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    Case Presentation-Neonatal Jaundice

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    DEEPAK BANDI

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    Case Presentation-Neonatal Jaundice

    Uploaded by

    DEEPAK BANDI
    5 views26 pages

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    Case Presentation-neonatal Jaundice

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    5 views26 pages

    Case Presentation-Neonatal Jaundice

    Uploaded by

    DEEPAK BANDI

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 26

    CASE PRESENTATION-

    PEDIATRICS

    MELWIN MABEN
    FINAL YEAR, HIMS HASSAN
    Name: Baby of Mrs. XYZ
    Age: 6 days
    Sex: Female
    Born on: 6th February 2020
    Period of Gestation: 38 weeks
    Mode of Delivery: Full Term Normal Vaginal Delivery
    Delivered at: HIMS Hassan
    Address: Arkalgud, Hassan
    Informant: Mother
    Education of Mother: PUC
    Reliability: Reliable
    Socioeconomic status: Class 3 of Modified BG Prasad
    Classification
    DOE: 12th February 2020
    Weight of baby: 2.7 kg
    APGAR Score: 1’: 9/10
    5’: 10/10
    Age of mother : 25 years
    Parity : P2 L2
    Blood group : Mother : B+
    Baby : B+
    Father : B+
    CHIEF COMPLAINTS
    C/o Yellowish discoloration of skin
    since 2 days
    HISTORY OF PRESENTING ILLNESS
    • Patient was apparently alright 2 days ago when
    mother noticed yellowish discolouration of skin
    and eyes which progressed from initially
    involving only face to now till umbilicus
    • It was associated with lethargy, and decreased
    feeding, decreased passage of urine with
    inconsolable cry
    • There are no aggravating and reliving factor
    No H/oclay coloured stools and dark staining urine
    No H/o admission to NICU, trauma, seizure, high
    pitched Cry , poor sucking
    No/H/o - vomiting, delayed passage of meconium
    or urine or passage of clay coloured stool
    No H/o Respiratory Difficulty
    No H/o diarrhoea
    No H/o fever
    ANTENATAL HISTORY
    • 1st Trimester
    • Birth order : 2
    • UPT was done
    • Pregnancy was confirmed after 2 months of amenorrhea
    by USG
    • No H/o : fever with rashes ,excessive vomiting, fatigue,
    exposure to radiation ,regular intake of drug, burning
    micturition ,increased frequency of micturition, bleeding
    or leaking per vagina.
    • Number of ANC visits: 2
    • Scan : dating scan done
    • Folic acid taken
    • 2nd TRIMESTER
    • Quickening : 5TH month of gestation.
    NO/H/o headache, fever with rashes, giddiness,
    swelling in the lower limbs which doesn’t subside
    with rest, blurring of vision, bleeding or leaking
    Per vagina, pain abdomen.
    • Number of ANC VISITS : 2
    • SCAN : Anomaly scan done and was normal
    • Iron and calcium supplements taken
    • dT Vaccine taken: Booster Dose
    • 3rd TRIMESTER
    • Foetal movement well perceived
    No H/o bleeding Per vagina ,leaking per vagina ,
    foul smelling discharge per vagina, pain abdomen,
    swelling in the lower limbs which doesn’t subside
    with rest, burning micturition ,increased frequency
    of micturition.
    • Iron and calcium tablets taken
    • Scan done and was found normal
    Total Weight gain during pregnancy : 12 kg
    NATAL HISTORY
    • DATE OF DELIVERY: 6th February 2020
    • Place of delivery : HIMS, Hassan
    • Normal Full Term Vaginal Delivery
    • A live female baby weighing 2.7kgs was
    delivered
    NEO-NATAL HISTORY
    • Baby CRIED IMMEDIATELY after birth
    • No H/o NICU ADIMISSION
    • BREASTFEEDING INITIATED WITHIN ½ AN HR OF
    DELIVERY
    • No H/o any yellowish discolouration of skin and
    mucous membrane
    • No H/o delayed passage of meconium ,urine or
    any diagnosis of congenital anomaly
    FEEDING HISTORY
    • Breastfeeding initiated within ½ an hour after
    delivery
    • Number of times during day – on demand
    • During night – 2
    • No supplementary feeding
    • Used to pass urine – 4 to 5 times / day
    • Stool – 3 to 4 times / day
    • Baby sleeps for about 1 hour after feeds and
    wakes up crying
    IMMUNIZATION HISTORY
    • At Birth BCG, OPV and Hep B were given
    FAMILY HISTORY
    • NO/H/O haemolytic disease, liver disease,
    disease of gall bladder , hereditary disease in
    the family

    4 years
    SUMMARY
    A 6 day old term baby girl of birth order 2 belonging
    to Class 3 of BG Prasad Classification who is
    exclusively breastfed and immunised till date , born
    to parents of a non consanguineous marriage by
    normal vaginal delivery with complaints of
    yellowish discolouration of skin since 2 days
    associated with lethargy , decreased urine output
    and decrease in appetite. There is no History of
    fever, vomitting, diarrhoea, clay coloured stools,
    high pitched cry, seizures, abnormal posture. It is
    probably a case of Physiological Jaundice.
    GENERAL PHYSICAL EXAMINATION
    • Posture / attitude :
    • Ventral : Complete lack of head control
    • Straight back with elbow and knees
    flexed and slight extension at hip
    • Prone : Head turned to one side
    • Pelvis high
    • Supine: Asymmetric tonic neck reflex present
    • When pulled to sit, complete head lag present
    • Activity decreased
    VITALS

    • Temperature : 98 F
    • Heart rate : 142 pulsations / min
    • Respiratory rate : 42 cycles / min
    • Pulses are well felt and regular
    • CAPILLARY FILLING TIME : Aproxx 3 sec
    • Pallor : Not present
    • Icterus : Present ( Kramer’s zone II)
    • Cyanosis : Not present
    • Oedema : Not present
    ANTHROPOMETRY:
    • Birth weight : 2.7 kg
    • Length : 50 cm
    • Head circumference : 34 cm
    • Chest circumference : 32.5cm
    • The above parameters are appropriate for
    gestational age
    HEAD TO TOE EXAMINATION
    Head : Normal
    Moulding : Not present
    Caput succedaneum : Not present
    Cephal hematoma : Not present
    Anterior and posterior fontanelle :
    Slightly sunken
    Any bruises : Not present
    Face : Yellowish Discolouration present
    Dysmorphic facies : Not present
    Eyes : Yellowish Discolouration present
    Nose : Normal
    Chest : Yellowish discolouration present ( till
    umbilicus)
    Umbilical cord and umbilicus: central , no
    discharge seen
    Genitals normal
    Extremities-limbs , digits, palm, sole : no icterus or
    pallor present
    SYSTEMIC EXAMINATION
    • PER ABDOMEN EXAMINATION
    • INSPECTION
    • Non distended
    • Umbilicus : central
    • Umbilicus stump :no discharge seen
    • Corresponding quadrant moves equally with
    respiration
    • No dilated veins , scars
    • Hernial orifices normal
    • Genitalia : normal
    • PALPATION
    • No local rise of temperature
    • No tenderness
    • No palpable mass

    • PERCUSSION : no organomegaly

    • AUSCULTATION : bowel sound heard


    RESPIRATORY SYSTEM
    Normal Vesicular Breath Sounds heard
    No crepitions, ronchi or other abnormal sounds
    Bilateral air entry present

    CARDIOVASCULAR SYSTEM
    S1 and S2 sounds heard, no murmurs

    CENTRAL NERVOUS SYSTEM


    All Cranial Nerves are normal on examination
    Tone of muscles is normal

    MUSCULOSKELETAL EXAMINATION
    Ortolani and Barlow test were done , no abnormalities
    detected
    Reflexes:
    • Rooting : Present
    • Sucking : Present
    • Moro’s : Present
    • Asymmetric tonic neck reflex : Present
    • Steeping : Present
    • Deep Tendon reflexes are normal
    DIAGNOSIS

    • 6 day old term single female neonate who is


    appropriate for Gestational Age with Birth
    weight of 2.7 kg with Neonatal Jaundice
    probably a case of breast feeding jaundice.

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