septicemia AVSD Brachial fistula

PMCCC30082020 A 14day old male 3.3 kg arrived with c/o poor activity murmer ulcerative wounds over neck (brachial fistula?? Leismaniasis?Pressure contact ulcers??) Baby was previously on mediacation somewhere else but Discharged on attendent will,, O/E I°P°Ln°Cy°Cl° CVS murmer,,CNS normal(feed taking sucking good) TLC on previous reports 64000,,on arrival RR 54bpm Spo2 75%(off O2) P/A soft with hepatomegalae Urine stool wnl DDX septicemial with ACHD Kindly add your valuable opinion

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I agree with your Diagnosis. Baby is septicemic. High Neutrophil count, band form, CRP, Rt sided consolidation are all suggestive. The Echo report and hepatomegaly do suggest AVSD. Few suggestions:- 1. Do Lumbar puncture, continue Iv antibiotics as per the culture and sensitivity report 2. Be a little liberal with respiratory support. Baby may develop PPHN, so ventilate early and give appropriate oxygen to maintain sats >95%. Rather ask the Cardiologist, what should be the target sats as the baby has AVSD. I expect normal sats initially. 3. Be cautious about fluids. You must not give too much fluids ( avsd can lead to heart failure) or too little fluids (as severe Respiratory distress can lead to insensible fluid losses). I would suggest start with 150 ml/kg/day - monitor capillary refill, BP, pulse volume, HR, oedema/ dehydration, urine output, serial Na levels, lactate levels to help you guide. In my opinion, the main problem here is Sepsis, but you can't ignore AVSD. Good luck

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