A 37d baby was. brought to me with h/o feeding problems ,vomiting and losing weight and failure to thrive in a moribund condition. Birth weight was 3 kg and present wt. is 1.75 kg. Birth history of resp distress and meconium aspiration. Spot the diagnosis and suggest management

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1st picture : DYSMORPHIC FACIES + LOW SET EARS + DEPRESSED BRIDGE NOSE + LOOSE SKIN FOLDS + STERNAL DEEP-INDRAWING + 2nd. Picture : ASYMMETRIC CHEST WALL LEFT SIDE + LEFT SIDE PECTROLIS MAJOR MUSCLE ABSENT. WORK UP WITH SKELETAL SURVEY, 2D ECHO, USG ABDOMEN TO R/O CHPS. KARYOTYPING. DX : ASYMMETRIC CHEST WALL LEFT SIDE FTT. D/D : SYNDROMIC CHILD. R/O : POLAND SYNDROME.

Sir I agree with your findings and I am also in favour of syndromic baby..The baby is on breastfeed and it is sluggish. No evidence of bolus was found in the epigastric area during and after breast feeding. Vomitus is not copious and also not regular. As the baby's condition is alarming I immediately referred the case to nearby VIMSAR MCH BURLA for further management.
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Definately failure to thrive . Take nutritional history feeding history in detail . Is baby fed on only foremilk or baby was fed on diluted cows milk or diluted formula milk . One month old baby classic time for showing features of chps . Do r/o gerd goo uti sepsis . Do cbc crp urine r/e serum electrolytes usg abdomen .

Can you please elaborate on feeding difficulties? I suppose a baby with IHPS should be avidly feeding. The differential could include HIV or congenital immune deficiency, esophageal motility related disorders, GERD and palato pharyngeal in coordination. The genitals look more hyper pigmented than the surrounding, CAH should also be kept in mind. Feeding difficulty with failure to thrive could be secondary to Prader Willi syndrome

Aspiration pneumonia, please in neonatal ICU as per the protocol, clinical judgment requested to very from standard protocol

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Congenital hypertrophic pyloric stenosis...IEM can also be thought of ... Torch infections ...

Is the baby breast fed ?
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I am also in favour of syndromic baby as opined by Dr.Brahmanand Merugu. The reasons I mentioned in reply to Dr. Merugu may please be verified. I am extremely thankful to all of you for participating and expressing your views.

It is a case of failure to thrive. Investigation to exclude causes starting from Hypertrophic pyloric stenosis to inborn errors of metabolism.

Baby looking like syndromattic adv usg abdo, Karyotyping R/o CHPS

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Congenital hypertrophic pyloric stenosis. Aggrees with Dr aS Agrawal.

Cong hypertrophic pyloric stenosis,GERD, IEM

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