Download to read offline
More Related Content
Similar to O.A. mortality review (2) 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)
O.A. mortality review (2) for paediatric residence doctors
- 1. SCBU OUTBORN MORTALITY OnuzulikeJennifer 7/8/24
- 2. History • O.A a7 hour old male admitted into SCBU outborn via children emergency ward following referral from military hospital on 1/8/24 at 9:30pm and died on 2/8/24 at 2:20 pm after spending 17 hours on admission.
- 3. History Presenting complaints: • Prematurityat 35 weeks +5 days • Fast breathing from birth History of presenting complaint: Child was born at 32 weeks + 5days gestation Fast breathing was observed few minutes after delivery. There was associated bluish discolouration of lips and extremities. He was commenced on intranasal oxygen. On account of the above complaints, he was referred to UPTH for expert care.
- 4. History • Pregnancy andbirth History: Pregnancy was supervised in a military hospital from 2 months gestation. There was no history of fever or rash in the first trimester. She was seronegative to HIV, Hepatitis B and C, non reactive to VDRL. Blood group 0 Rh D positive. Abdominal ultrasound scan done in first trimester was normal. She received 3 doses of Sulfadoxine- Pyrimethamine for malaria chemoprophylaxis. She had completed the protocol for tetanus vaccination during her last confinement. Repeat ultrasound scan done at 6 month showed a low lying placenta. • There was no history of intake of tobacco, alcohol or unprescribed drugs.
- 5. History • There wasno history of diabetes or hypertension. Pregnancy was carried to 35 weeks +5 days when she started experiencing bleeding per vagina. An ultrasound scan done showed placenta praevia. • She subsequently had an emergency caesarean section on account of antepartum haemorrhage secondary to placenta praevia and one previous caesarean section. Outcome was a live male neonate with apgar score of 71 , 55 810 . Birth weight was 2.6kg. There was no history of PROM or peripartum pyrexia.
- 6. History • He isthe seventh of seven children of parents in a monogamous family setting. Father is a 47 year old accountant who works in a private firm with tertiary level of education. • Mother is a 40 year old trader who owns a supermarket with secondary level of education. Family reside in a two bedroom apartment.
- 7. Review of systems •Central nervous system: Convulsion0 • Digestive system: Vomitting0 , diarrhea0 , haematemesis0 • Respiratory system: Grunting0 • Cardiovascular system: Cyanosis+ • Genitourinary system: Making urine+ • Haematologic system: Petechiae0 , purpura0
- 8. Examination • Very illchild, in respiratory distress with intercostal and subcostal recessions, hypothermic with temperature of 35.2o c, peripherally and centrally cyanosed, moderately pale, anicteric, no peripheral edema. SPO2 24% in room air and 62% on INO2.
- 9. Examination • Central nervoussystem Unconscious BCS E0 VO M1 1/5 Pupils were 4mm and reacted to light very sluggishly OFC 31.8cm Anterior fontanelle flat and normotensive Suck - absent Grasp- poor Moro-incomplete Decreased tone in all limbs
- 10. Examination • Cardiovascular system: HR124b/m S1 and S2 with grade 3/6 systolic murmur maximal at the left lower sternal border. • Respiratory system: RR 52c/min Reduce air entry bilaterally
- 11. Examination • Digestive system Abdomenfull moved with respiration Soft Liver was 2cm palpable below the right coastal margin Spleen not palpable Kidneys were not ballotable Bowel sound was absent Anus was patent
- 12. Examination • Genitourinary system Fairlymature male external genitalia Right testis in the scrotum Left testis in the upper scrotum
- 13. Diagnosis • He wasadmitted and managed as a case of late preterm (normal birth weight) with severe perinatal asphyxia Hypoxic ischemic encephalopathy stage 3 to rule out Cyanotic congenital heart disease ? Transposition of great arteries.
- 14. Investigations full bloodcount PCV 36% Decreased WBC 15.7 x 109 /l Normal Neutrophil 60% Normal lymhocytes 38% Normal Platelets 123 x 109 /l Normal
- 15. Investigations Serum Calcium, phosphateand magnesium Calcium 2.3mmol Normal Magnesium 1.2mmol Normal Phosphate 1.0mmol Normal
- 16. Investigations requested butnot done • Chest x-ray( Mobile x-ray) • Echo • Blood culture
- 17. Treatment • He wasplaced on • Intravenous dextrose water at 60mls/kg = 160 mls in 24 hours • intravenous Ceftazidine ( two doses) • NPO • Intranasal oxygen at 1l/min (Oxygen saturation ranged from 65-82%) • Input and output were ensured • RBG was monitored 4 hourly and remained normal • Consult was sent to cardiology unit • Father was counselled on child’s critical condition
- 18. Review • Ten minutesinto admission, child was noted to be apneic • RBG at this time was 5.4mmol/l • Temp 35.5o c, HR 140b/min, RR 0c/min, SP02 24% and was actively resuscitated. • He regained spontaneous respiration after 20mins.
- 19. Review • He wasreviewed by cardiology unit who requested for an urgent chest x- ray and Echocardiography.
- 20. Terminally • His conditioncontinued to deteriorate, the cyanosis persisted, the apneic attacks became more frequent and he suddenly stopped breathing. He did not respond to resuscitative measures and was certified clinically dead after spending 17 hours on admission. • Grief counselling was done
- 21. Summary • O.A whowas admitted into SCBU outborn at 7 hours of life on 1/8/24 at 9:30pm and died on 2/8/24 at 2:20pm after spending 17 hours on admission. • He was referred from military hospital with complaints of prematurity at 35 weeks plus 5 days, fast breathing from birth. Delivery was via emergency caesarean section on account of placenta praevia and one previous Caearean section.
- 22. Summary • On examination,Very ill child, in severe respiratory distress with intercostal and subcostal recessions, hypothermic with temperature of 35.2o c, peripherally and centrally cyanosed, moderaltely pale, anicteric, acyanosed. Appeared dusky. SPO2 62% in room air and 84% on INO2. RR 52c/min • He was unconscious with absent primitive reflexes. He had a grade 3/6 systolic murmur maximal at left lower sternal border.
- 23. Summary • He wasmanaged as a case of severe perinatal asphyxia, Hypoxic ischemic encephalopathy stage 3 to rule out cyanotic congenital heart disease ? Transposition of great vessels. • He received intravenous 10% dextrose water, Ceftazidine and intranasal oxygen, he was placed on NPO. RBG was monitored and remained normal. • He had several apneic attacks and subsequently did not respond to all resuscitative measures.
- 24. Summary • Vital signsat this point: HR Temp 35.5o c, HR 140b/min, RR 0c/min, SP02 24% • IPPV was commenced and continued • Terminally he failed to respond to resuscitative measures and was certified clinically dead o 2/8/24 at 2:20 pm after spending 17 hours 20 mins on admission.
- 25.