PERINATAL ASPHYXIA WITH ADRENAL HAEMORRHAGE AND SHOCK Dr. Dinakara Prithviraj, , Dr. Vivek Chail,Dr. Dr. Manjunath CB, Rasheed Dr. Bhagya, Dr. Swagata M, Aravind N Neonatal ICU, Dept of Pediatrics, Dept of Radiology. Vydehi institute of medical Sciences and research centre.Whitefield, Bengaluru Phone no : 080-28413385-89 ext 273 Email [email protected], [email protected]Live term male baby born by LSCS Ind – failed induction and fetal distress on 10.7.10 at 3:10 pm in peripheral hospital weighing 3 kgs. Baby was flaccid and required ambu bagging and chest compressions for 3-4 mins. Following this baby had improved.APGAR not known. Baby shifted to mother’s side, was feeding well.On the 2 nd day, baby developed weak cry, poor feeding and reduced activity and was admitted in medical college NICU. Baby developed hypoglycemia with convulsions. It was corrected with glucose administration , ,the baby was given Inj calcium gluconate(2ml/kg). Still convulsions persisted phenobarbitone even with this medications convulsions persisted ,then phenytoin was given. Inspite of all these the convulsions still persisted, and the baby was put on midazolam infusion. Noted gradually baby was becoming pale, having irregular respiration, Spo2 was fluctuating, given supplemental oxygen, Reports showed: USG brain – normal study Hb: 19.7g/dl; HCT: 60.7%; WBC: 21,300c/Cumm; P72, L20, E03; Platelets: 1.56 lakhs/cumm ; PS :microcytic normochromic blood picture S.calcium:6.5mg/dl ; Blood urea :52mg/dl ; S.creatinine0.7mg/dl, PT:3 mins ;APTT >5mins 2secs(prolonged) Inspite of all the above measures baby continued to have convulsions and hypoglycemia. The baby was discharged against medical advice and was admitted in our hospital . At the time of admission ; baby appeared pale, HR -200/min, RR-40-68/min irregular breathing, BP-30/20 mmHg, GRBS- 30 mg/dl, Temp- Hypothermia, CFT>5 secs, Icterus up to lower thighs, pupils mildly dilated,reacting to light, anterior fontanalle at level. Systemic examination: cardia – tachycardia, no murmur, feeble peripheral pulse ; respiratory – irregular respiration ; abdomen – soft, distended abd girth 36 cm, noted bilateral huge mass near the flanks ?renal ; cns – weak cry, hypotonic ,Baby was developing multifocal convulsions. Hypoglycemia corrected .Iv fluids started, 10%dextrose , Shock treated with 20 ml/kg NS. Baby put on Bubble CPAP with FiO2 60%, pressure 4 cm of H2O. Calcium gluconate 2 ml/kg. Ionotrops started Reports – Hb:17.8g/dl , HCT:51.8% , WBC:15400c/cumm , Platelets:1.3 lakhs, CRP:negative , Urea:49mg/dl, S.creatinine:0.56 mg/dl, Na:133.9mg/dl, K:3.7mg/dl, Cl:106mg/dl. LFT: normal study. S.calcium:8.6 mg/dl. TSH: 4.07micro IU/ml. Bilirubin: 14 mg/dl ; USG Brain – normal study USG Abdomen – B/l huge adrenal hemorrhage Right side 3.6 x 3.1cm;;. Left side 1.5x1.3cm. At this juncture , HIE with b/l adrenal hemorrhage and consumptive coagulopathy was suspected. Baby was treated with 2 mg iv Inj Vit K. Group specific fresh frozen plasma started and continued for 3 days. Baby passing urine & stool adequately. Blood glucose monitored meticulously and maintained within normal limits Ionotrops gradually tapered and stopped. Removed from Bubble CPAP, started supplemental O2. Electrolytes were monitored alternate days which were normal. Phototherapy was given for 6 days. SpO2 was normal and O2 stopped. No evidence of external hemorrhage like petechiae, purpura , internal hemorrhage like hematuria, nasal, oral, GI bleeding. Baby’s general condition improved, convulsions controlled, inj eptoin stopped low dose of phenobarbitone 3 mg?kg HS dose continued for 1 month. BP and blood glucose were maintained. Since S bilirubin and hemoglobin within normal limits (10mg/dl) and (15g/dl)
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PERINATAL ASPHYXIA WITH ADRENAL HAEMORRHAGE AND SHOCK · Neonatal adrenal haemorrhage is a well-known clinical entity. Birth trauma, prolonged labor, hypoxia, asphyxia, shock, septicemia
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PERINATAL ASPHYXIA WITH ADRENAL HAEMORRHAGE AND SHOCK
Dr. Dinakara Prithviraj, , Dr. Vivek Chail,Dr. Dr. Manjunath CB, Rasheed Dr. Bhagya, Dr. Swagata M, Aravind N
Neonatal ICU, Dept of Pediatrics, Dept of Radiology. Vydehi institute of medical Sciences and research centre.Whitefield,