This case presentation summarizes information about a 1 day old male patient who presented with difficulty breathing. The patient's history includes a home delivery at 36 weeks gestation. On physical exam, the patient displayed tachypnea, grunting, subcostal retractions, and alar flaring. Based on the history and exam, differential diagnoses included respiratory distress syndrome, neonatal sepsis, and meconium aspiration syndrome. Diagnostic tests showed elevated white blood cell count. The patient was started on antibiotics and showed improvement over time.
This case presentation summarizes information about a 1 day old male patient who presented with difficulty breathing. The patient's history includes a home delivery at 36 weeks gestation. On physical exam, the patient displayed tachypnea, grunting, subcostal retractions, and alar flaring. Based on the history and exam, differential diagnoses included respiratory distress syndrome, neonatal sepsis, and meconium aspiration syndrome. Diagnostic tests showed elevated white blood cell count. The patient was started on antibiotics and showed improvement over time.
This case presentation summarizes information about a 1 day old male patient who presented with difficulty breathing. The patient's history includes a home delivery at 36 weeks gestation. On physical exam, the patient displayed tachypnea, grunting, subcostal retractions, and alar flaring. Based on the history and exam, differential diagnoses included respiratory distress syndrome, neonatal sepsis, and meconium aspiration syndrome. Diagnostic tests showed elevated white blood cell count. The patient was started on antibiotics and showed improvement over time.
This case presentation summarizes information about a 1 day old male patient who presented with difficulty breathing. The patient's history includes a home delivery at 36 weeks gestation. On physical exam, the patient displayed tachypnea, grunting, subcostal retractions, and alar flaring. Based on the history and exam, differential diagnoses included respiratory distress syndrome, neonatal sepsis, and meconium aspiration syndrome. Diagnostic tests showed elevated white blood cell count. The patient was started on antibiotics and showed improvement over time.
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Case Presentation
Daguio / Dianalan / Ebrahim / Edding
Patient Information 01
R.B. 02
03
1 day old 04
Male 05
06 Chief Complaint Difficulty of Breathing History of Present Illness
5 hrs PTA Few mins PTA Admission at ZCMC
Home delivery via NSVD Noted tachypneic tachypneic 33 y/o mother: G5P5 (4105) Brought to local hospital subcostal retractions 36 weeks AOG Apprised for intubation alar flaring and grunting No reported complications Past Medical History
Maternal History ● G5P5 (4105) ● Prenatal check-ups & TT status: unknown ● No maternal illnesses ● With episodes of increased BP, no known maintenance medications ● no episodes of seizure Past Medical History
Birth History ● Reported AOG: 36 weeks ● Labor was not reported to be prolonged ● Traditional birth attendant PHYSICAL EXAMINATION
General pinkish, non-cyanotic, in obvious respiratory distress – alar flaring,
Appearance grunting, retractions, poor cry
Temp: 35.6C Vital Signs HR: 140 RR: 70
Weight: 2.07kg Anthropometric Length: 46.3cm Data Head circumference: 30cm PHYSICAL EXAMINATION Cold to touch Skin and Nails Birthmark at lateral aspect of left thigh (-) brownish discoloration of nails
PHYSICAL EXAMINATION (+) subcostal retractions, symmetrical chest expansion Chest harsh breath sounds, no heaves and thrills, normal rate and regular rhythm
Globular, non-tender (-) discoloration of umbilicus Abdomen (-) organomegaly Anus is patent
Extremities Cold to touch, (-) cyanosis
(+) rooting reflex
Neurological (+) babinski reflex IMPRESSION
Live preterm baby boy delivered via NSVD – Non Institutional
Delivery, 36 weeks by Ballard’s score, BW: 2.07kgs, Small for Gestational Age; Neonatal Pneumonia
Salient Features HISTORY PHYSICAL EXAM Preterm at 36 weeks RR = 70 Home delivery Grunting Difficulty of breathing Alar flaring Retractions (-) meconium stain: nails, umbilicus DIFFERENTIAL DIAGNOSIS
RESPIRATORY DISTRESS SYNDROME
RULE IN RULE OUT Preterm at 36 weeks Cannot totally rule out Home delivery Difficulty of breathing Tachypnea Grunting Alar flaring Retractions DIFFERENTIAL DIAGNOSIS
NEONATAL SEPSIS RULE IN RULE OUT Preterm at 36 weeks Cannot totally rule out Home delivery Difficulty of breathing Tachypnea Grunting Alar flaring Retractions DIFFERENTIAL DIAGNOSIS
MECONIUM ASPIRATION SYNDROME
RULE IN RULE OUT Preterm at 36 weeks PROM not reported Home delivery (-) meconium stain Difficulty of breathing Tachypnea Grunting Alar flaring Retractions DIFFERENTIAL DIAGNOSIS
CONGENITAL HEART DISEASE
RULE IN RULE OUT Preterm at 36 weeks (-) cyanosis Home delivery DOB not associated with feeding Difficulty of breathing or crying Tachypnea (-) abnormal facies Grunting Alar flaring Retractions DIFFERENTIAL DIAGNOSIS
TRANSIENT TACHYPNEA OF THE NEWBORN
RULE IN RULE OUT Preterm at 36 weeks More common for CS delivery Home delivery Persistence of symptoms after 48- Difficulty of breathing 72 hours Tachypnea Grunting Alar flaring Retractions Diagnostics (June 19) Diagnostics
● Medications: ● June 18-23: Ampicillin (100mg/kg/day q12) + Gentamycin (4 mg/kg IV q24) ● June 24 – July 2: Vancomycin + Cefotaxime (100 mg/kg/day IV q12) AS OF JULY 1, 2021
02 ●Congenital 03 Pres ents 04 imm edia 05 tely after 06 deli very Aspiration of infected amniotic Etiologic Agents 01
02 ●Early onset 03 First 3-7 04 days of 05 life acqu 06 ired befo re or duri ng Etiologic Agents 01
02 ●Late onset 03 Afte r7 04 days of 05 life Duri 06 ng/a fter 48 hrs of Clinical Presentation 01
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Thanks! 03
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06 CREDITS: This presentation template was created by Slidesgo, including icon by Flaticon, and infographics & images from Freepik Please keep this slide for attribution
