NICU STATS BLch.pptx................ .....

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1. NICU STATS J U N E 2024 BLCH NICU INCHARGE : DR USHA B K , DR UMAIR PG : DR D H A N ALAKSHMI R

2. NICU STATISTICS TOTAL NO OF ADMISSIONS IN B&LCH = 5 6 TOTAL NO. OF DEATHS – 9 NICU MORTALITY PERCENTAGE - 6 . 2 % MALE FEMALE 2 7 2 9 4 8 % 5 1 % I N B O R N O U T B O RN 3 6 2 6 4 % 3 5 %

3. / Admissions based on Diagnosis Diagnoses TOTAL 1. BIRTH ASPHYXIA HIE 1- 4 HIE 2- 6 HIE 3- 2. NNHB . Rh incompatibility . 4 3.ADD WITH SEVERE DEHYDRATION 4.BLEEDING DISORDER 5.PRETERM CARE 6

4. 6. RESPIRATORY DISTRESS TTNB 8 PT/RDS 6 Pneumothorax MAS 1 2 7.Neonatal convulsions ABM/ LOS HIE 8.Suspected IEM 9.Hypoglycemia 10.Hyperglycemia 1 1 2 2

5. REFERRED FROM GOVT HOSPITAL U l s o o r G H 3 G o w r i b i d n u r G H 1 C V R a m a n H o s p i t a l 1 J a y a n a gar GH 1 Ramnagar B B M P 1 Ganga agar B B M P 1 J a y a d e v a 1

6. REFERRED FROM M e d i s t a r 1 O Y S T E R 1 V y e d e h i 1 V c a r e 2 S a n j e e v i n i 1 S h i f a a 1 S e l f S h a l i n i N u r s i n g h o m e 1 K R p u r a m G H 1

7. GHOSHA TOTAL BABIES MILD HYPOTHERMIA(36.4-36) 1 2 ( 2 1 % ) MODERATE HYPOTHERMIA (32-35.9) 8 ( 1 4 % ) SEVERE HYPOTHERMIA (<32)

8. CPAP S TATS

9. Total no: of babies put on CPAP 2 6 CPAP FAILURE 3 Improved with CPAP 2 3 CPAP STATISTICS

10. Indication Number Post extubation 8 TTNB 4 RDS 6 MAS 8 INDICATIONS FOR CPAP

11. Ventilator statistics

12. Total number of babies put on ventilator 2 Improved 1 1 Death 9 On ventilator DAMA 1 VENTILATOR STATISTICS

13. NEWBORN OPD STATS Total no of follow-up cases - 1 1 4

14. PROCEDURES PROCEDURES NUMBER PICC LINE LUMBAR PUNCTURE 5 SURFACTANT ADMINISTRATION 4 UMBILICAL VEIN CATHETERISATION 1 2 D V E T

15. Antibiotics A n t i f u n gal 1 s t l i n e A m p i c i l l i n A m i k a c i n P i p t a z F l u c a n a z o l e 2 n d l i n e M e r o p e n e m A m p h o t e r e c i n 3 r d l i n e C o l i s t i n A N T I BIOTIC P O L I C Y

16. CULTURE REPORTS TYPE TOTAL POSITIVE NEGATIVE AWAITED BLOOD 2 4 4 1 6 4 CSF 5 4 1 ET TIP 3 3

17. RADIANT WARMERS 14 INCUBATORS 3 MONITERS 11 TRIAGE BEDS 3 FEEDING ROOM BEDS 14 PHOTOTHERAPY UNITS 5 EQUIPMENTS

18. R E F F E R A L D E T A I L S

19. NAME /AGE /SEX DOB DOA D a t e o f r e f e r r a l MOTHER DETAILS DIAGNOSIS R e f e rral t o O u t c o m e B / o A r s h i y a B e g u m D O B : 2 2 / 6 / 2 4 D O A : 2 2 / 6 / 2 4 D a t e o f R e f e r r a l : 2 5 / 6 / 2 4 G 3 P 2 L 2 / 3 1 + 1 w k s / G D M / A L V P T / L B W / A G A / R D S / I D M P a e d i a t r i c s u r g e r y Improved

20. DEATH DETAILS

21. TOTAL NO OF DEATHS - 9

22. NAME /AGE /SEX DOB DOA DOD DOS MOTHER DETAILS DIAGNOSIS COD FROM B / o S a q i b a Kausar F e male D O B : 2 / 6 / 2 4 D O A : 2 / 6 / 2 4 DOD 1 / 6 / 2 D O S : 8 V P T / V L B W / A G A / R D S - P S / B / L C T E V / L O S / S E P T I C S H O C K R e f r a c t ory S e p t i c s h o c k G O S H A B / o T a bassum D O B : 6 / 6 / 2 4 D O A : 6 / 6 / 2 4 D O D : 1 5 / 6 / 2 4 M P T / A G A / L B W / R D S - P S / P T C / L O S / S E P T I C SHOCK R e f r a ctory S e p t i c s h ock G O S H A U m m e s su l a i m D O B : 2 / 5 / 2 4 D O A : 1 1 / 6 / 2 4 D O D : 1 6 / 6 / 2 4 D O S : 2 7 d a y s G 4 P 3 L 3 / 3 8 W K S / V X T G / A G A / 3 1 % H Y P E R N A T R E M I C D E H Y D R A T I O N / A K I / S / P P E R I T ONEAL DIALYSIS / S SE P S I S W I T H S E P T I C S H O C K / S / P C A R D I A C ARREST M O D S S e l f

23. NAME /AGE /SEX DOB DOA DOD DOS MOTHER DETAILS DIAGNOSIS COD FROM B / o A y e s h a Khatoon D O B 1 4 / 6 / 2 4 D O A 1 4 / 6 / 2 D O D : 1 6 / 6 / 2 4 D O S : 2 d a y s V P T / V L B W / R D S - P S / P T C / H R O S / E O S S e v e r e R D S w i t h S e p t i c s h o c k GOSH A B / o T a r a n num D O B 1 7 / 6 / 2 4 D O A : 1 7 / 6 / 2 4 D O D : 1 8 / 6 / 2 4 T g / S G A / I U G R / S E V E R E PERINATAL ASPHYXIA-HIE 2 S e v e r e P e r i n a t a l Asphyxia G OSH A B / o H u s n a D O B 1 8 / 6 / 2 4 D O A : 1 8 / 6 / 2 4 D O D : 2 / 6 / 2 4 M P T / L B W / L G A / R D S - P S / P T C S e v e r e RDS G O S H A

24. NAME /AGE /SEX DOB DOA DOD DOS MOTHER DETAILS DIAGNOSIS COD FROM B / o Made e n a D O B : 2 2 / 6 / 2 4 D O A : 2 2 / 6 / 2 4 D O D : 2 3 / 6 / 2 4 D O S : 3 3 H O U R S V P T / L B W / A G A / R D S - P S / P U L M O NARY H E M O RRHAGE S e v e re R D S / P u l m o nary H e m o rrhage G O S H A B / o F r a n c y D O B : 2 1 / 5 / 2 4 D O A : 2 2 / 5 / 2 4 D O D : : 2 5 / 6 / 2 4 D O S : 3 6 D a y s L P T / A G A / L B W / B A - H I E 2 / R D - M A S / S E V E R E P P H N / V VA P / L O S / S E P T I C S H O C K / S E V E R E A N E M I A N e o n a t a l S e p s i s w i t h r e f r a ctory shock w i t h s e v e r e P P H N G O S H A B / o V i j ayalakshmi D O B : 1 9 / 6 / 2 4 D O A : 1 9 / 6 / 2 4 D O D : 2 5 / 6 / 2 4 D O S : 6 d a y s T G / A G A / P A - H I E 1 / L O S / SEPTIC SHOCK / INTRAV E N T R ICULAR H E M O RRHAGE I N T R A V E N T R I CULAR H E M O RRHAGE G O S H A

25. B / o S A Q I B A K A U S E R DOB: 2/6/24 DOA:2/6/24 DOD10/6/2 DOS: 8 D i a g n o s i s : VPT/VLBW/AGA /RDS-PS/B/L CTEV/LOS/SEPTIC SHOCK C a u s e o f D e a t h : Refractory Septic shock

26. VPT/VLBW/AGA/RDS-PS/LOS/SEPTIC SHOCK A very pre term (28+1wks) female baby was born on 2/6/24 at Gosha Hospital with birth weight 1.12kg. BCIAB, APGAR @1min - 5/10 and @5min - 7/10 and Injection Vitamin K given. Baby was intubated i/v/o central cyanosis and was shifted to Bowring NICU for further management. On admission baby had severe respiratory distress. Course in the Ward (Inc. medication): Baby referred from Gosha at 2 hours of life in view of severe respiratory distress. Baby shifted with ET insitu. Surfactant (Neosurf) given at 2 hours of life. Continued ventilator support {on V-SIMV}. At 12 hours of life, baby had cold peripheries, moderate pulse volume.started on ionotropes (Dobut 5mcg, Adre0.2 mcg).Shock improved ionotropes tapered and stopped over 72 hours, Baby weaned off to O2Prongs.On day 7 of life, baby had apnea not responding to stimulation or BMV . baby was intubated and continued on ventilator support and baby had hypocalcemia and gave QID calcium correction. Repeat septic screen came positive and upgraded antibiotics. Baby had sclerema upto chest and required higher PIP. baby had shock and cold peripheries, flash CRT s/o septic shock, started on ionotropes (adre and noradre) and FFP was transfused but shock worsened and became refractive to ionotropes, requiring higher ventilatory settings. Despite all resuscitative efforts, baby did not survive. Investigations Done : 02/06/2024 = Hb - 20.1gm/dl, TLC - 14870cells/cumm. 04/06/2024 = Hb - 18.4gm/dl, TLC - 4430cells/cumm, N/L/M - 50.2/33.7/13.5, platelet count - 0.98lakh/cumm, CRP - 22.4mg/l, Na/K/Cl - 144.8/5.7/106.9, serum calcium - 6.8mg/dl, STB - 12.5mg/dl, SDB - 1.2mg/dl, indirect bilirubin - 11.3mg/dl, T3 - 0.7ng/ml, T4 - 6.4micrograms/dl, TSH - mIU/L, serum urea - 35.7mg/dl, serum creatinine - 0.3mg/dl. 06/06/2024 = Cranial USG - no significant neuroparenchymal abnormality. 07/06/2024 = Hb - 17gm/dl, TLC - 7710cells/cumm, N/L/M - 18.4/23.1/56.2, serum urea - 31.2mg/dl, serum creatinine - 0.3mg/dl.

27. B / o T a bassum D O B : 6 / 6 / 2 4 D O A : 6 / 6 / 2 4 D O D : 1 5 / 6 / 2 4 D i a g nosis : M P T / A G A / L B W / R D S - P S / P T C / L O S / S E P T I C SHOCK C a u s e o f d e a t h : R e f r a c t o r y s e p t i c s h o c k

28. MPT/AGA/LBW/RDS-PS/PTC A moderate pre term (33+1 wks) male baby was born on 6/6/24 at Gosha Hospital with birth weight 1.64kg. BCIAB, Inj. Vitamin K given. Baby was admitted in Bowring NICU i/v/o respiratory distress SAS 6/10 Course in the Ward : Baby was referred from Gosha at 4 hours of life in view of respiratory distress. Child was given surfactant at Gosha at 1 hour of life, shifted to bowring with ET insitu. Baby was on Ventilator support ( FiO2: 40% PIP: 15, PEEP: 5).Baby had prolonged CFT of 4 secs and cold peripheries at 8 hours of life, Baby was started on ionotropes adrenaline 0.2mcg/kg/min.At 24 hours of life, In view of MAP 30mm/Hg, secured UVC and started on noradrenaline (0.3mcg/kg/min). At 36 hours of life , Mottling has improved, CFT- 2secs. MAP 52mm/Hg. Septic screen was positive : CRP:258, Upgraded antibiotic to Meropenam and Colistin. At 72 hours of life, Deranged coagulation profile INR: 1.8 , FFP transfusion was done twice. Repeat coagulation Profile was normal. But baby started requiring higher settings on Ventilator and shock worsened requiring higher dose of ionotropes ( Adre: 0.6mcg /kg/min, Noradre: 0.8mcg /kg/min, dobut: 5mcg/min). Baby started having altered aspirates and bleeding from ET tube. Despite maximum ventilator settings, maximum ionotropic support and effective resuscitation baby succumbed on 14/6/24 2:45pm.

29. Investigations Done : INV 6/6/24 CBC HB 13.1 TC 6690 DC: N- 50.6 % L- 40.9%, PLT- 1.03L Qcrp- <1 SR. Ca 9.6 UREA- CREAT- 14.7/0.5 STB/DB=2.1/0.6 BLOOD GROUP - A POSITIVE INV 9/6/24 CBC HB 13.2 TC 3140 PLT- 1.07L SR. Ca 8.6 UREA- CREAT- 56.1/1.2 STB/DB=8.7/1.6 Na/K/Cl - 140/6.4/108 PT - 23.9 INR - 1.8 APTT - 29 INV 11/6/24 Qcrp-248.6 SR. Ca 8.6 UREA- CREAT- 39/0.6 STB/DB= 11.5/3.6 Na/K/Cl - 142.1/4.3/116.6 PT - 16.5 INR - 1.2 APTT - 42.3

30. U m m e s su l a i m D O B : 2 / 5 / 2 4 D O A : 1 1 / 6 / 2 4 D O D : 1 6 / 6 / 2 4 D O S : 2 7 d a y s D i a g n osis : T G / A G A / 3 1 % H Y P E R N A T R E M I C D E H Y D R A T I O N / A K I / S / P P E R I T ONEAL DIALYSIS / S SE P S I S W I T H S E P T I C S H O C K / S / P C A R D I A C ARREST C a u s e o f D e a t h : M O D S

31. Course in the Ward (Inc. medication): On Day 20 of life, Baby was brought with complaints of refusal of feeds and lethargy for 1 days, decreased urine output for 2 days. On admission, baby had 32% severe dehydration, doughy skin, overriding of sutures and nil urine output, CRT@3 secs, HR:152bpm, PV: Moderate, GRBS: 257mg/dl. Iv fluids NS bolus given (10ml/kg). Started! /2DNS correction. Na:197, K: 7.9, Urea:505, creat: 6.6, Platelet: 54 000. Repeat investigations after 12 hours of fluid management and insulin correction for Hyperkalemia and Hyperglycemia, is Na: 183, Urea: 353, Creat:2.2. Planned for Peritoneal dialysis, at 12 hours of admission, Baby started having urine output of 1.3 ml/kg/hr. Secured central line and continued fluid correction. Again at 36 hours of admission, child had Anuria and increase in serum sodium to 195, creatinine: 2.8. Planned for Peritoneal dialysis. Referred to IGICH and VVH for further management under paediatric nephrologist. But baby could not be shifted due to nonavailability of beds and ventilator. Transfused Platelet and FFP (as APTT:66). Started Peritoneal dialysis with three initial rapid cycle. Baby had cardiac arrest following initial two rapid cycle, revived after 2 cycles of CPR and intubated. Baby was on Ventilator support, continued peritoneal dialysis. Started inotropes ( Adrenaline, Noradrenaline) in view of cold peripheries, feeble pulse and MAP:32mm/Hg. In view of persistent hyperglycemia, started insulin infusion (0.01U/kg/hr). In view of severe Hypokalemia (k= 2.1), potassium correction given. In view of Mottling, feeble pulse volume, increased inotropes to maximum and continued Peritoneal dialysis. But baby started desaturating on maximum ventilator settings. Despite effective resuscitation, baby succumbed on 16/6/24 2:50am.

32. Investigations Done : 11/06/2024 = Hb - 21.6gm/dl, TLC - 15690cells/cumm, platelet count - 0.54lakhs/cumm, Na/K/Cl - 197.8/7.9/155.7, serum creatinine - 6.2mg/dl, serum calcium - 12.1mg/dl, CRP - 0.3mg/l. 12/06/2024 = serum urea - 509mg/dl, serum creatinine - 2.2mg/dl, APTT - 66.8s, Na/K/Cl - 182.1/5/149.5, PT - 17.9s, Hb - 17.6gm/dl, TLC - 6510cells/cumm, platelet count - 0.35lakh/cumm, serum calcium - 10.9mg/dl, serum urea - 31.8mg/dl, serum creatinine - 4.6mg/dl. 13/06/2024 = serum urea - 353mg/dl, pH - 7.193, Na/K/Cl - 195.3/4.9/170.3, serum urea - 336mg/dl, serum creatinine - 2.8mg/dl. 14/06/2024 = Na/K/Cl - 193.8/5.8/169.9, serum creatinine - 2.4mg/dl, Hb - 15.5gm/dl, TLC - 11320cells/cumm, platelet count - 0.29lakh/cumm, serum urea - 234mg/dl, Na/K/Cl - 179.1/3.1/151.2. 15/06/2024 = Na/K/Cl - 181/3.6/>150, serum urea - 179mg/dl, serum creatinine - 1.9mg/dl, Na/K/Cl - 167.7/2.4/140.9.

33. B/o Ayesha Khatoon D O B 1 4 / 6 / 2 4 D O A 1 4 / 6 / 2 D O D : 1 6 / 6 / 2 4 D O S : 2 d a y s D i a gnosis : V P T / V L B W / R D S - P S / P T C / H R O S / E O S C a u s e o f d e a t h : Severe RDSwith Septic shock

34. COURSE : Baby referred from Gosha at 2 hours of life in view of severe respiratory distress. On admission, distress score was 6/10 and baby was intubated and surfactant(Neosurf) given at 3 hours of life. Baby continued on Ventilator support, baby had mottling, prolonged CFT and cold peripheries at 6hours of life, started ionotropes (Adre 0.2mcg/kg/min). But shock doesn't improved. Secured UVC and added Noradrenaline (0.2 mcg/kg/min), Dobutamine(5mcg/kg/min).CUS done showed Grade 3 IVH . Upgraded antibiotic to Meropenam. In view of hypocalcemia continued Iv calcium correction. At 60 hours, baby started requiring higher ventilator settings and increased ionotropes . Despite maximum ventilator settings and maximum ionotropes support, baby succumbed on 16/6/24 2.30pm. INVESTIGATION 15/06/2024 = Hb - 19.8gm/dl, TLC - 9510cells/cumm, N/L/E - 35.1/43.3/0.9, platelet count - 2.71lakh/cumm, BBG - O positive, Na/K/Cl - 134.3/3.5/98.7, serum calcium - 11.1mg/dl, CRP - 3.6mg/l.

35. B / o T a r a n num D O B 1 7 / 6 / 2 4 D O A : 1 7 / 6 / 2 4 D O D : 1 8 / 6 / 2 4 D i a gnosis : T g / S G A / I U G R / S E V E R E PERINATAL ASPHYXIA-HIE 2 C a u s e o f d e a t h : Severe Perinatal Asphyxia

36. Course in the Ward (Inc. medication): Baby referred from Gosha at 4 hours of life in view of perinatal asphyxia intubated at birth . Convulsions at 3 hours of life , loaded phenobarbitone 20mg/kg. Continued ventilator support. Baby had convulsions again at 7 hours of life loaded phenobarbitone 10/10mg/kg. Baby started having pulmonary hemorrhage and required higher ventilator settings. Started on ionotropes Dobutamine(10mcg/kg/min) and Adre(0.3mcg/kg/min). Bleeding was continuous and transfused FFP . Despite effective resuscitation and maximum efforts baby succumbed at 18 hours of lif INVESTIGATIONS 17/06/2024 = Hb - 17.7gm/dl, TLC - 37120, platelet count - 2.16lakh/cumm, Na/K/Cl - 132.6/4.7/87.5, BBG - AB negative, serum calcium - 9.9mg/dl, CRP < 1mg/dl.

37. B / o H u s n a D O B 1 8 / 6 / 2 4 D O A : 1 8 / 6 / 2 4 D O D : 2 / 6 / 2 4 D i a g n osis : M P T / L B W / L G A / R D S - P S / P T C C a u s e o f d e a t h : Severe R D S

38. A moderate pre term (32+6 wks) male baby was born on 18/6/24 at Gosha Hospital with birth weight 2.405kg. BNCIAB, bag and mask ventilation done, APGAR @1min - 5/10 and @5min - 7/10 and Injection Vitamin K given. Course in the Ward (Inc. medication): Baby not cried after birth and bag and mask ventilation given for 30 seconds. Baby was intubated i/v/o severe respiratory distress and given surfactant and was shifted to Bowring NICU at 3 hrs of life i/v/o persistent respiratory distress. X-Ray done and s/o severe RDS and baby also required high ventilator settings. Second dose of surfactant was given at 8hrs of life and baby continued to require high ventilator settings. At 2hrs of life baby had prolonged CFT and cold peripheries, IV NS bolus given, UVC secured and ionotropes started but CFT remains prolonged and peripheries were still cold so ionotropes were increased to maximum dose - dopamine 10mic/kg/min and dobutamine 10mics/kg/min. Shock remained refractive and hence baby was started on vasopressin but baby was not maintaining vitals on maximal ventilatory settings and succumbed on 19/06/2024.

39. Investigations Done : INV 18/6/24 CBC HB 17.5 TC 15120 DC: N- 33.1 % L- 53.8%, PLT- 2.19 PCV - 55.3 % Qcrp- <1 SR. Ca 11.4 BLOOD GROUP - A NEGATIVE ABG - pH : 7.21/pCO2 : 40.7mmhg/ pO2 : 53.9 mmhg/ BICARBONATE : 16.5mmol/l Admitted for : MPT/LBW/AGA/NEONATAL DEPRESSION/RDS - PS/IDM

40. B / o F r a n c y D O B : 2 1 / 5 / 2 4 D O A : 2 2 / 5 / 2 4 D O D : : 2 5 / 6 / 2 4 D O S : 3 6 D a y s D i a g n o s i s : L P T / A G A / L B W / B A - H I E 2 / R D - M A S / S E V E R E P P H N / V VA P / L O S / S E P T I C S H O C K / S E V E R E A N E M I A C a u s e o f d e a t h : Neonatal Sepsis with refractory shock with severe PPHN

41. LPT/AGA/BA-HIE-1/RD-MAS/LBW Brief Clinical History & Pertinent P. E. : A late pre term (35 wks) female baby was born on 21/5/24 at Gosha Hospital with birth weight 2.39kg. BNCIAB, required bag and mask ventilation, APGAR @1min - 5/10 and @5min - 6/10 and Vitamin K Injection given. Course in the Ward (Inc. medication): Baby delivered via LSCS i/v/o unfavorable cervix with PROM >24hrs. No antenatal steroids given. Baby did not cry immediately after birth, cried after bag and mask for 1 minute. Respiratory distress present with score of 5/10 and baby was put on CPAP and referred to Bowring for further management. At admission baby was on VCPAP, meconium stained umbilicus noted and first line antibiotics started (Ampicillin and Amikacin). At 24hrs of life baby had convulsions in the form of twisting with desaturation and was loaded with Phenobarbitone, but convulsions not aborted and baby was intubated and put on VSIMV.

42. RD MAS with severe PPHN, PERINATAL ASPHYXIA – HIE 2 Baby was on VCPAP for 24hrs, then intubated at 24hrs of life and was on continuous ventilator support. On day 7 of life baby had severe tachypnea with severe subcostal retraction and flip-flop saturation was present. Suggestive of PPHN so started on oral Sildenafil 1mg/kg/dose 8th hourly. But flip-flop saturation persistent and started on IV Milrinone (0.3mcgs/kg/min). Baby was continued on IV Milrinone for 12days and then tapered and stopped and continued oral Sildenafil. Baby was given 3 trials of extubation. On day 25 of life, baby was extubated to Venti CPAP for 48hrs but due to worsening of respiratory distress, cold peripheries with feeble pulse volume and convulsions, baby was intubated and continued on Ventilator support. Loaded Leviteracetam (20mg/kg) Further baby failed 3 trials of extubation and continued on ventilator support with nebulization of Adrenaline and Budecort but baby started requiring higher ventilator setting (FiO2 100, PIP – 19, PEEP – 6.5) and oxygenation index was severe (>60). On day 35 of life baby started desaturating on maximum ventilator settings and had bradycardia (<60 bpm), given 1 cycle of CPR and revived and continued on maximum ventilator support. Again at 36th day of life baby had desturation with bradycardia and CPR initiated.

43. SEPSIS (VAP – klebsiella) with SEPTIC SHOCK Initially baby was started on first line antibiotics (Ampicillin and Amikacin) but from day 3 of life baby noticed to have increased ET secretions so upgraded antibiotics to Piptaz. Day 5 of life, baby had raised CRP with thrombocytopenia, upgraded antibiotics to Meropenem and Colistin. ET secretions was positive for Klebsiella sensitive to Tigecycline, hence upgraded antibiotics to Tigecycline. Continued Fluconazole for 21 days. On day 27 of life, baby was noted to have cold peripheries and feeble pulse volume, therefore started on ionotropes-Adrenaline (0.2mcgs/kg/min). On day 34 of life rashes were noted in extremeties not involving palms and soles (erythematous, papular rashes which evolved to fluid filled pustular rashes within 48hrs), suggestive of Fungal sepsis and local Mupirocin ointment applied. On day 35 of life, shock worsened and increased adrenaline to 0.6mcs/kg/min. Despite that shock remained refractory. SEVERE ANEMIA I/V/O severe anemia PRBC transfused on 21/6/2024 (twice) and repeat Hb was 8.5gm/dl and PRBC transfused on day 35 of life Feeds initiated on day 2 of life via OGT and reached full feeds by day 12 of life. Baby was continued on full feeds OGT with IV antibiotics and anticonvulsants. i/v/o clinical worsening of respiratory distress and shock, IV fluid reinitiated

44. Investigations Done : 22/05/2024 = Hb – 18.7gm/dl, TLC – 19890cells/cumm, N/L/E – 44.8/40.7/0.7, platelet count – 2.05lakh/cumm, serum calcium – 9.4mg/dl, BBG – A positive. 24/05/2024 = Hb – 20.2gm/dl, TLC – 10830cells/cumm, N/L/E – 175/11/1, platelet count – 0.5lakhs/cumm, STB – 1.1mg/dl, SDB – 0.2mg/dl, Na/K/Cl – 131.3/4.4/97.1, CRP – 12.5mg/l. 25/05/2024 = Hb – 17.6gm/dl, TLC – 5930cells/cumm, N/L/E – 58.6/24.6/1.2, platelet count – 0.39lakhs/cumm, Na/K/Cl – 130.5/5.6/95.4. 27/05/2024 = Hb – 17gm/dl, TLC – 6710cells/cumm, N/L/E – 44.6/39.7/1.9, platelet count – 0.55lakhs/cumm, STB – 1.1mg/dl, SDB – 0.4mg/dl, Na/K/Cl – 134.2/6.5/95.4, CRP – 144mg/l. 30/05/2024 = Hb – 14.2gm/dl, TLC – 10370cells/cumm, N/L/E – 54.4/32.4/1.5, platelet count – 0.39lakh/cumm, STB – 0.6mg/dl, SDB – 0.4mg/dl, T3 – 1.2ng/ml, T4 – 9.2microgram/dl, TSH – 2mIU/l, CRP – 4.9mg/l. 03/06/2024 = Hb – 11.9gm/dl, TLC – 13940cells/cumm, N/L/E – 62.7/24.1/0.8, platelet count – 1.33lakhs/cumm, STB – 0.4mg/dl, SDB – 0.3mg/dl, AST – 127U/l, ALP – 223U/l, Na/K/Cl – 140.6/5.1/103, CRP – 135.9mg/l. 04/06/2024 = Hb – 11.3gm/dl, TLC – 8630cells/cumm, platelet count – 0.88lakh/cumm, CRP – 137.5mg/l, AST – 162U/l, ALP – 325U/l, Na/L/Vl – 135/5.1/98. 05/06/2024 = Hb – 10.9gm/dl, TLC – 10670cells/cumm, N/L/E – 63.2/25.1/0.9, platelet count – 0.59lakhs/cumm, Na/K/Cl – 136.3/4.8/99.1, CRP – 150.1mg/l, AST – 130U/l, ALP – 267U/l, T3 – 1ng/ml, T4 – 7.7microgram/dl, TSH – 1.2mIU/l. 07/06/2024 = ETT tip culture – Klebsiella pneumonia sensitive to colistin, tigecycline, cefoperazone/sulbactam. 11/06/2024 = Hb – 9.2gm/dl, TLC – 12460cells/cumm, platelet count – 0.47lakh/cumm, AST – 89.5U/l, ALP – 269U/l, Na/K/Cl – 135.4/3.8/96.9. 15/06/2024 = Hb – 8.8gm/dl, TLC – 27570cells/cumm, N/L/E – 67.9/20.6/2.2, platelet count – 2.02lakh/cumm, AST – 109U/l, ALP – 381U/l, Na/K/Cl – 130/6/89.7, CRP – 147.1mg/l. 17/06/2024 = Hb – 10.4gm/dl, TLC – 33410cells/cumm, N/L/E – 71.2/19.9/2.1, platelet count – 1.82lakhs/cumm, AST – 86.9U/l, ALP – 334U/l, Na/K/Cl – 135.9/5.5/96.4, CRP – 64.3mg/l. 20/06/2024 = Hb – 10.8gm/dl, TLC – 19520cells/cumm, N/L/E – 68.8/19/3, platelet count – 1.26lakhs/cumm, AST – 151U/l, ALP – 322U/l, CRP – 163.8mg/l, PT – 17.8s, APTT – 36.8s. 24/06/2025 = Hb – 8.9gm/dl, TLC – 11590cells/cumm, platelet count – 0.21lakhs/cumm, AST – 123U/l, ALP – 218U/l, Na/K/Cl – 129.9/5.2/90.9, USG ABD - mild ascites.

45. B / o V i j ayalakshmi D O B : 1 9 / 6 / 2 4 D O A : 1 9 / 6 / 2 4 D O D : 2 5 / 6 / 2 4 D O S : 6 d a y s D i a g nosis : T G / A G A / P A - H I E 1 / L O S / SEPTIC SHOCK / INTRAV E N T R ICULAR H E M O RRHAGE C a u s e o f d e a t h : I n t r a v e ntricular H He m o rrhage

46. A term (39wks) male baby was born on 19/6/24 at Gosha Hospital with birth weight 2.4kg. BCIAB, APGAR @1min - 5/10 and @5min - 7/10 and Injection Vitamin K given. Baby was referred from Gosha at 3hrs of life i/v/o perinatal asphyxia. Intubated i/v/o secondary apnea. On admission ET in situ with severe respiratory distress and bradycardia. Baby was on ventilator support and started on ionotrope - Adrenaline and required Fentanyl sedation of 2mcg/kg/min. On day 3 of life, baby was weaned off to VCPAP. Ionotropes tapered, minimal feeds initiated. But at day 5 of life, baby noticed to have altered aspirates and clinical sepsis. Septic screen was positive with deranged coagulation profile. Baby was transfused with FFP and PRBC and upgraded antibiotics to Meropenem and Colistin. Inj. Vitamin K was given and baby was intubated i/v/o worsening sepsis and shock. Ionotropes were increased - Adrenaline 0.6mcg/kg/min and Noradrenaline 0.6mcg/kg/min. But on day 6 of life, baby had AF bulge with sever pallor and convulsions. Loaded with Phenobarbitone and Levipill. CUS showed grade 4 IVH. Repeated PRBC and FFP transfusion. Despite maximum efforts, baby succumbed on 25/6/24 2:30 PM.

47. INV 20/6/24 CBC HB 15.4 TC 20420 DC: N- 29.2 % L- 59.9%, PLT- 3.20L Qcrp- <1 SR. Ca 10.6 BLOOD GROUP - B POSITIVE INV 21/6/24 PT - 19.9 INR - 1.4 APTT - 52.4 INV 22/6/24

48. CBC HB 12 TC 6790 DC: N- 40.6 % L- 48.6%, PLT- 1.71L Qcrp- 213 SR. Ca 8.2 UREA- CREAT- 25.7/0.8 STB/DB=6.3/1.1 Na/K/Cl - 136.3/4.7/105.3 TSH - 4.9mIU/L T3 - 0.7 ng/ml T4 - 7.6 mcg/dl INV 24/6/24 CBC HB 9.4 TC 1520 DC: N- 45.1% L- 42%, PLT- 1.23L Qcrp-246.9 SR. Ca 8 UREA- CREAT- 16.3/0.5 STB/DB=7/1.7 Na/K/Cl - 138.1/4.2/106.1 PT - 20.9 INR - 1.4 APTT - 51.9

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