Near term baby on 2nd DOL referred by pri Ped and brought by parents with H/o decreased Sp activity, dull,less responsive, distension of abdomen, decreased urine output LSCS delivery. O/e Baby lethargic, pulses ++/+, Spo2-98% in RA, HR 148-154/min at rest, No dehydration, S1&2 N, SM+, Lungs clear,BAE N, Abdomen distended (H/o meconium passage +), RBG at admission 48mg%, BL for Septic screen -ve, Sr Cr 1.8mg%, CKMB 32IU, Sr Electrolytes N, Sr Cal N., Initially treated by pri ped for couple of days and made a referral. Discussion(above evidence of images), Diagnosis, Management. X ray, ECHO 2D, Doppler,images posted.

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two day old baby with systemic signs+ abdominal distension but vitals stable and reports normal. creatinine looks apparently raised because it reflects maternal value for first 72 hours atleast and urine output might be less because of decreased feeds. Having said that, please mention exact gestational age and weight of the baby. DD: this might be 1)septicemia with paralytic ileus, 2)NEC ,3) hirschsprung with or without sepsis is also a possibility. p.s: baby could pass meconium in a case of hirschsprung upto 20 percent and later on become constipated.

Baby 36wk GA, BW 2.2kg and adm Wt 2.1kg, Apgar N at 1&5 min by record.
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This is a case of NT baby with hemodynamically significant PDA with signs of pulmonary plethora and systemic hypo perfusion resulting in the above clinical behavior - CNS signs and GIT and Renal deranged signs, PDA closed by med therapy and baby recovered . Thank you for all participants .

PDA and ASD OS / PFO
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decreased urine put with systemic symptoms is a very early sign of sepsis,looking for cutis mamorata,peripheral CRT,peripheral pulses,dusky feet and the mean BP help in suspecting sepsis early,NG aspirates(abnormal), occult blood in stool,hyponatremia,decreased bicarbonate,increased ionised calcium.is the abdominal distension tense with veins prominent,(surgical )or medical lastly if fed,it can be NEC or metabolic disorder.

ARDS and meconium is not completely evacuated, advised plain water enema and NICU management.

As for case history the infant might have been suffering from septicaemia & necrotising enterocolitis. .

It's difficult to diagnose. creatinine is on higher side so child might have septicemia or renal failure due to Cong renal disease. Bowels are dilated and feeding tube shadow not seen in stomach. Sugar is also on lower side. Age of child,wt at birth and present wt and progress of child after treatment will guide for further management.

AKI sepsis TR finding

worth looking for Hirschprungs disease as well if abd distension ( baby may pass meconium initially) with septic screen being negative ; creatinine being on higher side be watchful with urine output ... echo findings ?

hs PDA, PFO/ASD OS, predominantly L to R Shunts
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on xray abdom it's necrotising enterocolitis

Sir is there any vomiting ? Wts the ABG look like?

no H o vomiting, ABG not done as there no RD , vitals quite N and no sepsis
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