Respiratory Distress Due To Neonatal Pneumonia (P23), Clinically Early Onset Neonatal Sepsis.pptx

Respiratory Distress Due To Neonatal Pneumonia (P23), Clinically Early Onset Neonatal Sepsis

1. EVIDENCE BASED CASE RESUME Preterm Baby (35-36 Weeks) (P07.3), Low Birth Weight (2200 Gram) (P07.1), Appropriate For Gestational Age, Vigorous Baby, Respiratory Distress Due To Neonatal Pneumonia (P23), Clinically Early Onset Neonatal Sepsis, Apnea o f Prematurity (P36.9), Icterus Neonatorum d ue t o Breast Feeding Jaundice (P59.0), Necrotizing Enterocolitis Grade 1 (P77.9), Sugestif Disseminated Intravascular Coagulation (D65), Anemia Neonatal (P61.2), Electrolyte Imbalance (Hyponatremia, Hypokalemia, Hypocalcemia) (E87.8)

2. 1. Patient witch chief complaint of abdominal distention, what is the differential diagnosis of abdominal distention in neonates? The differential diagnosis of abdominal distention were obstruction, perforation, infection, constipation, and ascites. Intestinal obstruction included duodenal, jejunal, ileal, and colonic atresia, volvulus, annular pancreas, or congenital bands. Perforation such as local intestinal perforation and spontaneous intestinal perforation. Infection included necrotizing enterocolitis, sepsis. Constipation included cystic fibrosis, hirschsprung’s disease, celiac disease, cow’s milk protein intolerance. Ascites such as biliary ascites, urinary ascites, chylorus ascites, neonatal hepatitis, alpha1-antitrypsin deficiency, congestive heart failure, severe valvular regurgitation, pancreatic ascites, gastric adenocarcinoma.

3. 2. Patient is late pre-term neonates, why retinopathy of prematurity screening and auditory screening test still put on monitoring in this paper? Screening criteria of ROP : - All babies born with gestational age ≤ 34 weeks - All babies born with a weight ≤ 1500 grams - All babies born with a gestational age > 34 weeks or birth weight > 1500 grams with special problems that require screening at the discretion of a neonatologist. If the baby is born with a gestational age > 30 weeks, do a screening 2-4 weeks after birth (at least once during hospitalization), and if the baby is born with a gestational age ≤ 30 weeks, do a screening 4 weeks after birth (at least once during hospitalization) The patient require screening retinopathy of prematurity because the patient with a gestational age > 34 weeks or birth weight > 1500 grams with special problems, such as the patient need the high flow oxigenation and long duration of oxygenation, severe septic, and recurrent transfusion. The auditory screening test because the patient was exposed of environment that inevitable noise sources such as medical machines and telephone for several days during hospitalized. The patient also administrate drugs that ototoxic, such as amikacin and gentamicin.

4. 3. How differentiate acute respiratory distress due to neonatal pneumonia and trancient takipnea of new born ? We need look of the history of the patient, the risk factor of the infection from the mother and the fetal and the chest X-ray. If the neonatal pneumonia were found consolidation at lung or segmental consolidation. The risk factors of trancient takipnea of new born are late preterm with section caesarean delivery method, asphyxia or severe asphyxia during birth. The chest X-ray appeared was like water fill the segment of lung.

5. 4. Why the diagnosis was breast feeding jaundice not the breast-milk jaundice ? Breast-milk jaundice typically presents in the first or second week of life and usually spontaneously resolves even without discontinuation of breastfeeding. However, it can persist for 8-12 weeks of life before resolution. Breast-milk jaundice is caused by breast milk. Some human breast milk factor that may related to breast milk jaundice were prenane-3a,20ß-diol, interleukin IL1ß, ß-glucuronidase, epidermal growth factor, and alpha-fetoprotein. Incidents in term infants ranges from 2-4%. In most infants, the bilirubin level fell on day 4, but in breast-milk jaundice, the bilirubin continued to rise, even may reach 20-30 mg/dL by 14 days of age. Breastfeeding jaundice is jaundice caused by a lack of milk intake. Usually occurs on the 2nd or 3rd day when there is not much milk production. This condition can lead to hyperbilirubinemia, caused by increased enterohepatic circulation due to lack of milk intake. The patient with history of trophic feeding with breastmilk, only at level 20 ml/kg/day with poor acceptability, and the patient fasted. This lead to calorie deprivation, later on increased enterohepatic cycle that cause icteric conditions.

6. 5. What is the preeclamsia and eclampsia and what the dangerous of that condition ? Preeclampsia is defined as a new-onset of hypertension with systolic blood pressure greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or equal to 90 mmHg after 20 weeks of gestation with proteinuria and or end-organ dysfunction (renal dysfunction, liver dysfunction, central nervous system disturbances, pulmonary edema, and thrombocytopenia). Eclampsia is defined as the new onset of generalized tonic-clonic seizures in a woman with preeclampsia. Eclamptic seizures can occur antepartum, 20 weeks after gestation, intrapartum, and postpartum. Seizures before 20 weeks are rare but have been documented in gestational trophoblastic disease. The conditions can affect the the decreased blood flow of uteroplacental mother to the fetal because the vessel was spasm.

7. 6. What is advantage of trophic feeding ? Trophic feeding was minimal volume that can give to the neonate to prevent the intestinal villi from atrophy, to stimulate the prematurity of the intestine.

8. TERIMA KASIH