Age: 20 Days
HAC Funds: Rs 50,000/-
Secondary to Hyper Insulinism
Term/ LGA/ Baby Girl
Baby of Gurramma is a 20 days old baby girl, birth weight of 5kg was delivered to primi mother by LSCS (Ind: Large baby with breech presentation) on 31.05.2012 at 2.45pm. Baby cried immediately after birth. Baby was started on cow milk with 1/2 dilutions with water. Apgar scores and resuscitation details were not known. She was K/C/o Neonatal seizures and Hypoglycemia (low serum cortisol) and was treated with IV fluids, IV antibiotics and anticonvulsants and discharged. Again baby developed hypoglycemia on day 20 of life, for which she was re-admitted in Hospital for further management.
Gurramma is a 26 years old primi mother. Second degree consanguineous marriage.
G1 – Present pregnancy, spontaneous conception, regular ANC’s taken, received two doses of Inj.TT. All three trimesters were uneventful. Antenatal scans were normal. No history PIH/ APH/ UTI/ Hypothyroidism/ Oligohydramnios/ Polyhydramnios/ PROM/ Fever.
On admission baby was euthermic and euvolemic. Her heart rate of 148/min, respiratory rate was 38/min and was maintaining saturation at room air. On auscultation of chest, air entry was bilaterally equal with normal heart sounds. Abdomen was soft with no organomegaly. AF was at level. Cry, tone, activity and reflexes were normal. On examination coarse facial features and bilateral hairy pinna were noted. In view of LGA baby with hypoglycemia and low serum cortisol (out side report) detailed anthropometric measurement was taken, upper and lower limb ratio was 1.7 at birth and though apparent shortening of proximal part of all four limbs noted, but on measurement all datas were in normal range and were symmetrical.
Weight at admission: 4.54kgs.
Weight at present: 4.60kgs.
Head Circumference: 37cms.
Symptomatic Persistent Hypoglycemia (Low serum cortisol):
Baby was nursed in thermoneutral environment. In view of history of hypoglycemia, he was started on IV fluids along with Inj.Hydrocortisone and Inj.Pantodac. Her initial hemogram showed HB of 14.0g/dl, WBC count of 7,600cells/cumm, platelet count of 6.28lakhs/cumm and CRP of 1.4mg/dl. Her blood sugars were serially monitored which showed persistent hypoglycemia, for which Tab.Diazoxide and Inj.Octreotide were started and GIR was adjusted as per need. CSF analysis was normal and CSF culture was sterile. Complete urine examination was normal. CSF lactate was normal (1.5mmol/L). On day 3 of life baby had umbilical discharge, pus was sent for culture which isolated Pseudomonas aeruginosa, for which baby was started on IV antibiotics. On day 4 of admission baby become dull and lethargic, for which her IV antibiotics were upgraded after sending blood culture. Baby had one episode of seizures, for which she was loaded with Inj.Phenobarbitone and continued on maintenance dose.
Thyroid Function Test:
Done on 21.06.2012:
TRRIODOTHYRONINE (T3) – 83.54pg/ml
THYROXINE (T4) – 8.60micro g/dl
THYROID STIMULATING HORMONE (TSH) – 0.91micro IU/ml
Baby was started on IV fluids initially and later paladay feeding was introduced. Her feeding was gradually increased and upgraded to direct breast feeding. Baby is accepting and tolerating feeds well. At present baby is on Tab.Diazoxide and Inj.Octretide along with feeding. Plan is to monitor blood sugars serially and may require surgical intervention if hypoglycemia persist.
Father is a Driver who have spent Rs.63, 000/- on the baby so far and is not in the condition to afford further expenses towards the Hospital stay.
Hospital: Rainbow Hospital
Consulting Doctor:Dr. A.Venkatalakshmi