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
Head: normocephalic, (-) lumps and deformities
EYES: anicteric sclera, pink palpebral conjunctivae
EARS: symmetric, (-) lesions or deformities
HEENT
NOSE: (+) alar flaring, (-) discharges
THROAT/MOUTH: (-) deformities
*no abnormal facies observed
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
Complete blood count
● Hgb: 206 ● Mono: 3
● Hct: 0.55 ● Eos: 0
● WBC: 16.5 ● Baso: 0
● Neu: 52 ● Plt: 102
● Lym: 45
Diagnostics
Blood GS/CS
● Staphylococcus
COVID RT-PCR: negative
Peripheral Blood Smear
● RBC – normochromic, normocytic
● WBC – mature looking leukocytes
● Slightly decreased platelets
Management
● Fluids: D5IMB 100 cc/kg/day
● 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
Complete blood count Blood GS/CS
● Hgb: 184 ● Mono: 14 ● No growth
● Hct: 0.49 ● Eos: 3
● WBC: 10.1 ● Baso: 1
● Neu: 41 ● Plt: 151
● Lym: 41
CXR (June 24)
neonatal
pneumonia
Discussion
Risk Factors
● Prematurity
● Prolonged rupture of membranes (>18hrs)
● GBS colonization
● Chorioamnionitis
● Intrapartum maternal fever
● Fetal tachycardia
Etiologic Agents 01
02
●Congenital
03
●Early onset
04
●Late onset
05
06
Etiologic Agents 01
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
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02
Thanks!
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