Neonatal Case 2 (Jaundice).

2000/2001

Name: Baby of Juliet Carlos. DOB: 16.12.00. Birth weight: 2600 g. Sex: Male. Reason of admission of mother: Jaundice. Age: 2 days. Date of admission: 18.12.00. Neonatal History: The baby was re!ter" #$% w&s'. (is weight at birth was 2600 g. (e cried i""ediately after birth) and was gi*en to the "other. + gar score for the baby was 8 at 1 "inute and , at % "inutes. -o resuscitation was done) and he did not suffer fro" res iratory distress. The "other blood grou is +.) whereas the baby is +.. (e started breast!feeding) and assed his urine and "econiu". (e was gi*en ro hylactic *ita"in /. (e has been *accinated with BC0 and (e atitis B. Maternal and Pregnancy History: Juliet is a $1 years old 2ili ino cashier in su er"ar&et. 3he is not related to her husband. There is no history of chronic illness or allergy) and she is not co" laining of any health roble". 4n addition) she is not on any "edication. 3he has 2 healthy boy and girl. The boy is fro" re*ious "arriage and he5s now 1 years old) and his birth weight was 2800g. The %!year!old girl is fro" her current husband and her birth weight was about $ /g. #0ra*ida $) ara $'. The "other didn5t ha*e any co" lications during her deli*eries. 2a"ily li*es in /uwaitat in a $!bedroo" a art"ent. The husband is a business"an and he5s non!s"o&er. They ha*e a dog at ho"e. This regnancy was lanned by the cou le. The "other last "enstrual eriod #6M7' was on 8.8.2000) and 9:: was on 1%.1.2001. 3he started antenatal care by
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re*ious regnancies before or after

Neonatal Case 2 (Jaundice).

2000/2001

the end of the 2nd "onth) and no abnor"alities were detected. 3he too& *ita"in tablets. 3he has gestational diabetes) otherwise no other co" lications e.g. no rash) no infection) no fe*er) no swelling in ly" h nodes. 'eli(ery: 3he resented at 16.12.00 with lea&ing a"niotic li;uor since 8:00 .". 6abor started at 10 .". #16.12.00'. CT0 was used for "onitoring. 6i;uor color was nor"al. Baby deli*ered at 11:00 .". 16.12.00 by nor"al s ontaneous *aginal deli*ery #-3<:') *erte= resentation) no instru"ent was needed. + gar score was 8 at 1 "inute) and , at % "inutes. Clinical )*a+ination: 17.12.00 Skin: The child is slee ing co"fortably. (e is not ale or cyanotic. The child5s s&in is yellowish. -o Ca illary he"angio"ata or Mongolian s ots. There is s&in eeling on the forear". Head: The head is sy""etrical) with nor"al head circu"ference #$8 c"'. There is no swelling on the head) no ca ut succedaneu") no ce halohe"ato"a. -o suba oneurotic swelling. +nterior fontanel is al able 2=2. 3utures are al able. 7osterior fontanel is about 1.% = 1.% c". -or"al hair. Ears: 9lasticity of the cartilage is nor"al. -o dys"or hic features in the ear i.e. nor"al osition. -o discharge fro" the ear. 9=ternal auditory "eatus is resent. Child res onded to sound caused by cla ing of the hands. Eyes: Both eyes ha*e si"ilar si>e. 3clera is yellow #?aundice'. -or"al iris and cornea.
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Neonatal Case 2 (Jaundice).

2000/2001

-or"al u il reaction and red refle=. 9yes "o*e in all directions sy""etrically. 9 icanthic fold #he5s 2ili ino'. -o widening between the eyes.

Nose: -or"al sha e and si>e. There no obstruction) no discharge) no choanal atresia or stenosis. There is no flaring of the alae nasi. -or"al breathing fro" nose. Mouth and throat: Mouth si>e is nor"al. There is no "icrosto"ia. -o cleft li s or alate. -o high!arched alate. Tongue: -or"al si>e) no tongue tie) nor"al color and "o*e"ent. -o natal teeth) gu" and alate are nor"al) no 9 stein earls. Neck: -o "asses in the nec&. -o redundant s&in #webbing'. -or"al "o*e"ent in all direction #no torticollis'. -o tenderness or swelling on the cla*icle. CV system: (eart rate is 1$0@"in. Brachial) radial) fe"oral and dorsalis edis ulses are all resent. +ll ulses are si"ilar on both sides. -o brachial!fe"oral ulses delay. + e= beat could be felt roughly in 8 th intercostal s ace about 2 c" fro" the "id!cla*icular line. An auscaltation) both 31 and 32 heart sounds are resent. 32 sound is s lit. -o "ur"ur. Chest examination: -o e=tra ni les. -i les are in the 8th intercostal s ace. -o breast enlarge"ent. -o intercostal) subcostal) or su rasternal retraction. Bes iratory rate is 8% breath@"in. An auscaltation) e;ual air entry to both lungs) breath sound is broncho*esicular. -o added sounds. Abdomen: C"bilical stu" is resent. -o distention or swelling in the abdo"en.
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Neonatal Case 2 (Jaundice).

2000/2001

3 leen is al able 2 c" below costal "argin. 6i*er is al able 2 c" below costal "argin. /idneys are not al able. -o "asses could be felt.

Genitalia: 7enis is nor"al) no hy os adias) e is adias) or other abnor"alities. Crethral o ening is at the ti of the glans enis. Two testes could be felt in the crotu". -o herniation. -o hydrocele. Extremities and back: +r"s are sy""etrical with nor"al fingers in the hands. -or"al creases in the hands. Both legs are sy""etrical with nor"al toes. -o tenderness on the li"bs. +ll ?oints are "o*ing without restriction. (i s are nor"al #Artolani and Barlow5s tests showed nor"al stable hi s'. There is no cur*ature or abnor"al hair tufts on the bac&. -o ilonidal sinus or s inal defects. CNS: -or"al "uscle tone #no hy otonia or hy ertonia'. -or"al eye "o*e"ent. -or"al sy""etrical facial e= ression. -o fasciculation in the tongue. 7ri"iti*e refle=es: all are symmetrical. Moro5s refle= #.*e'. Booting refle= #.*e'. 3uc&ing refele= #.*e'. 7al"ar gras refle= #.*e'. 7lantar gras refle= #.*e'. +sy""etrical tonic refle= #.*e'. 7lacing refle= #.*e'. 3te ing refle= #.*e'. :ee tendon refle=es #.*e'. Measurements: 6ength D 8, c". Eeight D 2600 g. (ead circu"ference D $8 c".
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#,0th ercentile'. #10th ercentile'. #,0th ercentile'.

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Neonatal Case 2 (Jaundice).

2000/2001

Te" erature (eart rate Bes iratory rate

D $1C. D 1$0@"in. D 8% breath@"in.

2A66AE!C7: 18.12.00 F 3uc&ing well) and assed urine. F 6oo&s well ?aundiced. F Chest) C<3) abdo"en) C-3 -+:. F :irect bilirubin D 0.$ "g@d6. F 3eru" bilirubin D 12.6 "g@d6. F 3hift the baby to the 3CBC and start hotothera y. 19.12.00 F Eeight D 2$%0 g. F Baby is still ?aundiced. F Chest) C<3) abdo"en -+:. F (i s are stable. F 2e"oral ulse felt bilaterally. F 3uc&ing well. F Baby blood grou is +.. F 067: deficiency #!'*e. F CBC results: EBC D 1.1 = 10$. 6y" hocyte D $6.$ G Monocytes D %.$ G 0ranulocytes D %8.8 G (gb D 16 g@d6 MC< D 108., f6. MC(C D $%.8 g@d6. (ct D 8% G MC( D $8.%G Betics D 6.%G F F F F F F Ca. D 102 "g@d6 ! 7A8 D 8.1 "g@d6. :irect bilirubin D 0.$ "g@d6 Total bilirubin D 18., "g@d6 +lbu"in D $.8 "g@d6. 7lan: Continue hotothera y.
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Neonatal Case 2 (Jaundice).

2000/2001

Chec& seru" bilirubin to"orrow. 20.12.00 F Eeight D 2$1% g. F Jaundiced Total seru" bilirubin D 1$ "g@d6. F Chest) heart) abdo"en -+:. F 7lan: Continue hotothera y. Chec& seru" bilirubin. 21.12.00 F Child is doing well. F Chest is clear. F 3eru" bilirubin D 11 "g@d6. F /ee in hotothera y and re eat Total bilirubin to"orrow. 22.12.00 F Child is doing well. F 3eru" bilirubin D ,.% "g@d6. 23.12.00 F Child is doing well. F Chest is clear. F 3eru" bilirubin D 8 "g@d6. F Can be discharged. /u++ary: 7re!ter" #$% wee&s') + ro riate for gestational age) ?aundiced "ale infant who has been treated.

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