Period 01.11.2010 to 30.11.

2010

Admission 76

Death 3

% of Deaths 3.95%

Name
Tinni

Age
4 months

Cause of Death
Severe acute malnutrition (wasting type) with Keratomalacia with Septicaemia Downs Syndrome with Pneumonia with HF

Hafsa

3 months

Sajib

10 years

AML with Hepatitis

Tinni, 4 months old partially immunized female infant, weighing 2.5 kg, 2nd issue (1st twin)of non consanguineous parents, hailing from Narayanganj, Dhaka was admitted in DMCH on 3rd November at 10:30PM with the complaints of fever for 7 days, cough for same duration, respiratory distress for 3 days and reluctant to feed for 2 days.

According to statement of informant mother, she was reasonably well 7 days back. Then she developed fever with cough which was low grade initially, and fever turned to high grade for last 3 days. Her fever was continuous in nature, and associated with cough and respiratory distress. The baby was reluctant to feed for last 2 days. With these complaints she was treated by local doctors. Her birth history was uneventful. After birth, she was on breast milk for first few

days. Then diluted formula milk (Lactogen -1) was given occasionally with breast milk. She had history of repeated attack of diarrhoea since birth.

On admission, patient was ill looking, cachectic, dyspnoeic. Mildy anaemic. Jaundice, Cyanosis was absent. Baby was non-edematous, not dehydrated. Opacity was present in both eyes. Temp 102oF, RR68/min, HR 140 b/min. Chest indrawing was present. There was crepitation over both lung fields. On abdominal examination, liver was palpable about 3c.m. from MCL. Other systemic examinations revealed normal findings. BCG mark was present in left upper arm. There was no change in skin and hair. Bed side urine albumin was nil. CBG was 7.0 mmol/L. Regarding anthropometry : Weight 2.5 kg, length 51 cm Wt for length on -5.2 SD Length for age on -4.1 SD Wt for age on -5 SD

 CBC with PBF ESR Blood grouping & Rh typing CXR Urine R/M/E & culture sensitivity Serum electrolytes

We started NG tube feeding with F-75 diet 2 hourly total 12 feeds/day. Total fluid 100 ml/kg /day Total calorie 75 kcal /100 ml Protein - 1.0 gm / 100 ml

 O2 inhalation (1L/min) Inj. Ampicillin Inj. Gentamycin Inj. MgSO4 Syp. Zinc Syp. KT

Tab. Folison Cap. Retinal Forte Aprocin eye drop Homatropin eye drop Tetracycline eye ointment Syp. Paracetamol Nebulization

 CBC :
Hb 7.2 gm/dl

TC 18000/cu mm DC - N 50 % L 40 %

Platelet count - 200000/cumm

Blood group :

B (+) ve

Other investigation reports were not available.

 Ill looking, dyspnoeic Chest indrawing present Temp. - 1000F Heart rate 130 b /min

Respiratory rate 62 /min

Heart NAD, Lungs

Treatment continued

Crepitation present allover the lung field Abdomen Soft, non-tender

 Ill looking
Resp. Distress present Chest indrawing present Temp. - 1010F Heart rate 128 b /min Respiratory rate 72 /min Heart NAD, Lungs Treatment continued

Crepitation present allover the lung field

 Ill looking
Resp. Distress present Chest indrawing present Temp. - 990F Heart rate 120 b /min Respiratory rate 66 /min Heart NAD, Lungs Rx Added Inj. Ceftriaxone

Crepitation present allover the lung field

 Resp. Distress present Chest indrawing present Heart rate 90 b /min Respiratory rate 68 /min Heart NAD, Lungs Rx Added O2 inhalation 2L/min by

N/C

Crepitation present allover the lung field

 Pt. was lethargic Gasping breathing Heart rate 81 b /min Pupil dilated, and not Rx Added
O2 inhalation 4L/min by H/B

reacting to light

 Gasping breathing continued Heart rate 75 b /min Pupil dilated and fixed, not Rx Added
Ambu bag ventilation given

reacting to light Reflex activity poor

 Cessation of breath No audible Heart sound Pupil dilated and fixed, not CPR started

reacting to light Reflex activity absent

 No respiration No Heart beat Pupil dilated and fixed, not

reacting to light Reflex activity absent There was no sign of life

Patient was declared clinically dead at 06:10PM on 04.11.2010

Cardio respiratory failure due to severe acute malnutrition with Keratomalacia with Septicaemia

Thank You