Download to read offline
More Related Content
Similar to Mortality SCBU Twin 2 (1) for paediatric residence doctors
![CLINICAL_BLOOD_TRANSFUSION__EDITED[1].pptx](https://cdn.slidesharecdn.com/ss_thumbnails/clinicalbloodtransfusionedited1-240903171619-5f7504e8-thumbnail.jpg?width=640&height=640&fit=bounds)
Mortality SCBU Twin 2 (1) for paediatric residence doctors
- 1. SCBU Outborn Mortality By OnuzulikeJennifer 11/9/24
- 2. History • A.C. wasa 4 day old female preterm admitted into SCBU outborn at 21 hours of life on 2/9/24 at 7:30pm following referral from a private hospital and died on 5/9/24 at 12:20pm after spending 3days 15 hours 10 mins on admission. She presented with complaints- • of prematurity at 28 weeks • No cry at birth
- 3. History • Child didnot cry at birth and was actively rescuscitated. • He received intranasal oxygen, endotracheal surfactant, Intravenous Caffeine, Intravenous Ceftazidine, Improvised CPAP and was nursed in an incubator. • On account of financial constraint and parent’s request was referred to UPTH for expert care.
- 4. History Pregnancy and birthHistory: • Pregnancy was supervised at Mbodo Aluu Primary health care from 2 months gestation. Seronegative to RVS, Hepatitis B and C, non reactive to VDRL. Blood group O Rhesus D posititve. • There was no history of fever or rash in the first trimester. No history of intake of alcohol, tobacco or herbal concotion.
- 5. History • She receivedtwo doses of intramuscular tetanus toxoid and sulfadoxine-pyrimethamine for malaria chemoprophylaxis. • There was no history of diabetes mellitus or hypertension. Obstetric scan done at 4months showed twin gestations dichorionic and diamniotic. • Pregnancy was complicated at 28 weeks gestation by preterm contraction and rupture of membrane for which mother presented to booking facility.
- 6. History • She wasreferred to spring rose hospital rumuaghaolu where she had SVD of first twin who weighed 0.9kg, APGAR score of 71 95 . Index twin was delivered via emergency caesarean section on account of retained second twin and footling breech. Outcome was a live female who did not cry at birth and weighed 0.8kg, APGAR score was 31 75 910 . • She had PROM of 16 hours. There was no history of peripartum pyrexia.
- 7. History • Family andsocial History: She was the third of three children of parents in a monogamous family setting and second of a set of twin. First sibling is a 3 year old female alive and well. First twin was a male managed as a preterm extreme low birth weight with presummed neonatal sepsis- partially corrected severe anaemia, respiratory distress syndrome. Had EBT in the referral hospital and died within two hours of admission.
- 8. History • Father isa 38 year old businessman sells clothes with secondary level of education. Mother is a 33year old cleaner at shell hospital with secondary level of education. Family live in a 2 bedroom apartment.
- 9. Examination • General examination:Small baby in respiratory distress, with intercostal and subcostal recessions, peripherally cyanosed, hypothermic (temperature< 350 c) anicteric, no peripheral edema. SP02 95% on intranasal oxygen. RBG 5.6mmol/l. • Weight 0.84kg
- 10. Examination • Central nervoussystem Conscious AF flat and normotensive OFC 22.9cm Suck absent Grasp poor Normal tone in limbs
- 11. Examination • Digestive Abdomen wasfull moved with respiration Soft Liver was tipped Spleen was not palpable Kidneys were not ballotable • Cardiovascular system HR124b/min S1S2
- 12. Examination Respiratory: • RR 80c/min •Vesicular breath sound Genitourinary system Immature female external genitalia
- 13. Examination • Musculoskeletal system: Purplishblue discolouration of soles of both feet and left palm. Dubowitz corresponded to 30 weeks (SGA)
- 14. Diagnosis She was managedas a case of • Preterm extreme low birth weight (SGA) with severe perinatal asphyxia • Presumed neonatal sepsis-Congenital pneumonia • Respiratory distress syndrome
- 15. Investigations Hb 17g/dl Normal PCV50% Normal TWBC 57.0 x 109 /l Increased Neut 72% Normal Lymphocyte 26% Normal Platelet 395 x 109/l Normal
- 16. Investigations Sodium 128mmol/l decreased Calcium 1.5mmol/l Decreased Potassium 5mmo/lDecreased Magnesium 1.9mmol/l Normal Chloride Phosphate 1.8mmmol/l Normal Bicarbonate 15mmol/l decreased Creatinine 30umol/l Normal Repeat sodium 136mmol 5/9/24 Normal Repeat Potassium 3.6mmol/l Normal
- 17. Working clinical diagnosis •With retrieval of investigation results, she was then being managed as a • Preterm extreme low birth weight (SGA) with severe perinatal asphyxia Presumed neonatal sepsis-Congenital pneumonia Respiratory distress syndrome Hypocalcaemia
- 18. Treatment She received Improvised bubbleCPAP Intravenous Ceftazidine at 75mls/kg= 65mg 12 hourly Intravenous Caffeine loading dose 20mg/kg= 16mg stat then 5mg/kg= 4mg daily Intravenous 10% dextrose water at 70mls/kg/day= 60mls and changed to 10% dextrose water in 1/5th saline. Intravenous calcium gluconate bolus at 2mls/kg= 1.6mls
- 19. Treatment • She waswrapped in a nylon bag. • RBG was being monitored and remained normal • Input and output monitoring was done. • Urine output ranged from 1.2mls/kg/hr to 1.4mls/kg/hr
- 20. Review • Two daysinto admission, she deteriorated and was noted to appear dusky and very ill looking • Vital signs were Temperature 35.7o c RR 65c/min, HR 136b/min, SPO2 95-96% on improvised bubble CPAP • She was clinically pale • Incubator temperature was increased by 0.8oc , • On account of sepsis and to replace blood volume taken from sample collection, she had a double volume exchange blood transfusion with 136mls and top up with 16mls of whole blood under intravenous lasix cover.
- 21. Review • Three daysinto admission she was reviewed and was noted to have copious secretions. Vital signs at this time were Temp 36o c, HR 140b/min, RR68c/min,SP02 95% on intranasal oxygen commenced on trophic feeds 1.5mls 3 hourly. • She was suctioned; effluent was copious mucoid secretions.
- 22. Terminally • On furtherreview she was noted to still have copious secretions in the mouth, while being suctioned she became apneic. • Vital signs at this time were RR 0c/min, HR Ob/min, SPO2 was unrecordable • Active resuscitation was commenced and she failed to respond. She was certified dead on 5/9/24 at 12:20 pm after spending 3 days 15 hours 10mins on admission. • Grief counselling was done and child was transferred to the morgue.
- 23. Summary • A.C. a4 day old female preterm admitted into SCBU outborn at 21 hours of life on 2/9/24 at 7:30pm following referral from a private hospital and died on 5/9/24 at 12:20pm after spending 3days 15 hours 10 mins on admission. She presented with complaints- • of prematurity at 28 weeks • No cry at birth
- 24. Summary • She wasthe second of a set of twin delivered via emergency caesarean section on account of retained second twin and footling breech. APGAR score was 31 75 910. • Birth weight was 0.8kg. First twin weighed 0.9kg with APGA score of 71 95 Mother had PROM of 18 hours.
- 25. Summary • General examination:Small baby in respiratory distress, with intercostal and subcostal recessions, peripherally cyanosed, temperature less than 350 c, anicteric, no peripheral edema. SP02 95% on intranasal oxygen. RBG 5.6mmol/l. • RR 80c/min, HR 140b/min
- 26. Summary • She wasadmitted and managed as of preterm extreme low birth weight (AGA) with severe perinatal asphyxia, Probable sepsis, Respiratory distress syndrome. Hypocalcaemia. • FBC – Total WBC of 57 x 109/l, Had Hypocalcaemia of 1.5mmol/l • She received intranasal oxygen with Improvised bubble CPAP, intravenous 10% dextrose water, Intravenous Calcium gluconate, Intravenous Ceftazidine, Ceftazidine, Genticin.
- 27. Summary • She hada double volume exchange blood transfusion with 136mls of fresh whole blood on account of sepsis and top up with 16mls under IV lasix cover. • Her clinical condition continued to deterioriate and terminally while being suctioned, she suddenly became apneic and failed to respond to resuscitative measures and was certified clinically dead on 5/9/24 at 12:10 pm.
- 28.