30hrs newborn male child having severe respiratory distress with feeble peripheral pulse. H/0 TERM/AGA/NVD/SBA. VITALS- HR-157/min, RR->85/min, SPO2-74-76%with O2. We intubate the child and put on high frequency ventilation. Inotropic support dopamine, dobutamine, adr. , With antibiotics Mero+Amika and IVF nd calcium gluconate and anticonvulsants. Inj vit.k od for 5days and FFP transfusion done. Adv Management and DDX

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Theres seems to b cardiomegaly with opacity seen in cxr . Is there history of diabetes in mother . Do echocardiography . Is the baby maintaining saturation after ventilation . Check for signs of chf. U have given treatment for prolonged pt . Whats aptt level .start ionotrop like dobutamine . Baby is definately in sepsis as crp is positive . Send blood c/s . Check the lactate blood gas . Whats the mother blood group . Do ABG . Start phototherapy too . Hb level dct .

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Meconium aspiration pneumonia. Birth asphyxia Premature rupture of membrane. Congenital pulmonary hypoplasia. Congenital anomaly like hiatus hernia. Diaphragmatic hernia SIRS criteria need to evaluate pneumonia severty

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Sepsis, sepsis related coagulopathy , neonatal jaundice . Continue same management, ventilation, Surfactant replacement therapy ?? ABG abdominal ultrasound, ECHO

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Bilateral homogenous opacity could be RDS but rare in term baby... ABG send blood culture Continue ionotropes Kindly recheck UVC position it looks above diarhragm so pull out Mainly ventilatory management required repeat pt inr and xray chest

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Ultrasound. Abdomen. ? Aspiration. Should be kept in mind

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Congenital pneumonia

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Congenital pneumonia probably. ? May aspiration of fluid may cause this

acute respiratory distress syndrome

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Surfectant

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