Pneumonia

• Magno, Bb. Boy• NB/M• Born in Cavite• On his 9th hospital day

History of Present Illness

• Born pre term to a 24 G1P1 (1001) mother at St. Martin Clinic in Cavite assisted by a hilot via SVD in breech presentation. No noted complications during labor and delivery.

• The patient was noted to have good activity and good suck

• On the 10th hour of life the hilot noted that the patient had poor suck and moderate activity. Upon close PE, they noted that the patient had an imperforate anus.

• Patient was immediately brought to the PGH ER. On transit the patient was noted to be in respiratory distress with deep shallow breathing. They also noted circumoral cyanosis hence admission subsequent admission.

• Patient was immediately brought to the ER

• Birth and Maternal History– Mother is a 24 G1P1 (1001) who had 2 PNCUs at a

local health center. There was no note of any infection or illness during the entire course of pregnancy. The patient took multivitamins and Ferrous Sulfate as supplements.

– There was no exposure to any teratogen and radioactive substances.

• Past Medical History– As above

• Family History– (+) hypertension and kidney disease – maternal

side– (+) asthma – paternal side– No congenital anomalies/ mental retardation in

the family

• Personal and Social History– Father is a 24 year old contractual construction

worker– Mother is a 24 year old housewife– No one in the family smokes or drinks.

• Developmental history:– (+) grasp reflex– (+) sucking reflex– (+)doll’s eye– (+) moro reflex

• Immunization History– None given

• Nutritional History– The patient was exclusively breastfed

PE at the ER 12th hour of life

• Acyanotic, poor activity, poor suck, cold clammy• HR: 120s- 140s RR: 40s GP T: 36.7 – 37.2• Weight: 1900 g Length: AC: 30cm

CC:31cm HC: 32cm• Anicteric sclerae, Pink Conjuctivae, Anterior

fontanelle open, flat, (+) alar flaring, • (+) intercostal retractions, no crackles no

wheezing, Dynamic precordium, no precordial bulging

• Dynamic precordium, no precordial bulging, apex beat at the 4th ICS LMCL, no murmurs, no thrills.

• Abdomen: soft, non tender, non distended, normoactive bowel sounds, no organomegally

• (+) imperforate anus, grossly male genitalia, bilaterally descended testes

• CRT 2 secs, FEPP

• E/N neurlogic findings

• HGT < 40

Course in the ER1s

t Hos

pita

l Day

A> Preterm32 weeks by PA, SVD in breech presentation, LBB, NID;HMD vs neonatal pneumonia; R/O neonatal sepsis; imperforate anus

Management:IVF: D10 IMB (FM) Tx:Ampicillin (200) LDAmikacin (18) LDMetronidazole (30)Blood type: A+CBC: Hgb 202, HCt 0.601, pc 149, wbc 12.57, N 0.668, L 0.195Na 138, K 5.0, Cl 101, Ca 2.12, Blood GS/CS doneCXR: (+) infiltrates R upper lung field with note of coiling of OGT Referral: Pedia Sx

A> Preterm32 weeks by PA, SVD in breech presentation, LBB, NID;neonatal pneumonia; R/O neonatal sepsis; imperforate anus; Esophagela Atresia with distal TEF

P> for TLC, tube G, proximal esophagostomy or thoracostomy, esophago-esophagostomy, TLC

(patient was immediately transferred to ward)

Course in the Ward1s

t Hos

pita

l Day

BP: 80 palp RR:70s T: 36.8 note increase in intercostal and subcostal retractions, and use of abdominal muscles

Asse

ssment

A> Preterm32 weeks by PA, SVD in breech presentation, LBB, NID;neonatal pneumonia; R/O neonatal sepsis; imperforate anus; Esophagela Atresia with distal TEF

Manage

ment

The patient was intubated with ET 3 level 8

FiO2: 60%RR 50PIP/PEEP 16/5IT: 0.5

2n

d Hos

pita

l day

Intubated, sedatedHR:140s RR: 40s T: 37.0C BP: 80 sys

2n

d Hos

pita

l Day

A>Preterm32 weeks by PA, SVD in breech presentation, LBB, NID; neonatal pneumonia; R/O neonatal sepsis; S/P Right Posterolateral Thoracotomy, Esophagoesophagectomy, CTT R, TLC (Saure, 11-3-09)

Fluids: D10 IMB (FM) at 8 cc/hr NPO, HGT q8TFI: Respiratory: ET: 3 Level 860%, 16/5, 50, 0.5ABG: 7.39/ 32.6/ 181.6/20.4/99.5%

• 1st Hospital Day– A> Preterm32 weeks by PA, SVD in breech presentation, LBB, NID;– HMD vs neonatal pneumonia; – R/O neonatal sepsis; imperforate anus

– Management:– IVF: D10 IMB (FM) – Tx:– Ampicillin (200) LD– Amikacin (18) LD– Metronidazole (30)

– Blood type: A+– CBC: Hgb 202, HCt 0.601, pc 149, wbc 12.57, N 0.668, L 0.195– Na 138, K 5.0, Cl 101, Ca 2.12, Blood GS/CS : no growth– CXR: (+) infiltrates R upper lung field– Referral: Pedia Sx