18022018 NICU 1 Refferd case 2.5 month male 5.5 kg Admitted with c/o tachypnea dyspnea SCR+nt abdominal distension O/E RR 68 bmp PR 164 bpm SpO2 79% off O2 P/A distended soft with hepatomegalae(+4 cm Urine passed Stool passed Temp Afebrile Pallor +nt Refferal history 15 days before asymptomatic then noisy breathing with tachypnea present admitted in another hospital with inj pipzo,amika and discharged with syp linezolid After 1 day of discharge remision of symptoms occured admitted again for 7 days with inj vanco,amika,azithro,meropenem,linezolid and pipzo CTthorax suggestive of multiple consolidation 18/02/2018 8 am Pt is on vent with SIMV/28 bpm/40%/5cm H2O SpO2 97% PR 182 bpm RR 58 bpm(on disconnecting vent with very much sCR) Reports attached( note:digital x ray is older than normal one) What could be the causetive organism (CMV??Pulm koch?) What may be role of surfactant in this case? Kindly comment your valuable opinion Our ddx bronchopneumonia vs pulm koch with septicemia 19/02/2018 Disconnected vent but not maintaining PR 164 bpm RR 70 bmp SPO2 74% P/A distended soft with liver +4 cm Temp afebrile 1.which vent mode is best for such a case in with baby is tachypnic hypoxic poor activity with exessive SCR+nt...SIMV or AC 20/02/2018 Inj fluconazole and ATT started since the day of baby arrival ...baby is on vent so unable to nebulise with tobramycin(for suspected pseudomonas infection ....culture of a blocked ETT sent yesterday) exessive drooling was present so iadded glycopyrolate 0.1 ml iv 8 hrly Baby was placed on vent CPAP yesterday20/02/2018 since morning but suddenly at 4 pm baby held his breath f/b gasping and cynosis hypoxia(what could be the cause ...antibiotics? )

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Pneumonic consolidation

Since marked consolidation is there,c/s needed rt from 1st day&2 or 3rd drugs in the form of antifungal was needed.u continue on CPAP& more over endotracheal flegm may be sent for AFB&gene expert test.mother to be screened for CMV &koch’s disease also. Meanwhile cont-mero,vanco,macrolide If off&on spo2 comes to 92% with CPAP then observe after switching off&on cpap.

We sent the tube portion for culture On CPAP we nebulised with tobramycin and N acytylcystine There is No FTT,fat in stool,COPD history ect On CPAP SCR was exessive and baby poses laboured breathing however respiratory rate was WNL In ABG CO2 retension observed so under these observations we gain placed the baby on SIMV mode
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Rule out tuberculosis in mother.i had seen a similar case.thr was no history of tb In mother.but when tested mother was positive.treated baby with antitb n baby improved.u can add antifungal also

Inj fluconazole and ATT started since the day of baby arrival ...baby is on vent so unable to nebulise with tobramycin(for suspected pseudomonas infection ....culture of a blocked ETT sent yesterday) exessive drooling was present so iadded glycopyrolate 0.1 ml iv 8 hrly Baby was placed on vent CPAP yesterday20/02/2018 since morning but suddenly at 4 pm baby held his breath f/b gasping and cynosis hypoxia(what could be the cause ...antibiotics? )
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Left broncho pneumonia mostly bacterial Consider blood culture (Not of much use now) Discuss with your microbiologist who can give about the common organisms and appropriate sensitivity this may help in using the most appropriate antibiotic we have a good paed icu and they manage the ventilator parameters May be you can consider packed cell transfusion Please rule congenital causes

Not much responsive to antibiotics as vanco,fortum,oflox,amika Cystic fibrosis?? (But no h/o ftt,chronic reccurent urti lrti ect ) Now nebulising with tobramycin
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Buble CPAP helpful

Pneumonia......Cultures will help .rule out CHD/Immunodeficiency/cystic fibrosis.

Crp not obviously elevated. If TB suspected then mother should be a open tuberculosis pt . Child should have hepatomegaly

Hepatomegalae +4 cm
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Consolidation is definitely there... Blood culture for bacteria and fungus. Piptaz +vanco... Add Antifungal.. If not responding

Consolidation left lower lobe .. Resolution with antibiotics
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Left hemithorax is opaque with trachea and mediastinum central. Consolidation pneumonic.

26/02/2018 Placed on hood,60 ml/3hrly feeding via orogastric tube going on,vitals are normal ,chest is yet not clear(attached X ray recent) improovement in cx ray observed
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Bronchopneumonia , rule out cystic fibrosis

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