primi / on fertility treatment for 5 years. No H/o. PIH, GDM, Fever with rash, hypothyroidism during antenatal period. EDD was 15.09.10. Amniotic fluid was thick meconium stained and blood stained. Placenta was unhealthy. No H/o. cord around the neck. Baby was delivered at 4.30am on 06.08.10. Baby cried soon after birth but then developed respiratory distress. No H/o. cyanosis or convulsion. O/E : Baby cry and activity were moderate. Trunk was pink,
acrocyanosis +, CFT < 3 sec, HR : 110/min, regular. Mean arterial pressure : 65 mm/of/Hg. RR : 60/min, regular, Spo2 : 80% without oxygen and 90% with 5lit/min oxygen via hood. No pallor, icterus, edema. No external congenital
anomalies. No signs of dehydration. CVS : S1 S2 +, normal, no murmurs, RS : Mild distress + (sub costal indrawing and nasal flaring +), Bilateral air entry equal, NVBS heard over both lung fields, Bilateral firn crepts +. P/A : soft, no organomegaly. CNS : Moving all four limbs. AF normal. NNR sluggish. On investigation: Complete blood count and serum creatinine were normal. CRP was negative and blood culture revealed no growth of organisms. Baby developed convulsion during course of stay in hospital. Baby was managed with bubble CPAP, Iv. Antibiotics, Iv. Fluids, anticonvulsants and other symptomatic & supportive treatment measures. With this babys respiratory distress subsided and general condition improved. Feeds were gradually introduced which was well tolerated by baby. Hence baby was discharged with following advice.
INVESTIGATION
Glucometer
GLUCOMETER SUGAR
1PM 112 mg/dl 7PM 80mg/dl 2pm 173 mg/dl 10PM 95 mg/dl 4AM 158 mg/dl 10AM 117 mg/dl 4PM 113 mg/dl 10PM 129 mg/dl
11-08-2010 / 09:31 11-08-2010 / 09:32 11-08-2010 / 09:40 11-08-2010 / 12:30 11-08-2010 / 12:58 11-08-2010 / 12:59 11-08-2010 / 12:59 11-08-2010 / 13:00
BLOOD BANK

BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) 0.7 0.4 to 1.4 mg/dL 08-08-2010 / 07:19
MICROBIOLOGY
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes and 06-08-2010 / 18:20 macrocytes.NRBCs 2/100 WBC. No nucleated RBCs or hemoparasites. WBC count normal . No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :62% Eosinophils :02% Monocytes :02% Lymphocytes :34% 06-08-2010 / 18:20
Platelets Count normal in Number and morphology IMPRESSION : --
06-08-2010 / 18:20 06-08-2010 / 18:20
ADVICE ON DISCHARGE Tab. Gardenal Syp. Eptoin 15mg 1.5ml HS BD TID 1/5 th BD 1/5th OD TID x x x x x x 3 months 3 months 1 month 1 month 1 month 1 week
Syp. Deriphylline 8 drops Tab. Cavetra Tab. Aldactone Domstal drops 25mg 25mg 6 drops
Name : B/o. Punitha devi Age/Sex : NB/ M Dept : Neonatology Hos.No: 475966 Mrd.No : 352040 Ward: IL.NB. NICU D.O.A : 28.08.10 D.O.D : 30.08.10 ************************************************************************
REF.BY.DR. MUTHUARASAN.,
PLACE : PARAMAKUDI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME PERINATAL ASPHYXIA PPHN COURSE:

This term / AGA / male baby was born at private hospital by LSCS (Ind : Failed induction) on 28.08.10 @ 1.40pm. Baby was deeply asphyxiated, cried after, tracheal toileting bag and mask ventilation. H/o. Thick meconium stained liquor +. Since baby had severe distress baby was referred to MMHRC on 28.08.10 for further management. No H/o. cord around the neck. Maternal history : G2 A1. No Maternal H/o. PIH, PROM, GDM & fever with rash. O/E : babys activity & cry : nil, cyanosed, dyspnoeic +, tachypnoeic +, not icteric, no birth injury & no obvious external anamoly, CVS : S1 S2 heard, RS : ICR +, SCR +, RR@80/mnt, Bilateral air entry +, bilateral crepts +, P/A : Soft, CNS : NNR absent. Baby was investigated peripheral smear showed Hb : 15gms%, TC : 16,200 cells/mm3 & platelet count : 2.8 lakhs, PCV : 45. CRP : Positive, serum creatinine : 1.3mg/dl (30.08.10). Baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inotropic support. ABG showed PH : 7.182, Pco2 : 80.9, Po2 : 20.7 with HCo3 : 29. ventilator settings were changed accordingly. Now baby is on mechanical ventilator support, with high frequency mode with Fio2 100%, maintaining Spo2 : 98%. Condition & prognosis of the baby were well
explained to the parents, since parents were not willing for further management, baby is discharged AGAINST MEDICAL ADVICE on 30.08.10 @ 8.30pm.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING A POSITIVE HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) 15.0 16200 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 29-08-2010 / 13:25 30-08-2010 / 11:53 30-08-2010 / 11:53
PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) Plasma Creatinine (Jaffe Kinetic) CRP-C REACTIVE PROTEIN C- Reactive Protein
285000 150000 to 450000 Cells/cumm 45 5.0 110 35 31 17.3 6.7 1.3 44 to 62 % 4.9 to 5.6 Mill/Cumm 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 11 to 15 % 6 to 10.2 Fl 0.4 to 1.4 mg/dL
30-08-2010 / 11:53 30-08-2010 / 11:53 30-08-2010 / 11:53 30-08-2010 / 11:53 30-08-2010 / 11:53 30-08-2010 / 11:53 30-08-2010 / 11:53 30-08-2010 / 11:53 30-08-2010 / 18:53
POSITIVE 48 ul/ml RBCs show macrocytic normochromic. No nucleated RBCs or hemoparasites. WBC count neutrophilia with toxic changes. No atypical or immature cells.
30-08-2010 / 18:49 30-08-2010 / 11:53
DIFFERENTIAL COUNT :
NeutroPhils :81% Eosinophils :01% Monocytes :02% Lymphocytes :16% Platelets Count normal in Number and morphology
30-08-2010 / 11:53
30-08-2010 / 11:53 30-08-2010 / 11:53
IMPRESSION :
--
Name : B/o. Bhuvaneswari Age/Sex : NB/ F Dept : Neonatology Hos.No: 475533 Mrd.No : 351772 Ward: IL.NB. NICU D.O.A : 26.08.2010 D.O.D : 03.09.2010 ************************************************************************
DIAGNOSIS: PRETERM (30 32 WEEKS) / AGA RESPIRATORY DISTRESS SYNDROME SURFACTANT 1 DOSE GIVEN NEC / RH INCOMPATIBILITY
SEP 10
Name : B/o. Abirami Age/Sex : NB/ M Dept : Neonatology Hos.No: 476819 Mrd.No : 352616 Ward: IL.NB. NICU D.O.A :04.09.2010 D.O.D :06.09.2010 ************************************************************************
DIAGNOSIS: PRETERM (28-30 WEEKS) / VLBW / RESPIRATORY DISTRESS SYNDROME ( 1 DOSE OF SURFACTANT GIVEN ON 04.09.10 ) / SHOCK
Name : B/o. Vidhya Age/Sex : NB/ M Dept : Neonatology Hos.No: 472603 Mrd.No : 349870 Ward: IL.NB. NICU D.O.A : 05.08.10 D.O.D : 02.09.10 ************************************************************************
REF.BY.DR. SABARI RAJA.,
PLACE : SIVAGANGAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME HYPOXIC ISCHEMIC ENCEPHALOPATHY STAGE I CHRONIC LUNG DISEASE COURSE:
This term / AGA / male baby was delivered via LSCS on 04.08.10 at 6.30pm was admitted on the first day of life with H/o. Respiratory distress since birth. Mother is 25 years old, primi with H/o. GDM and PIH during antenatal period. No H/o. fever with rash, hypothyroidism, recurrent UTI during antenatal period. H/o. Meconium staining of amniotic fluid. No H/o. PROM or cord around the neck. Baby cried soon after birth, H/o. Respiratory within 2 hours after birth. No H/o. Convulsion or cyanosis. Baby was managed with in a private hospital with O2, Iv. Fluids, Iv. Antibioitcs and since distress didnt subside, baby was referred here for further management. O/E : baby had moderate cry and activity, colour : pink, CFT < 3 sec, no pallor, icterus, cyanosis, edema, no external congenital anamolies. No signs of dehydration. RS Tachypnoea + with RR of 80/min, regular, Spo2 : 85% (in room air), nasal flaring, sub costal and intercostals indrawing +, bilateral NVBS +, crepts heard over both lung fields. CVS : S1 S2 +, normal. No murmur, P/A : Soft, no organomegaly, CNS : Moving all four limbs,
NNR sluggish, AF : Normal. On investigation : complete blood count, blood sugar and serum creatinine were normal. CRP was positive (48mg/dl). Chest x ray showed bilateral infiltrates. Blood culture showed no growth of organisms. Baby was intubated and connected to mechanical ventilator support. During the course of stay in hospital baby recived blood transfusion thrice (whole fresh blood once and packed cell twice). Baby was on ventilator for 14 days. Baby was managed with Iv. Fluids, Iv. Antibiotics, inotropes, vaso pressors and pulmonary vasodilators (cavetra). Baby was also started on diuretics as weaning from the ventilator was difficult and CLD was suspected. Other symptomatic and supportive treatment measures were instituted. Enteral feeds was introduced but baby developed abdominal distension, NEC was suspected and managed conservatively with Nil per oral, then gradually feeds wre gradually introduced. With these above management babys general condition improved, respiratory distress subsided, now taking feeds well, hence baby was discharged with following advice.
INVESTIGATION
Glucometer
GLUCOMETER SUGAR 2AM 95 mg/dl 10AM 73 mg/dl 6PM 79 mg/dl 11-08-2010 / 13:03 11-08-2010 / 13:04 11-08-2010 / 13:04
2AM 79 mg/dl
11-08-2010 / 13:05
BLOOD BANK

BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) POTASSIUM (ISE) 0.4 5.0 0.4 to 1.4 mg/dL 3.5 to 5 mEq/L 06-08-2010 / 21:12 06-08-2010 / 14:22
MICROBIOLOGY
CRP-C REACTIVE PROTEIN C- Reactive Protein POSITIVE 48 MICROGRAM/ML 07-08-2010 / 15:34
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBCs show normochromic normocytes macrocytes.NRBCs +. Hemoparasites nil. WBC count neutrophilic leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :88% Stab :03% Eosinophils :00% Monocytes :02% Lymphocytes :07% Platelets Count normal in Number and morphology IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS WITH SHIFT TO LEFT. 06-08-2010 / 18:18
06-08-2010 / 18:18
06-08-2010 / 18:18 06-08-2010 / 18:18
ADVICE ON DISCHARGE
Tab. Aldactone Tab. Cacerta Syp. Deriphylline Syp. Domstal drops Syp. Silybon
1/4th 1/5th 80 80 100
OD BD TID TID TID
x x x x x
2 weeks 1 weeks 2 weeks 2 weeks 1 weeks
Name : B/o. Kousalya Age/Sex : NB/ F Dept : Neonatology Hos.No: 477497 Mrd.No : 353032 Ward: IL.NB. NICU D.O.A : 09.09.10 D.O.D : 09.09.10 ************************************************************************
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME ? PPHN
COURSE:
This 1 day old term female baby as referred to MMHRC on 08.09.10 as a case of Meconium aspiration. Baby delivered by LSCS (Ind: Fetal distress with meconium stained Liquor) on 08.09.10 at 10.44a.m. H/o. Baby didnt cry after birth. H/o. respiratory distress since birth. H/o. Meconium aspiration+. No H/o. cyanosis, convulsion at birth. No significant maternal history. O/E: Babys cry and activity weak, CFT > 3 sec, peripheral cyanosis+. No pallor / icterus / external anomaly. CVS : S1 S2 +, RS: RR @ 78/min, SCR+, ICR+. Bilateral air entry +, Bilateral crepts +, P/A : Soft, no organomegaly, CNS : NNR sluggish. Chest x ray suggestive of meconium aspiration. Baby was intubated and connected to mechanical ventilator. Managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inotropes and supportive measures. In spite of all above measures baby went into sudden cardiac arrest, resuscitation measures done as per the guidelines, but could not be revived and DECLARED DEAD on 09.09.10 @ 7.a.m. INVESTIGATION:
BLOOD BANK

PATHOLOGY
RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100WBCs. WBC count shows neutrophilic leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :73% Eosinophils :01% Monocytes :05% Lymphocytes :21% Platelets Count normal in Number and morphology IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS WITH SHIFT TO LEFT. 09-09-2010 / 16:06
09-09-2010 / 16:06
09-09-2010 / 16:06 09-09-2010 / 16:06
Name : B/o. Shanthi Age/Sex : NB/ M Dept : Neonatology Hos.No: 474075 Mrd.No : 350822 Ward: IL.NB. NICU D.O.A :16.08.2010 D.O.D :06.09.2010 ************************************************************************
REF.BY.DR. JEYAM.,
PLACE : MELUR
DIAGNOSIS: MECONUM ASPIRATION WITH SEPTICEMIA HIE STAGE II III WITH NEONATAL SEIZURES COURSE:
This newborn male baby was referred to MMHRC on 16.08.10 as a case of severe birth asphyxia. Baby was born by normal vaginal delivery on 15.08.10. baby did not cry for about half an hour after birth and was resuscitated (details not known). Baby was deeply cyanosed at birth. H/o. respiratory distress since birth. H/o. Irritable cry since few hours after birth. No H/o. convulsion. No H/o. Cord around the neck. H/o. Thick meconium stained liquor +. No H/o. PPROM II stage of labour +. Maternal history : 27 years old P2 L1 A0, IIcm, conceived seven years after first delivery, spontaneous conception. EDD : 15.08.10. No H/o. PIH, GDM, Hypothyrodism, fever with rash. O/E : Irritable cry, moderate activity, colour : pink, CRT < sec, HR : 130/mt, RR : 64/m right, Spo2 : 90% without O2 and 100% with O2 via hood. MAP : 70 mmHg. No pallor, not icteric, no cyanosis, no edema, no dehydration, no extneral congenital anamaly +, CVS : S1 S2 heard, no murmur, RS : tachypnea +, SCR , ICR +, Nasal flaring +, Bilateral air entry equal, NVBS +, no adventitious limbs, AF : normal. On investigations Hb : 18.8gm%, TC :
24,600cells, Platelet count : 1.8 lakhs, CRP : Negative (17.08.10), serum creatinine : 1.0mg/dl (17.08.10), 0.5 (20.08.10). chest x-ray showed bilateral infiltrates. Baby was managed with nasal C-PAP, O2, Iv. Fluids, Iv. Antibiotics, Inotrope support, Iv. Anticonvulsant (developed convulsion after admission). During the hospital course baby had abdominal distension developed icterus & respiratory distress managed with phototherapy, and other supportive measures. Baby was gradually weaned from nasal C-PAP, enteral feeding started, tolerating well. With these above measures, babys cry and activity improved, on DBF, tolerating well, icterus decreased, no further convulsion occurred. Hence discharged today to continue the following advice.
INVESTIGATION
BLOOD BANK

BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) 1.0 0.5 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 17-08-2010 / 18:50 20-08-2010 / 14:24
MICROBIOLOGY
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBCs show macrocytic normochromic .NRBCs+ Hemoparasites nil. WBC count neutrophilic leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :79% Eosinophils :00% Monocytes :05% Lymphocytes :16% Platelets Count Adequate IMPRESSION : -16-08-2010 / 11:35
16-08-2010 / 11:35
16-08-2010 / 11:35 16-08-2010 / 11:35
INVESTIGATION Inj. Ronem Tab. Gardenol 125mg 15mg IV BD HS x x 5 days 3 months
Syp. Silybon Domstal drops
10 drops 8 drops
TID TID
x x
2 weeks 2 weeks
Name : B/o.Ambujam Age/Sex : NB/ M Dept : Neonatology Hos.No: 477908 Mrd.No : 353277 Ward: IL.NB. NICU D.O.A :11.09.2010 D.O.D :12.09.2010 ************************************************************************
REF.BY.DR. INDIRA RAJA.,
PLACE : MADURAI
DIAGNOSIS: PRETERM (28-30 WEEKS) / LBW RESPIRATORY DISTRESS SYNDROME SURFACTANT THERAPY GIVEN
Name : B/o. Karthika Age/Sex : NB/ F Dept : Neonatology Hos.No: 476724 Mrd.No : 352536 Ward: IL.NB. NICU D.O.A : 03.09.10 D.O.D : 06.09.10 ************************************************************************
DIAGNOSIS: TERM / RESPIRATION DISTRESS THICK MECONIUM ASPIRATION SYNDORME PERINATAL ASPHYXIA COURSE:
This term / AGA / female baby was delivered by normal vaginal delivery on 03.09.10 at MMHRC H/o. baby cried soon after birth developed respiratory distress since birth hence admitted at NICU for further management. H/o. Thick meconium stained liquor +. No H/o. cyanosis, convulsion at birth. Maternal history : 23 years, G4, P1, L1, A2, EDD : 09.09.10. No H/o. PIH, GDM, fever with rash, UTI, Hypothyrodism . No H/o. Prolonged II stage of labour, cord around the neck. O/E : babys cry : moderate, activity : good, HR : 140/m , RR : 52/min, mean BP : 60 mmHg, Spo2 : 95% with O2. no pallor, not icteric, no cyanosis, no external congenital anamoly, no birth injury. CVS : S1 S2 heard, RS : grunting +, SCR +, ICR +, Bilateral air entry +, no added sounds, P/A : Soft, CNS : NNR +. On investigations Hb : 12.9gm%, TC : 1, 58, 000cells (corrected count - 29000), platelet count : 2.8 lakhs, PCV : 38, serum creatinine : 0.9mg/dl. CRP : Negative. Chest x-ray showed bilateral infiltrates. Peripheral smear showed leukoerythroblastic picture with neutophilic leukocytosis. Baby was managed with oxygen, Iv. Fluids, Iv. Antibiotics, Inj. Calcium glucaonte, Inj. Vitamin K. RTF started and increased to full feeds, tolerating well. With these above measures babys respiratory distress
decreased, cry and activity improved, tolerating breast feeds and hence discharge today with the advice to continue the following.
INVESTIGATION
PERIPHERAL BLOOD SMEAR STUDY HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) 12.9 13.6 to 19.6 g/dL 06-09-2010 / 10:20 06-09-2010 / 10:20 06-09-2010 / 10:20 06-09-2010 / 10:20 06-09-2010 / 10:20 06-09-2010 / 10:20 06-09-2010 / 10:20 06-09-2010 / 10:20 06-09-2010 / 10:20 06-09-2010 / 10:20
158000 10000 to 25000 Cells/cumm 287000 38 5.2 89 24 27 32.3 9.8 150000 to 450000 Cells/cumm 44 to 62 % 4.9 to 5.6 Mill/Cumm 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 11 to 15 % 6 to 10.2 Fl
BIO CHEMISTRY
MICROBIOLOGY
CRP-C REACTIVE PROTEIN C- Reactive Protein NEGATIVE RBCs show normocytic normochromic .Macrocytes +.NRBCs+ ( 450/ 100 WBCs ) Hemoparasites nil. WBC count - Corrected WBC count 29,000 cells / cumm.Neutrophilic leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :48% Band form :08% Myelocytes :04% Lymphocytes :40% Platelets Count Adequate. IMPRESSION : SUGGGESTIVE OF LEUKOERYTHROBLASTIC PICTURE. CLINICAL CORRELATION AND REPEAT SMEAR IS SUGGESTED IF CLINICALY WARRANTED. 05-09-2010 / 12:33 06-09-2010 / 10:20
06-09-2010 / 10:20
06-09-2010 / 10:20 06-09-2010 / 10:20
Name : B/o. Sangeetha Age/Sex : NB/ M Dept : Neonatology Hos.No: 481193 Mrd.No : 355246 Ward: IL.NB. NICU D.O.A :04.10.2010 D.O.D :16.10.2010 ************************************************************************
DIAGNOSIS: MECONUM ASPIRATION SYNDROME HIE STAGE II NEONATAL SEIZURES ACUTE RENAL FAILURE SPONTANEOUS PNEUMOTHORAX ICD DONE ON 06.10.10 COURSE:
This Term / AGA / male baby was born at private hospital by vaccum extraction on 04.10.10 @ 5.30a.m. H/o. Baby didnt cry immediately after birth, cried after resuscitation (details not known). H/o. Meconium aspiration +. H/o. Baby developed respiratory distress since birth, hence brought to MMHRC on 04.10.10 for further management. Maternal history : H/o. PROM 15 hrs+, No Maternal H/o. PIH / GDM / PROM & fever with rash. O/E : Babys activity & cry Nil, CFT prolonged, peripheral cyanosis +, dyspnoeic +, tachypnoeic +, not anemic, not icteric, no cyanosis, no birth injury & no obvious external anamoly. CVS: S1 & S2 heard, RS : RR @ 72/mt, SCR + / LCI +, Bilateral air entry +, bilateral crepts +, P/A: soft, CNS: NNR sluggish encephalopathy +. Baby was investigated peripheral smear showed Hb : 14.8gm%, TC : 30,400cells/mm3, Platelet count : 2.6 lakhs, PCV: 45. Serum creatinine : 1.5mg/dl (06.10.10), 0.6mg/dl (08.10.10), CRP: Negative. Chest x-ray suggestive of MAS. Baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj.
Calcium gluconate, Inj. Vitramin K & Inotropic support.Baby had convulsions 2 episodes, (outside) Inj. Gardenol was added. Baby had raised Renal parameters with decreased urine output managed with Inj. Lasix. ABGs were done periodically & ventilator settings were adjusted according. As baby had desaturation on 06.10.10, Chest x ray was taken which showed Pneumothorax (right side). Hence ICD done and air let out. Baby had GI Bleed, Inj. Rantac was added & 1 FFP transfusion was given on 07.10.10. With these above measures, babys activity improved, respiratory distress settled, convulsions controlled so weaned from the ventilator on 11.10.10. Baby was started on small Ryles tube feeds & gradually raised. Repeat Serum creatinine became normal. Urine output improved. Baby was slowly weaned from the oxygen & oral feeds tried. As air entry improved on right side and chest x ray became normal ICD was removed. Now Babys activity improved had no further convulsions & taking feeds oral well hence discharged today with the advice to continue the following.
INVESTIGATION:
BLOOD BANK
BLOOD GROUPING & Rh TYPING
O POSITIVE
04-10-2010 / 15:59

BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) 1.5 0.6 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 06-10-2010 / 10:23 08-10-2010 / 13:21
MICROBIOLOGY
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY RBCs show normochromic normocytes and macrocytes. Nucleated RBCs 2/100WBCs. WBC count neutrophilic leukocytosis. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :75% Eosinophils :01% Monocytes :05% Lymphocytes :19% Platelets Count normal in Number and morphology IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 04-10-2010 / 18:42
04-10-2010 / 18:42
04-10-2010 / 18:42 04-10-2010 / 18:42
ADVICE ON DISCHARGE Tab. Gardenol Domstal drops 15mg 80 drops HS TID x x Till further advice 2 weeks
OCT 10
Name : B/o.Devasudha Age/Sex : NB/ M Dept : Neonatology Hos.No: 481130 Mrd.No : 355194 Ward: IL.NB. NICU D.O.A : 03.10.10 D.O.D : 14.10.10 ************************************************************************
REF.BY.DR. SURYA PRABHA.,
PLACE : PARAMAKUDI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME
COURSE:
This term / AGA / male baby was referred to MMHRC on 03.10.10 as a case of Meconium aspiration syndrome with respiratory distress. Baby was delivered by LSCS (Ind : Previous LSCS with fetal distress) on 02.10.10. H/o. Meconium aspiration +, cried soon after birth and developed respiratory distress since birth. H/o. Grunting +. No H/o. Cord around the neck, cyanosis, jaundice at birth. Maternal history : 30 years, G2, P1, L1 NCM parents. No H/o. PIH, GDM, Hypothyroidism, UTI, fever with rash. O/E : Babys cry and activity : weak. Colour : cyanosis+, CFT > 3 sec, no pallor / external congenital anomaly. CVS: S1 S2 +, RS : RR @ 88/mt, SCR +, ICR +, Grunting +, Bilateral+, Bilateral crepts+, P/A : Soft, CNS : NNR absent. On investigations, Hb : 14.6g%, TC : 12800cells, Platelet count 2.3 lakhs. Serum creatinine 0.6mg%. CRP : Positive (12). Blood culture no grew organisms. Chest x-ray showed bilateral infiltrations. ECHO
showed OS ASD (4mm) with IAS aneurysm, no pulmonary hypertension. Baby was managed with mechanical ventilator support, inotropic support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K. ABG was periodically recorded, which was showing metabolic acidosis, correction with NaHco3 given and ventilator settings changed accordingly. Inspite of mechanical ventilation, ABG showed hypoxia and baby could not be weaned from the ventilator. Need for prolonged ventilator support and the condition of the baby were well explained to the parent. As they were not willing for further management, baby discharged AGAINST MEDICAL ADVICE on 14.10.10.
INVESTIGATION
BLOOD BANK

PERIPHERAL BLOOD SMEAR STUDY HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) Plasma Creatinine (Jaffe Kinetic) CRP-C REACTIVE PROTEIN C- Reactive Protein POSITIVE 12 MICRO GRAM /ML RBCs macrocytic normochromic. No nucleated RBCs or hemoparasites seen. WBC count mild leukocytosis seen. No atypical or immature cells seen. DIFFERENTIAL COUNT : NeutroPhils :59% Eosinophils :00% Monocytes :03% Lymphocytes :38% Platelets Count Adequate on smear IMPRESSION : MILD LEUKOCYTOSIS NOTED. 04-10-2010 / 22:37 04-10-2010 / 13:02 14.6 12800 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 04-10-2010 / 13:02 04-10-2010 / 13:02 04-10-2010 / 13:02 04-10-2010 / 13:02 04-10-2010 / 13:02 04-10-2010 / 13:02 04-10-2010 / 13:02 04-10-2010 / 13:02 04-10-2010 / 13:02 04-10-2010 / 13:02 04-10-2010 / 21:58
230000 150000 to 450000 Cells/cumm 43 3.6 119 40 33 18.3 7.1 0.6 44 to 62 % 4.9 to 5.6 Mill/Cumm 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 11 to 15 % 6 to 10.2 Fl 0.4 to 1.4 mg/dL
04-10-2010 / 13:02
04-10-2010 / 13:02 04-10-2010 / 13:02
Name : B/o.Sathiya priya Age/Sex : NB/ F Dept : Neonatology Hos.No: 479565 Mrd.No : 354348 Ward: IL.NB. NICU D.O.A : 23.09.10 D.O.D : .10.10 ************************************************************************
REF.BY.DR. MATHIAZHAKAN.,
PLACE : BODINAYAKANUR
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME NEONATAL SEIZURE PPHN ? BRONCHO PULMONARY DYSPLASIA COURSE:
This term / AGA / female baby was born by at private hospital normal vaginal delivery on 22.09.10 @ 3.30pm. H/o. Baby cried soon after birth. H/o. Baby developed respiratory distress since birth. H/o. Meconium aspiration +. H/o. Baby developed cyanosis & irritable cry for which baby was treated at referral doctor clinic with oxygen Iv. Antibiotics & referred to MMHRC on 23.09.10 for further management. Maternal history : G2 P1 L1 A0, H/o. PROM 4 hrs. No MH/o. PIH, GDM, Fever with rash & Hypothyroidism. O/E : Babys activity weak, cry : irritable, CFT > 3 sec, peripheral cyanosis +, dyspnoeic +, Tachypnoeic +, not icteric, no birth injury, no obvious external anamoly, CVS : S1 S2 heard, RS : RR@72/mt, LCI +, SCR +, Bilateral air entry equal, bilateral crepts +, P/A : Soft, CNS : NNR sluggish. Baby was investigated peripheral smear showed Hb : 13.7gms%, TC : 15,900cells/mm3 & platelet count : 2.7 lakhs, PCV : 38, CRP : Negative. Serum creatinine was normal. Chest x-ray suggestive of meconium aspiration syndrome. ECHO showed CHD, OS ASD (8mm) with L -> R shunt mild PHT. Baby was managed with mechanical ventilator support, Iv. Fluids, Iv.
Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inotropic support. Baby had convulsion, Inj. Gardenol was added. Baby was started on small ryles tube feeds & gradeually raised. ABGs was done periodically & ventilator settings were adjusted according to that. With these above measures babys respiratory distress settled convulsions controlled so weaned form the ventilator on 05.10.10. As baby had increased respiratory distress with desaturation, connected to C-PAP. Baby was weaned from the C-PAP on 09.10.10 & put on oxygen hood. As baby had difficulty in weaning from the oxygen, bronchopulmonary dysplasia was
suspected, Tab. Aldactone & deriphylline drops were added. Baby was slowly weaned from the oxygen therapy & oral feeds tried. Now babys respiration became normal, had no further convulsions active & taking oral feeds. Baby is discharged today with the advice to continue further follow-up with the referral doctor.
INVESTIGATION
BLOOD BANK

BIO CHEMISTRY
MICROBIOLOGY
CRP-C REACTIVE PROTEIN C- Reactive Protein PERIPHERAL BLOOD SMEAR STUDY RBCs show macrocytic normochromic. No nucleated RBCs or hemoparasites. WBC count neutrophilic leukocytosis with shift to left. No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :68% Eosinophils :00% Monocytes :05% Lymphocytes :27% Platelets Count Adequate IMPRESSION : -24-09-2010 / 11:32 NEGATIVE 24-09-2010 / 08:26
24-09-2010 / 11:32
24-09-2010 / 11:32 24-09-2010 / 11:32
ADVICE ON DISCHARGE Deriphylline drops Tab. Aldactone 8 drops 25mg TID 1/4th OD x x 2 weeks 2 weeks
Name : B/o. Bharakath nisha Age/Sex : NB/ F Dept : Neonatology Hos.No: 482821 Mrd.No : 356281 Ward: IL.NB. NICU D.O.A :14.10.2010 D.O.D :18.10.2010 ************************************************************************
DIAGNOSIS: PRETERM (29-30 WEEKS) / ELBW / RESPIRATORY DISTRESS SYNDROME / SURFACTANT THERAPY GIVEN
Name : B/o. Jaringursiyatha TwinII Age/Sex : NB/ F Dept : Neonatology Hos.No: 483021 Mrd.No : 356423 Ward: IL.NB. NICU D.O.A :16.10.2010 D.O.D :16.10.2010 ************************************************************************
DIAGNOSIS: PRETERM (32-33 WEEKS) WITH RESPIRATORY DISTRESS SYNDROME HIE WITH SHOCK SURFACTANT THERAPY GIVEN
Name : B/o. Uma Maheswari Age/Sex : NB/ F Dept : Neonatology Hos.No: 484469 Mrd.No : 357472 Ward: IL.NB. NICU D.O.A : 27.10.10 D.O.D : 27.10.10 ************************************************************************
REF.BY.DR. JENITHA.,
PLACE : ODDANCHATRAM
This term / AGA / female baby was born at private hospital by LSCS (Ind : Meconium stained liquor with fetal distress) on 27.10.10 @ 12.30am. H/o. Baby had weak cry at birth, had developed respiratory distress soon after birth. Baby was admitted at referral doctor hospital, had cyanosis & hypoglycemia+ on correction given, inotropes were started, baby had convulsion managed with Inj. Phenobarbitone (outside) and referred to MMHRC on 27.10.10 for further management. Maternal history : No MH/o. PIH, GDM, Fever with rash & UTI. O/E : Babys activity & cry poor, peripheral cyanosis +, CFT > 3 sec, perfusion poor, BP not recordable, dyspnoeic +, tachypnoeic +, dehydration +, not anaemic, not icteric, no obvious external anamoly, CVS : S1 & S2 heard, no murmur, RS RR@80/mt, SCR+, ICR+, bilateral air entry +, Bilateral crepts+, P/A : Soft, CNS : NNR absent, encephalopathy +. Baby was investigated, peripheral smear showed Hb : 23.5gms%, Tc : 33,900cells/mm3 & platelet count : 1.1 lakhs, PCV : 74. Baby
was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Dopamine infusion, Inj. Calcium gluconate and Inj. Vitamin K. Baby had persistent hypotension with peripheral cyanosis, Inj. Nor adrenaline infusion was started. ABG done showed PH 7.059, PCo2 : 81.4 & PO2 : 11.7 with Hco3 : 22.5, ventilator settings were changed accordingly. Even with these above measures baby had desaturation, pulmonary vasodilators were started. Planned for ECHO. Now baby is on mechanical ventilator support with Fio2 100% maintaining Spo2 96% & with inotropes support. Since parents were not willing for further management, baby is discharged AGAINST MEDICAL ADVICE on 27.10.10 @ 7.30PM.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING O POSITIVE HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) 23.5 23900 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 27-10-2010 / 13:37 27-10-2010 / 16:39 27-10-2010 / 16:39
PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram)
27-10-2010 / 16:39 27-10-2010 / 16:39 27-10-2010 / 16:39 27-10-2010 / 16:39 27-10-2010 / 16:39 27-10-2010 / 16:39 27-10-2010 / 16:39 27-10-2010 / 16:39 27-10-2010 / 16:39
RBCs-Mild erythrocytosis seen. Macrocytic normochromic normocytes. No nucleated RBCs or hemoparasites. WBC - Marked neutrophilic leukocytosis noted with shift to left . No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :72% Eosinophils :01% Monocytes :05% Lymphocytes :22% Platelets Count Adequate. IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS.
27-10-2010 / 16:39
27-10-2010 / 16:39 27-10-2010 / 16:39
NOV10
Name : B/o. Madhubala Age/Sex : NB/ F Dept : Neonatology Hos.No: 485258 Mrd.No : 357987 Ward: IL.NB. NICU D.O.A :01.11.2010 D.O.D :07.11.2010 ************************************************************************
DIAGNOSIS: SEVERE BIRTH ASPHYXIA PRETERM (28-30 WEEKS) RESPIRATORY DISTRESS SYNDROME / 2 DOSES OF SURFACTANT THERAPY GIVEN
Name : B/o. Siva sankari Age/Sex : NB/ M Dept : Neonatology Hos.No: 483091 Mrd.No : 356472 Ward: IL.NB. NICU D.O.A : 17.10.10 D.O.D : 31.10.10 ************************************************************************
DIAGNOSIS: TERM / MAS / BIRTH ASPHYXIA SEPTICEMIA ? BPD
COURSE:
This term / AGA / Twin II / male baby was born at MMHRC by normal vaginal delivery on 17.10.10. H/o. Baby didnt cry soon after birth. H/o. Meconium stained liquor +. Baby was intuabted & tracheal toileting given, after that baby developed spontaneous respiration. H/o. respiratory distress since birth. Maternal history : H/o.PROM +, H/o. fever for 1 day before delivery+. No MH/o. GDM, PIH, UTI. O/E : babys activity & cry : moderate, CFT < 3 sec, colur : pink, dyspneic +, tachypneic, no pallor / icterus / birth injury / obvious external congenital anomaly. CVS : S1 & S2 heard, RS : RR@60/mt, SCR +, ICR+, Bilateral+, P/A : Soft, CNS : NNR sluggish. Baby was investigated which showed Hb : 15.5gm%, TC : 22,300cells/mm3 & platelet count : 2.1 lakhs, peripheral smear showed neutron philic leukocytosis with shift to left. PCV : 47, serum creatinine was normal. Blood culture showed no growth. CRP : Negative. Chest x-ray showed bilateral infiltrates. Baby was managed with C-PAP, Iv. Fluids, Iv..
Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inotropic support. With these above measues respiratory distress settled hence weaned form the C-PAP & put on O2 hood. Baby was started on small ryles tube feeds & gradually raised. As baby had abdominal distension kept in NPO for 72 hrs then ryles tuibe feeds restarted. As baby had difficulty in weaning from the oxygen bronchopulmonary dysplasia was suspected & Tab. Aldactone was added. Baby was slowly weaned form the oxygen & oral feeds tried. Now baby is active, respiration became normal & taking oral feeds well hence the baby is discharged today with the advice to continue the following.
INVESTIGATION
BLOOD BANK

BIO CHEMISTRY
MICROBIOLOGY
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY RBC macrocytic normochromic. No hemoparasites seen. WBC count neutrophilic leukocytosis with shift to left. No atypical or immature cells seen. DIFFERENTIAL COUNT : NeutroPhils :73% Eosinophils :00% Monocytes :05% Lymphocytes :22% Platelets Count Adequate on smear. IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS. 18-10-2010 / 11:15
18-10-2010 / 11:15
18-10-2010 / 11:15 18-10-2010 / 11:15
ADVICE ON DISCHARGE
Inj. Ronem Syp. Domstal Tab. Aldactone
125mg 5 drops 25mg
IV BD TID 1/6th OD
x x x
5 days 2 weeks 2 weeks

Dept : Neonatology Ward: IL.NB. NICU
Name : B/o.Yogeswari Hos.No: 484879
Age/Sex : NB/ M Mrd.No : 357713
D.O.A : 29.10.10 D.O.D : 13.11.10 ************************************************************************
REF.BY.DR. RAVISANKAR.,
PLACE : MADURAI
DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH PPHN
COURSE:
This term / AGA / male baby was born at private hospital by normal vaginal delivery on 29.10.10 @ 12.45pm. H/o. Baby had weak cry at birth. H/o. Meconium aspiration + resuscitated at referral doctor clinic & refereed to MMHRC on 29.10.10 for further management. Maternal history : No MH/o. PIH, GDM, PROM & fever with rash. O/E : Babys activity & cry weak, had no spontaneous respiration & cyanosed immediately intuabted with ambu bag ventilation Spo2 picked up, not anemic, not icteric, no obvious external anamoly, CVS : S1 S2 heard, RS : Bilateral air entry equal with ET tube, P/A : Soft, no organomegaly, CNS : NNR not elicitable. Baby was investigated peripheral smear showed Hb : 17.4gms%, TC : 6900cells/mm3 & platelet count : 1.9 lakhs, PCV : 52. CRP : Positive. Serum creatinine was normal. Blood culture showed no growth. chest xray suggestive of bilateral meconium infiltrations. Baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Ionotrophic support. Series of ABGs were done & ventilator
settings were adjusted according to that. Baby was started on small ryles tube feeds on 01.11.10 & gradually raised. As baby had abdominal distension kept in NPO for 72 hrs. With these above measures babys abdominal distension reduced, so ryles tube feeds restarted. As babys ABGs showed raised Pco2, suspected PPHN & managed with High frequency ventilation. Baby was slowly weaned from the ventilator on 06.11.10 & Ionotropes were stopped. Baby was extubated on 09.11.10 & put on O2 hood. As babys respiratory distress settled gradually weaned from the oxygen therapy & oral feeds tried. Now baby is active respiration became normal & taking oral feeds. Baby is discharged today with the advice to continue further follow-up with the referral doctor.
INVESTIGATION
BLOOD BANK

PERIPHERAL BLOOD SMEAR STUDY
HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram)
17.4 6900
13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm
30-10-2010 / 12:01 30-10-2010 / 12:01 30-10-2010 / 12:01 30-10-2010 / 12:01 30-10-2010 / 12:01 30-10-2010 / 12:01 30-10-2010 / 12:01 30-10-2010 / 12:01 30-10-2010 / 12:01 30-10-2010 / 12:01
BIO CHEMISTRY
MICROBIOLOGY
CRP-C REACTIVE PROTEIN C- Reactive Protein PERIPHERAL BLOOD SMEAR STUDY RBCs - macrocytic normochromic. No nucleated RBCs or hemoparasites. WBC count within normal range neutrophilic prepondarence noted No atypical or immature cells. DIFFERENTIAL COUNT : NeutroPhils :71% Eosinophils :01% Monocytes :05% Lymphocytes :23% Platelet just adequate on smear IMPRESSION : NORMOCYTIC NORMOCHROMIC BIOOD PICTURE 30-10-2010 / 12:01 POSITIVE 24 MICROGRAM/ML 31-10-2010 / 17:09
30-10-2010 / 12:01
30-10-2010 / 12:01 30-10-2010 / 12:01
Name : B/o. Siva sankari Age/Sex : NB/ M Dept : Neonatology Hos.No: 483090 Mrd.No : 356471 Ward: IL.NB. NICU D.O.A : 17.10.10 D.O.D : 22.11.10 ************************************************************************
DIAGNOSIS: BIRTH ASPHYXIA MAS NEONATAL SEIZURE SEPTICEMIA WITH NEC COURSE:
This term / AGA / male / Twin I / was born at MMHRC by normal vaginal delivery on 17.10.10 @ 125am. H/o. Baby did nt cry soon after birth. H/o. Thick mecnoium aspiration +, baby was immediately intubated, tracheal toileting given. Baby developed severe respiratory distress since birth shifted to NICU for further management. Maternal history : H/o. PROM 5 hrs. No H/o. PIH, GDM, UTI & hypothyroidism. O/E : babys activity & cry weak, peripheral cyanosis, CFT > 3 sec, dyspnoeic +, tachypnoeic +, no birth injury & no obvious external anamoly, CVS : S1 S2 heard, RS : RR@ 80/mt, LCI +, SCR, Bilateral crepts +, P/A : Soft, CNS : NNR sluggish. Baby was investigated peripheral smear showed HB : 16.6gms%, TC : 7500cells/mm3 & platelet count : 2.4 lakhs, PCV : 50, serum creatinine : 0.9mg/dl (19.10.10). Chest x-ray showed bilateral extensive infiltrates. CRP : positive. Blood culture showed no growth. baby was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Calcium gluconate, Inj. Vitamin K & Inotropic support. Baby had convulsions on 18.10.10, managed with Inj. Gardenol. Baby was started on small tyles tube feeds & gradually raised. Baby had decreased urine output, managed with Inj. Lasix on 24.10.10. baby had abdominal distension. NEC was suspected hence kept NPO. Baby was odematous with serum creatinine : 1.3mg/dl ( 30.10.10). Fluid restriction was done & Inj. Lasix added. On 30.10.10, baby had
bleeding from the injection sites and became pale, (HB was 6.5gms%), managed with WFB transfusion. Baby had petechial spots, repeat platelet count was 20,000 only managed with platelet concentrate transfusion. With these above measures babys abdominal distension reduced, small ryles tube feeds was restarted. Babys urine output improved & repeat serum creatinine became normal (1.11.10). As baby had GI bleed & pallor +, managed with 1 WFB & platelet transfusion OD for 4 days. Baby was weaned form the ventilator on 06.11.10 & extubated on 08.11.10. but baby had again developed distress hence connected to C-PAP on 09.11.10. Baby had desaturation with the C-PAP, so intubated and again connected to
mechanical ventilator support on 13.11.10. As baby had difficulty in weaning form the ventilator, BPD was suspected and Tab. Aldactone added. Baby again developed abdominal distension with vomiting of feeds, antibiotics were changed and kept NPO again. Now baby is on mechanical ventilator support with Fio2 100%, maintaining Spo2 of 95% & in NPO. Condition & prognosis of the baby & need for prolonged ventilator support were well explained to the parents. Since parents want to continue further management at Government Hospital, baby is discharged AGAINST MEDICAL ADVCIE on 22.11.10 at 1pm.
INVESTIGATION
HAEMOGLOBIN (Photometric Measurement) 7.1 PLATELET COUNT (Plt Histogram) 11.2 to 19.6 g/dL 22-11-2010 / 02:38 20000 150000 to 450000 Cells/cumm 31-10-2010 / 06:51
BLOOD BANK

BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) POTASSIUM (ISE) POTASSIUM (ISE) 0.9 0.6 1.3 0.9 1.0 3.5 3.0 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 3.5 to 5.1 mEq/L 3.5 to 5.1 mEq/L 19-10-2010 / 03:05 23-10-2010 / 07:50 30-10-2010 / 17:14 01-11-2010 / 23:25 02-11-2010 / 14:26 18-11-2010 / 17:34 20-11-2010 / 15:07
MICROBIOLOGY
CRP-C REACTIVE PROTEIN C- Reactive Protein POSITIVE 24microgram/ml 19-10-2010 / 03:02
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBC macrocytic normochromic . No hemoparasites seen. WBC count moderate neutrophilic leukocytosis noted. No atypical or immature cells seen. DIFFERENTIAL COUNT : NeutroPhils :66% Eosinophils :00% Monocytes :05% Lymphocytes :29% Platelets Count Adequate on smear. IMPRESSION : NEUTROPHILIC LEUKOCYTOSIS NOTED. 18-10-2010 / 11:12
18-10-2010 / 11:12
18-10-2010 / 11:12 18-10-2010 / 11:12
Name : B/o. Bhuvaneswari Age/Sex : NB/ F Dept : Neonatology Hos.No: 487000 Mrd.No : 359168 Ward: IL.NB. NICU D.O.A : 15.11.10 D.O.D : 24.11.10 ************************************************************************
DIAGNOSIS: PRETERM / VLBW / SEVERE BIRTH ASPHYXIA WITH SHOCK ACUTE RENAL FAILURE RESPIRATORY DISTRESS SYNDROME SURFACTANT THERAPY GIVEN
Name : B/o. Subathra Age / Sex: NB/F Dept : Neonatology Hos.No : 488871 Mrd.No : 360323 Ward : I NB NICU D.O.A : 27.11.10 D.O.D :28.11.10 ************************************************************************ REF.BY.DR.PUSHPALATHA GOKULNATH., PLACE : MADURAI
DIAGNOSIS: PRETERM (28-30 WEEKS) / VLBW RESPIRATORY DISTRESS SYNDROME NEONATAL SEIZURE SURFACTANT THERAPY GIVEN
DEC 10
Name : B/o. Palaniammal Age / Sex: NB/F Dept : Neonatology Hos.No : 488534 Mrd.No : 360125 Ward : I NB NICU D.O.A : 24.11.10 D.O.D :01.12.10 ************************************************************************ DIAGNOSIS: PRETERM (28 - 30 WEEKS) / VLBW / RESPIRATORY DISTRESS SYNDROME CHD (SMALL PDA / SMALL ASD) ? SEPTICEMIA NEONATAL SEIZURE SURFACTANT THERAPHY GIVEN
Name : B/o. Manimegalai Age / Sex: NB/F Dept : Neonatology Hos.No : 490472 Mrd.No : 361429 Ward : I NB NICU D.O.A : 09.12.10 D.O.D :10.12.10 ************************************************************************ DIAGNOSIS: SEVERE BIRTH ASPHYXIA / MECONIUM ASPIRATION SYNDROME / IUGR / MULTI CYSTIC DYSPLASTIC KIDNEY COURSE:
This term / IUGR / female baby delivered by LSCS (Ind : Severe oligohydramnios AFI 3) on 08.12.10 at 10.04pm at MMHRC. H/o. Baby was not cried immediately after birth, (thick mecnoium stained liquor +). Baby cried after tracheal toileting and bag and tube ventilation. Baby was shifted to NICU for further management. Maternal history : 22 years, primi, conceived after infertility treatment. Antenatal USG abdomen showed dysplastic left kidney + severe oligohydramnios. Apgar score 1 mint 3/10, 5 mits 7/10. O/E : activity weak, wt: 1.5kg, acrocyanosis +, no pallor. CVS : S1 S2 heard, murmur +, RS : NVBS, no added sounds, no organomegaly, CNS : NNR absent. Child was investigated which showed Hb : 14.5gms%, TC : 49,300cells/mm3, platelets 80,000, PCV : 45%. Blood culture sent, reports awaited. Chest x-ray showed cardiomegaly with bilateral infiltrates. Child was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics Inj. Calcium gluconate, Iv. Inotropes and Inj. Vitamin K.
ABG was done periodically and ventilator settings changed accordingly. USG abdomen showed multi cytic dysplastic kidney. Urology opinion was obtained. As baby had bleeding form injection site and platelet count was only 80,000, baby was managed with platelet concentrate and FFP transfusion. Condition of the baby and prognosis were explained to the parents. As they were not willing for further management, baby was discharged AGAINST MEDICAL ADVCIE on 10.12.10.
INVESTIGATION :
BLOOD BANK
BLOOD GROUPING & Rh TYPING A POSITIVE PERIPHERAL BLOOD SMEAR STUDY 09-12-2010 / 09:28
HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) POTASSIUM (ISE) PERIPHERAL BLOOD SMEAR STUDY
14.5
13.6 to 19.6 g/dL
09-12-2010 / 10:30 09-12-2010 / 10:30 09-12-2010 / 10:30 09-12-2010 / 10:30 09-12-2010 / 10:30 09-12-2010 / 10:30 09-12-2010 / 10:30 09-12-2010 / 10:30 09-12-2010 / 10:30 09-12-2010 / 10:30 09-12-2010 / 05:22
49300 10000 to 25000 Cells/cumm 80000 150000 to 450000 Cells/cumm 45 3.3 135 42 31 22.5 7.2 3.5 44 to 62 % 4.9 to 5.6 Mill/Cumm 76 to 96 Fl 27 to 32 pg/cell 32 to 36 % 11 to 15 % 6 to 10.2 Fl 3.5 to 5.1 mEq/L
RBC mild anisocytosis, predominantly macrocytic normochromic. 33 NRBC/100 WBC. No hemoparasites nil seen. WBC count marked leukocytosis with predominance of lymphocytes. Mild shift to left in neutrophilic series noted. No atypical or immature cells seen. DIFFERENTIAL COUNT : Metamyelocytes :06% NeutroPhils :21% Monocytes :04% Lymphocytes :69% Platelets Count just Adequate on smear (90,000 cells/cumm) IMPRESSION : MARKED LEUKOCYTOSIS. Adv: 1) Please correlate with clinical details 2) Coombs test, Tetic count.
09-12-2010 / 10:30
09-12-2010 / 10:30
09-12-2010 / 10:30 09-12-2010 / 10:30
Name : B/o. Sasi kala Age / Sex: NB/M Dept : Neonatology Hos.No : 491926 Mrd.No : 362361 Ward : I NB NICU D.O.A : 18.12.10 D.O.D :19.12.10 ************************************************************************ DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH BA WITH PROFOUND SHOCK COURSE:
This term / AGA / male baby was delivered by LSCS (Ind : CPD with Grade III MSAF) on 18.12.10 11.05am. H/o. Baby did not cry after birth, intubated and referred to Christian hospital, hence baby was connected to ventilator, chest x-ray was taken, showed bilateral haziness and desaturation and hence referred here for further management. H/o. cyanosis +. Mother had UTI 2 days before delivery and treated with antibiotics. No H/o. GDM, PIH, Hypothyroidism, fever with rash. O/E : ET tube in site, Spo2 : 65% with bag & mask ventilator, peripheries were cyanosed, HR : 170/mt, RR : 60/mt, no pallor, not icteric, no external anamoly +, umbilicus : unhealthy +, CVS : S1 S2 heard, RS : Bilateral crepts +, P/A : Soft, CNS : NNR sluggish. Baby was investigated Hb : 13.4, TC : 23400, platelet count ; 1.37 lakhs, blood culture sent report awaited. Chest x-ray showed bilateral infiltrates. Baby was managed with mechanical ventilator, inotrope support, Iv. Antibiotics and other supportive measures. ABG taken after 1hr showed, severe metabolic acidosis, correction with NaHco3 given. Ventilator settings changed
accordingly. Bleeding from UVC site +, managed with packed cell transfusion. Baby had desaturation followed by bradycardia and went for cardio respiratory arrest and could not revived and DECLARED DEAD on 19.12.10 at 6am.
INVESTIGATION
BLOOD BANK
BLOOD GROUPING & Rh TYPING A POSITIVE HAEMOGLOBIN (Photometric Measurement) TOTAL WBC COUNT (Coulter Principle) 13.4 26400 13.6 to 19.6 g/dL 10000 to 25000 Cells/cumm 19-12-2010 / 09:42 20-12-2010 / 10:10 20-12-2010 / 10:10
PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram)
20-12-2010 / 10:10 20-12-2010 / 10:10 20-12-2010 / 10:10 20-12-2010 / 10:10 20-12-2010 / 10:10 20-12-2010 / 10:10 20-12-2010 / 10:10 20-12-2010 / 10:10 20-12-2010 / 10:10
RBC macrocytic normochromic .8 NRBC/100 WBC. No nucleated RBCs or hemoparasites seen. WBC count marked leukocytosis with lymphocytic prepondrance.Mild shift to left noted. No atypical or immature cells seen. DIFFERENTIAL COUNT : Metamyelocytes :06% NeutroPhils :28% Eosinophils :02% Monocytes :07% Lymphocytes :57% Platelets Count Adequate on smear IMPRESSION : MODERATE LEUKOCYTOSIS WITH SHIFT TO LEFT.
20-12-2010 / 10:10
20-12-2010 / 10:10 20-12-2010 / 10:10
Name : B/o. Nandhini Age / Sex: NB/M Dept : Neonatology Hos.No : 491929 Mrd.No : 362369 Ward : I NB NICU D.O.A : 18.12.10 D.O.D :29.12.10 ************************************************************************ DIAGNOSIS: MECONIUM ASPIRATION SYNDROME WITH NEONATAL SEIZRUE WITH ACUTE RENAL FAILURE COURSE:
This term / AGA / male baby was referred to MMHRC on 18.12.10 as a case of MAS. H/o. Baby didnt cry immediately afterbirth APGAR 4 and 6. baby was resusciated and referred here for further management. Maternal history : 34 years, primi, k/c/o hypothyroidism on T- Eltroxin H/o. PIH +. No H/o. GDM, fever with rash, UTI. Baby was delivered by LSCS ( Ind : fetal distress with mild PIH). O/E : baby ET tube in situ tachypnoea +, dyspnoea +. CFT > 3 sec, RS : air entry equal on both sides, bilateral crpts +, CVS : S1 S2 +, P/A : Soft, liver 1cm palpable, CNS : NNR sluggish. Baby was investigated which showed Hb : 13, TC : 26900, platelet : 2.62 lakhs, CRP : Negative. PCV : 40, TSH : 3.12. Repeat Hb : 12.3 (28.12.10), serum creatinine : 1.5 (1.12.10), 1.4 (22.12), 1.4 (24.12), 1.6 (26.12), 1.6 (28.12). Blood culture showed no growth. ET tip culture sent awaited. Serum K+ : 1.4. USG abdomen showed heterogenous echogenic cystic lesion in right lobe of liver (26.12.10). Child was managed with mechanical ventilator support, Iv. Fluids, Iv. Antibiotics, Inj. Ratnac, Inj. Calcium gluconate, Iv.
Inotropes and Vitamin K. As child had GI bleed, FFP was transfused on 22.12.10. renal failure was managed with fluid restriction and Inj. Lasix. With these above measues child respiratory distress settled, hence started weaning form ventilator (23.12.10) and extubated on 27.12.10. Child developed respiratory distress on 28.12.10 and hence reintubated and connected to mechanical ventilator. Despite this measures baby had persistent renal failure and had hypokalemia which was corrected with KCL. Baby went in to sudden cardiac arrest at 12.30am (24.12.10). Despite active resuscitation, could not be revived & DECLARED DEAD on 24.12.10 at 1am.
INVESTIGATION
HAEMOGLOBIN (Photometric Measurement) 12.3 11.2 to 19.6 g/dL 28-12-2010 / 05:31
BLOOD BANK

PERIPHERAL BLOOD SMEAR STUDY HAEMOGLOBIN (Photometric Measurement) 13.0 TOTAL WBC COUNT (Coulter Principle) PLATELET COUNT (Plt Histogram) PCV (Hct) (Calculated) TOTAL RBC COUNT (Coulter Principle) MCV (RBC Histogram) MCH (Calculated) MCHC (Calculated) RDW (RBC Histogram) MPV (Plt Histogram) 13.6 to 19.6 g/dL 20-12-2010 / 10:14 20-12-2010 / 10:14
26900 10000 to 25000 Cells/cumm
BIO CHEMISTRY
Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) Plasma Creatinine (Jaffe Kinetic) 1.5 1.4 1.4 1.4 1.5 1.6 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.4 to 1.4 mg/dL 0.34 to 5.6 IU/mL 3.5 to 5.1 mEq/L 20-12-2010 / 20:39 23-12-2010 / 00:16 24-12-2010 / 07:43 24-12-2010 / 10:17 26-12-2010 / 08:19 28-12-2010 / 06:17 19-12-2010 / 15:44 28-12-2010 / 22:48
Serum Thyroid Stimulating Hormone (CLIA) 3.12 POTASSIUM (ISE) 1.4
MICROBIOLOGY
PATHOLOGY
PERIPHERAL BLOOD SMEAR STUDY . RBC macrocytic normochromic.3 20-12-2010 / 10:14 NRBC/100WBC. No hemoparasites nil. WBC count marked leukocytosis with mild shift to left. No atypical or immature cells seen. DIFFERENTIAL COUNT : Metamyelocytes :05% NeutroPhils :46% Eosinophils :02% Monocytes :08% Lymphocytes :39% Platelets Count Adequate on smear IMPRESSION : MARKED LEUKOCYTOSIS. 20-12-2010 / 10:14
20-12-2010 / 10:14 20-12-2010 / 10:14
Name : B/o. Logeswari Age / Sex: NB/M Dept : Neonatology Hos.No : 482816 Mrd.No : Ward : I NB NICU D.O.A : 14.10.10 D.O.D :31.12.10 ************************************************************************ DIAGNOSIS: PRETERM WITH VLBW RESPIRATORY DISTRESS SYNDROME (SURFACTANT GIVEN ON 14.10.10) PDA ( SURGICAL CLOSURE DONE ON 16.11.10) NEONATAL SEIZURE BRONCHOPULMONARY DYSPLASIA

Thesis

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Thesis

Hochgeladen von

Copyright:

Verfügbare Formate

APRIL 08 MARCH 09 MAS : 21

D.O.A : 26.12.08 REF. BY. DR. MAHALINGAM

D.O.D : 03.01.09 PLACE: MADRUAI

Lakhs/Cumm 26/12/2008 mg /dl 27/12/2008

PERIPHERAL SMEAR SHOWED (26.12.08):

RBCs show normochromic

Name : B/o. Amarshanthi

Ward : IL.NB. NICU

Name : B/o. SOORATH EMINA

Ward : IL.NB. NICU

D.O.A : 02/02/09 D.O.D : 05/02/09 ************************************************************************

REF.BY.DR.KYRDUDYN DIAGNOSIS: PNEUMONITIS (EARLY ONSET OF SEPSIS) COURSE:

17.1 7200 51 101 34 33 18 4.9 6.7

COUNT PLATELET COUNT

Admission weight : 2.715 Kg Discharge weight : 2.975 Kg

Name : B/o. KALAIARASI Hos.No : 403698

Age / Sex: NB/ M Mrd.No : 305199

Dept : Neonatology Ward : I NB NICU

WBC count shows

DC: Neutrophils: 82%,

Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 12%. Platelets count normal in

Admission Weight : 3.250 Kg Discharge Weight : 3.320 Kg

Name : B/o. PUSHPALATHA Hos.No : 404046

Age / Sex: NB/ M Mrd.No : 305407

Dept : Neonatology Ward : I NB NICU

Date 05/02/2009 06/02/2009

gm/dl cells/cumm gm/dl cells/cumm % % FL FL PG PG % % % % MILL/Cumm MILL/Cumm FL FL

05/02/2009 05/02/2009 05/02/2009 06/02/2009 06/02/2009 06/02/2009

WBC count shows

No atypical or immature cells.

DC: Neutrophils: 82%,

Eosinophils: 01%, Monocytes: 05%, Lymphocytes: 12%. Platelets count normal in

Name : B/o. Ushnara {Twin I}

Ward : IL.NB. NICU

D.O.A : 25.02.09 D.O.D : 26.02.09 ************************************************************************

16.1 18,400 49 106 35 32 17.1 4.6 7.8 61 38 01 2.7

gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm

Name : B/o. Ushnara {Twin II} Age/Sex : NB/ M

Ward : IL.NB. NICU

D.O.A : 25.02.09 D.O.D : 26.02.09 ************************************************************************

19.7 11,200 60 103 33 32 17.5 5.8 8.2 24 75 01 2.0

gm/dl cells/cumm % FL PG % % MILL/Cumm FL % % % Lakhs/Cumm

Name : B/o. ANITHA BEGAM

Ward : IL.NB. NICU

D.O.A : 09/02/09 D.O.D : 28/02/09 ************************************************************************

PERIPHERAL SMEAR SHOWED (30.03.09) :

RBCs show normochromic

Monocytes: 05%, Lymphocytes: 45%. Platelet count diminished. LEUKOCYTOSIS. THROMBOCYTOPENIA.

Name : B/o. Poomari Hos.No : 408068

Age / Sex: NB/F Mrd.No : 308130

Dept : Neonatology Ward : I NB NICU

PERIPHERAL SMEAR SHOWED (14.03.09) :

RBCs show normochromic

Admission Weight : 2.825 Kg Discharge Weight : 2.72

Name : B/o. Kavitha

Ward : IL.NB. NICU

D.O.A : 09.05.09 D.O.D : 09.05.09 ************************************************************************

PERIPHERAL SMEAR SHOWED (19.05.09) :

RBCs show normochromic

IMPRESSION: NORMAL SMEAR STUDY.

advice to continue further follow up with the referral doctor.

/ HPF / HPF mg/dl mg/dl

RATIO CREATININE POTASSIUM SODIUM UREA