Concluded Case

Preterm 30-32 wk baby with b.wt 1.560 kg delivered by NVD to multipara mother.baby had resp distress since birth.father says he was told that liquor was meconium brought to us after 6 hrs of birth.Kept on bcpap for 24 hrs and gradually weaned off.trophic feeds started but baby started having apnea.Suspected of NEC.antibiotics were upgraded in view of positive CRP and TLC 3600 which has been responsive to antibiotics but baby still having feed intolerance after restarting of feeds after 48 hrs and has bilious output around 9 ml in 24 hrs.Investigations below

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As child preterm,LBW,has all the symptoms &signs feeding Intolerance,like gastric residue, abd.distention,apnea,bile stained emesis, bloody stool c CRP-( NEC)& most complication—-> is Infection R/O Intestinal obstruction in view of bilious vomiting, Management is in ICCU protocals + Nursing care

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As child preterm,LBW,has all the symptoms &signs feeding Intolerance,like gastric residue, abd.distention,apnea,bile stained emesis, bloody stool c CRP-( NEC)& most complication—-> is Infection R/O Intestinal obstruction in view of bilious vomiting, Management is in ICCU protocals + Nursing care

Tq.dr.Renjini Chandran
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Can you explain feed intolerance? How old is the baby, when was the feed restarted? How much did baby tolerate, what were the signs of intolerance - vomiting, bilious aspirate, abdominal distension or something else? How is the stool frequency? Looking at xray - abdomen doesnt seem significantly dilated or signs of NEC.

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

H/0 bilious aspirates ? Intestinal obstruction or mal-rotation Positive CRPQ and decrease in tlc s/o septicemia Xray chest reveals cardiomegaly with s/o aspiration pneumonitis Adv USG abd, bld culture and 2D echo

Lt lower zone consolidation likely aspiration pneumonitis Kub is normal

I completely agree with sir
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Bowel wall edema? Still suspect nec/sepsis Withhold feeds for 7days. Get procalcitonin levels. Vit k 1mg. TPN. Abd girth monitoring. Regular NG suctioning.

Feed intolerance due to probable NEC.Withhold feeds,continue TPN,IV antibiotics.observe with abdominal girth monitoring.

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