Children under 5 picu death audit JULY.pptx

Death

1. DEPARTMENT OF PAEDIATRICS PICU DEATH AUDIT –JULY 2024

2. D.O.A: 06/07/24 at 4:30 am D.O.D: 16/07/24 at 10:07 pm Duration of hospitality: 10 days 16 hours Diagnosis: Dilated cardiomyopathy|Bronchopneumonia | suspected seizure disorder SIVATHURUVAN 4MONTHS / MCH

3. Death Summary Sivathurvan,4 month/ Mch , 1 st born out of 3*CM, brought by mother, whose reliability was good with c/o breathing difficulty x1day, h/o bed h/o cough and cold x1day Feeding difficulty x1month Reffered from Kayalpattinamprivate hospital in view of distress child. Received at GTKMCH in impending respiratorty failure,hypoxic posturing GCS-E1V2M4 Child intubated and connected on to mechanical ventilator.

4. antiepileptics, iv antibiotics started seizure setteled on examination. Ejection systolic murmur + CBC- mild elevation on total count. RFT- normal, CXR revealed cardiomegaly with features s/o bronchopneumonia USG cranium- B/L lateral ventricles prominent CSF analysis – revealed acellular, low sugar and normal protein On day2 child further had seizures in the form of Tonic clonic movements with tachycardia, iv antiepileptics administered, 3% NaCl infusion started. Echo revealed left ventricular hypertrophy On Day 3 child had repeated seizure episodes. Hence Midaz iv infusion started. Child developed sudden cardiac arrest. Child revived after 2 dosesof adrenaline bolus dose with bag and tube ventilation. Ionotropic support given. iv antibiotics hiked up

5. On D5 repeat X-Ray revealed R UL opacity persistent.iv antibiotics hiked up. persistent high O2 support required On D6, investigations revealed elevated liver enzymes On D8, repeat LFT normal Child continued on ventilatory support along with AED’s + iv antibiotics. Genetic study planned On D10, child developed shock, ionotrope support hiked up. shock persistent desaturation present. Ventilatory support hiked up. child developed cardiac arrest. Inspite of all resuscitative measures baby could not be revived and hence declared dead on 16/07/2024 at 10:07pm.

6. INVESTIGATIONS 6/7/2024 8/7/24 10/7/24 15/7/24 HB 11.7 11.3 11.9 9.1 TC 20000 13700 15200 7400 DC 71/13/16 70/17/13 72/15/13 67/13/20 PLT 5.67 4.10 2.69 4.66 PCV 39.4 35.8 37.7 29.3 NA + / K+ 137.9 / 6.26 136.4 / 4.4 127.4 / 3.31 143.7 / 4.4 141.1/4.5 146.5/2.93 UREA / CREATININE 32 / 0.7 25/0.4 20/0.5 BILIRUBIN 0.3 / 0.1 / 0.1 0.5/0.3/0.2 0.4/0.2/0.2 Sr.PROTEIN 6.1 4.9 4.4 OT / PT / ALP 236/168/375 214/142/282 217/122/96 PT / APTT / INR 14/31/1.2 CRP NEGATIVE

7. INVESTIGATIONS CONT 6/7/24 CKMB – Negative CSF SUGAR & MICRO PROTEIN - 44/ 99 6/7/24 BLOOD C/S – URINE C/S _ 10/7/24 ET TUBE C/S - THYROID PROFILE – FT3 – 2.30 FT4 – 9.01 TSH – 3.88

8. CHEST XRAY

9. Akhidheekshan , 8 months/ Mch Date of admission: 25/6/24 at 7:08 am Date of expiry: 11/07/24 at 1.20 am Duration of hospital stay: 15 days 18hrs 20 mins Cause of death: Multiorgan dysfunction syndrome| Global developmental delay| Failure to thrive| Motochondrial encephalopathy

10. 8 months/ Mch , 2 nd born out of NCM immunized up to 31/2 month of age with developmental delay, born by LSCS [prev. LSCS] B.wt 3.1 kg. No h/o NICU admission. Referred from ICH, a case of GDD| Mitochondrial encephalopathy| ?Leigh’s syndrome| FTT| Klebsiella pneumonia for further follow up. Family h/o similar illness in elder sibling and died at 8 months. On admission, child in post tracheostomy status, IVF, NG feeds 2 AED’s given child on room air saturation maintained At D9 of admission, child went in for apnoea, bag and tube ventilation was started and connected to mechanical ventilator, saturation maintained. Child went in for shock, IVF, inotropes was started. ENT opinion was obtained tracheostomy tube position checked and advised tracheostomy care.

11. At D11 of admission Rt. AE decreased ?Rt. pneumothorax+ needle thoracostomy followed by ICD done, IVF, iv antibiotics was continued inotropes and mechanical ventilator support continued. At D12, of admission decreased urine output RFT increased LFT increased Again went in for shock inotropes was hiked up. ABG- metabolic acidosis (+), NaHCO3 maintenance started, U/O monitoring was done. At D16 of admission child went in for sudden cardiac arrest, inspite of all resuscitative measure baby could not revived and declared expired.

12. INVESTIGATIONS 25/6/24 2/7/24 5/7/24 7/7/24 8/7/24 9/7/24 HB 11.1 11.6 10.0 9.5 TC 16700 14900 12600 15200 DC 35/59/6 61/33/6 61/34/5 66/34/- PLT 5.66 4.71 2.61 2.19 PCV 34.2 36.3 37.1 30.3 UREA/ CREATININE 17/0.3 39/0.5 66/0.6 81/0.5 80/0.6 BILIRUBIN 0.2/0.1/0.1 0.2/0.1/0.1 TOTAL PROTEIN 4.7 4.2 A/G/ OT/PT 2.7/2.0/ 1328/1055 2.8/1.4/ 42/10 ALP 131 124 NA+/K+ 134.6/6.39

13. INVESTIGATIONS 25/6/24 - Blood culture - No growth 25/6/24 - CRP - Negative[5.16mg/dl] 02/7/24 - CRP - Negative 03/7/24 - urine culture - No growth

14. CHEST XRAY

15. HAJIRA BANU 6mon/FCH Day of admission: 19/7/24 at 11:00 am Day of expiry: 25/7/24 at 8:25 am Duration of hospital stay: 5 days 21 hrs Cause of death: High grade immature teratoma with recurrence | Post VP shunt

16. Hajira Banu, 6 months old Fch 1 st born out of NCM brought by mother whose reliability was good. K/C/O high grade immature teratoma with Rt craniotomy with Lt VP shunt done|seizure disorder on AED’s, chemotherapy 1 cycle completed and advised chemotherapy and follow up, but patient attender not willing for further management and chemotherapy. At 19/7/24, 11am brought with alleged h/o seizures lasting >20 mins AEDs was given. Seizure setteled IVF, iv antibiotics, AEDs was started D3 of admission abdominal distension(+) Xray shows dilated bowel loops (+) USG abdomen shows normal study antibiotics hiked up abdominal distension was reduced.

17. D5 of admission baby went in for shock IV NS bolus given inotrope was started shock corrected D5 of admission CBG was low GIR was started, CBG maintained. D6 of admission child went in for sudden cardiac arrest. Inspite of all resuscitative measures baby could not revived hence declared expiry on 25/7/24 at 8.25 am

18. INVESTIGATIONS 19/7/24 20/7/24 21/7/24 23/7/24 25/7/24 HB 11.4 10.4 10.2 TC 4600 2100 2300 DC 62/31/7 48/40/12 45/48/7 PLT 3.57 1.79 1.65 PCV 32.7 32.0 32 UREA/ CREATININE 15/0.4 24/0.4 NA+/K+ 117.9/4.28 125.5/4.2 122.9/3.99 128.0/4.96 BILIRUBIN 0.2/0.1/0.1 TOTAL PROTEIN 5.1 A/G OT/PT 3.5/1.6 19/15 CRP POSITIVE (62.43) Sr.CALCIUM 7.9 8.9

19. XRAY