SAMPLE PEADS ADDMISSION NOTES

Contents
CASE 1- (SAM + AGE) .............................................................................................................................. 2
CASE 2: ?? BOWEL OBSTRUCTION ......................................................................................................... 5
CASE 3- (CSF (+) meningi s) ................................................................................................................... 8
CASE 4 – Right Inguinal Abscess ........................................................................................................... 11
CASE 5- Afebrile fi ng episode? Cause ............................................................................................... 13
CASE 6- Transient Tachypnea of Newborn ........................................................................................... 15
CASE 7- PNW (TPROM >48 hrs r/o NNS) / (R/o ABO compa bility sec to O+ mum, r/o NNJ)/
(Prolonged 2nd stage labor- NNS)........................................................................................................ 16
CASE 8- Acute Bronchiol s v/s pneumonia ......................................................................................... 17
CASE 10- Neonatal jaundice- above phototherapy ............................................................................. 21
Case 11- AGE no dehydra on ............................................................................................................... 24
CASE 1- (SAM + AGE)
Time of Admission: 9:20pm
Date: 18/04/23

A 2 y/o 7/12 old It male referred case from Tavua Hospital with Presen ng c/o of:
 LBM × 5/7
 Vomi ng ×3/7

HPI- According to the mother, child had been generally well un l 5 days prior to consulta on he
started experiencing LBM,non bloody, watery in consistency with 5 episodes.4 days prior to
consulta on he presented to Tavua Hospital with same issues and was given ORS, an bio cs (oral)
and PCT and then was send home.child was unable to tolerate the medica ons, hence started
Vomi ng (non projec le,non bilous)from sunday. Child was called for r/v on Tuesday hence
presented to tavua Hospital.was assessed with SAM < -3SD, AGE with some dehydra on and
Normocy c Anaemia. Hence referred to Lautoka for Hospital.

ROS
(+)LBM
(+) Vomi ng
(+) decrease appe te
(-) fever
(-) fits
(-)Cough
(-) sore throat

Pead’s Hx
 Antenatal Hx: born to a G2P2 mum via NVD, nil complica ons
 Natal: NVD, term neonates,
 BW: 2.86kg
 APGAR: 3, 5, 10
 Postnatal: Nil issues, DWt: 2.70kg
 Nutri onal:
 Exclusively breas ed for 8months
 Started on mashed foods a er 8/12
 Now ea ng family food
 Decrease appe te, only tolera ng liquids
 Immuniza on status: up to date
 Dev milestones:
 says 1 or 2 words together
 Able to follow Simple instruc ons
 *able to work steadily

PHx
admi ed in 2021 for 10% burn and K/C/O SAM

FHx:Unremarkable
SHx: lives with parents and 2 siblings, father is carpenter, mother house du es

O/E: child is sick looking, irritable, not in any obvious distress.

Vitals:
HR:132
T:36.4
RR: 20
Spo2:99%

HEENT
(- )pallor
(-)icteric sclera
(+) sunken eyes
(-) tracheal tug
(-) nasal flaring

Chest
CLF
Good AE
S1S2 R
(-) murmurs

Abdo
Skin turgor N
So non tender
No organomegaly

Ext
CR < 2 secs
Good vol pulses
Hypopigmenta on on inner thighs

A.
1.SAM (<-3SD)
2. AGE with some dehydra on
3. Normocy c Anaemia

Plan
1. Admit to CHWD
2. Fbc,Year, LFT, TFT, serilogy-HIv, VDRL, TPHA, Hep B,BC, blood film
3.Meds:
Ampicillin,Genta,Folic acid,zinc, mul vitamin,vitamin A
4.Start ReSomal at 5ml/kg/ 30mins for 1st 2 hrs
5. Reassess hydra on status a er 2hrs
6.send stool
7.send mSu
8.start F75
9.Mum updated
CASE 2: ?? BOWEL OBSTRUCTION
1y 6/12 old FOID male same presenta on to ED w/ c/o of:
 no bowel output × 4/7

HPI: According to mother child was well un l 4 days prior to admission they no ced that child did
not have any bowel output. Mum brought child to ED 4 days ago where they were given some
an bio cs and sent home. Mum also men oned that child teething and had been ea ng less since 6
days ago and is only breast feeding also men oned that child is not as ac ve as he was in the
weekend during mothers day celebra on at their mother.

ROS:
(-) fever
(-) Vomi ng
(+) iritable when abdomen is touched
(-)fits
(-)Cough
(-) rinohorrea
(-) Hematuria
(+) decrease appe te
PU
(-)BO

PHX: Nil previous admission was reviewed in ED by surgery for inguinal hernia and hydrocele
scrotum since it was minimal thus was sent home on septrin and PCT.

PSHx: Nil previous surgery

DHx: No known allergies
FHx: Unremarkable
Paeds Hx:
 Birth wt= 3.15Kg
 Current wt= 9.75Kg
 Born via NVD
 Apgar: 8,9,9
 Nil complica ons during pregnancy and delivery.
 Dev Milestones: appropriate to age
 Immuniza on: child received Vaccina on ll 14 weeks, did not receive 12-month vaccine and
18 month vaccine yet. MCH card sighted.

 Nutri on: Breas eed ll 4 months of age then mixed feed with lactogen ll 6 months then
was started with mashed food & breas eed. Now child can feed on home cooked meals but
for past 6 days has been no ced not to be feeding well.
Social Hx:
-Lives at saweni in a household of 4 members. Mother, father, sister & pa ent.

-No one in the family is sick.

-Father smokes

- (+)use of mosqui e coil

- Government water

Father is the bread winner of the family

O/E : comfortably breast feeding, non-sep c, non- dysmorphic, nil respiratory distress noted.
Vitals:
T: 36.6, P: 147bpm, RR: 31, SPO2: 99% RA, GCS 15/15

HEENT
Nil pallor conj
Nil jaundice
Moist oral mucosa
No tracheal tug
No nasal flaring

CHEST:
CLF, ✖ crepita ons,✖ wheezes
Good air entry bilaterally
No chest indrawings noted.
CVS: S1, S2 noted and no murmur.

Abdo: Child gets irritable on palpa on & ghtens the abdomen.

(+) bowel sound

EXT:
GVP
Warm and well perfused
CR < 2 Sec
No cyanosis on the limbs

Genitalia:
Normal male genitalia
Testes both descended.

Inves ga on:
FBC:
W- 16010 (N:46%,L:40%)
HB-11
P/M-35/79
PLT-634K

U& esCr:
U:3, Na: 135, K:5.1, Cl:105, Glu:6.4

A. No bowel output ? Obstruc on

P.
1.Admit to CHWD once RDT nega ve
2.2/3 IVF cocktail maintenance @27ml/hr
3.Meds: Lactulose 5ml PO Stat, Ampicillin, Gentamicin
4.Monitor vitals
5.For erect KUB xray
6. FBC/u& Cr/BC done
7.for mash food diet
CASE 3- (CSF (+) meningi s)

A 1 year 8-month-old IT, female referred from sigatoka hospital with complaints of:
 Fever x1/7
 Fi ng episode @ 10:3opm yesterday

HPI:
According to the mother, the child was well a day prior to presenta on before he developed fever on
Saturday around 4pm. They ini ally stayed home before the child had a fi ng episode @ around
10:30pm where the mother described it as s ffening and jerky movements of the arms, upward
rolling of the eyes and drooling las ng about 5-10mins (Self terminated). A er which they presented
to sigatoka hospital. From there they were managed and transferred to Lautoka for Lumbar puncture
and review

Perinatal History:

 Antenatal:
-G1P1
-All antenatal bookings were a ebded
-Mothers' serology was nega ve
- Not classified as GDM or HTN
-No other complica ons during pregnancy

 Natal:
-Birth before arrival
-Birth weight- 2.58kg
-Head circumference: 34cm
No resuscita on interven ons at birth

 Neonatal:
-No superficial and congenital abnormali es noted
-Mother was lacta ng well
-Baby was feeding well upon discharge

 Growth and development:

-All milestones were achieved- ll 18 months-child was able to walk, talk more than 6 words
in mother tongue, child points and picks things and gives things to the mum
-Current weight: 10.3kg

 Nutri on:

-Exclusively breast fed ll 3 months of age and then started together with formula milk
-Solids foods introduce at 6 months of age
-Currently has family food- carrots, dalo, cassava, bread
-No known allergies to any food
Past illness and Admission:
-Admi ed in Lautoka hospital in September 2022 for CSF (+) meningi s

Drug HXT: Nil allergies

Immuniza on:
-Child has received all immuniza on ll 18 months. MCH card sighted

FHX: No one in the family is sick

SHX:
-Pxt lives with 7 family members in the household in Nadrala Village
-Father is a farmer in his village
-Mother is a student at FNU Naisinu
-Has access to flush toilets
-No domes cated pets at home

ROS:
(+) FEVER, (-) FATIGUE (+) IRRITABLE (-)RASHES (-) HEADACHE (-) RHINORRHEA (-) COUGH (-)
TACHYPNEA, (-) DIARRHEA, (-) VOMITTING, (+) URINARY INCONTINECE

O/E:
-Pxt si ng comfortably on mum's lap
-Irritable upon approach
-Nil obvious resp. distress
-Alert
-Ac ve

Vitals Sign:
HR-147
T-37.7
RR-28
SPO2-97% RA
CBG-5.7

HEENT:
(+) Mild pallor, no jaundice, (+) moist oral mucosa, no s ffening of neck, no lymphadenopathy, pupil
both equal and reac ve to light

RESP
-Equal air entry bilaterally, clear lung fields, Nil crepita on

CVS: S1S2 regualr, Nil murmur noted

GASTRO: So , nontender, no organomegaly

EXT: CR<2s, Good volume pulse, warm and well perfused, No rashes

INVESTIGATION:
FBC:
 WCC-15600 granulocytes= 71%
 HB- 8.69
 MCV/PCV-60/20
 PLT-254000

UECR: S ll pending

LUMBAR PUNCTURE:
 -Appearance-clear and colourless
 -RBC 5X10'6
 -WBC 10X10'6
 -DS No organism seen (NOS)
 -Await culture
 -Polymorps- 60%
 -Lymphocytes-40%

ASSESSMENT:
1-CSF (+) meningi s
2-Microcy c anaemia

PLANS:
1-Admit to CHWD if RDT nega ve
2-Do FBC/ UECR/ BC
3-Lumbar puncture
4-Meds:
ce riaxone 100mg/kg IV OD
Dexamethasone 0.15mg/kg
Ampicillin 50mg/kg IV Q6H
Paracetamol 15mg/kg PO Q6H
5-Do head circumference daily
6-Cont. IVF cocktail at 28ml/hr over 12 hrs
7-Monitor for any fits
8-Monitor vitals
9-Refer PRN
CASE 4 – Right Inguinal Abscess

1 yr 11 month IT male refered from rakiraki hospital

 C/o: right inguinal abscess for 1 wk.

HPI:
According to mum baby was well one wk prior to admission un l she no ced child to have right
inguinal swelling. Ini ally it started as a small bump on the skin to look more larger and reddish. The
child also became irritable and complained of pain in the right groin region. Hence mum took child to
rakiraki hospital on Wednesday when child also started to have fever on day of admission. His
inguinal abscess over me worsened hence today was refered across for incision and drainage.

ROS: +Fever and inguinal abscess

Paed hx:
 Antenatal: G5P5 , nil complica ons during pregnancy.

 Natal: child was born via NVD at rakiraki hospital.

 Postnatal: baby was kept for observa on for 24 hrs and then discharged.
Discharge wt 3.45kg

 Developmental milestone: all appropriate for age. Can speak 5-6 words, able to obey
commands, able to walk steadily.

 Nutri on: family food and bo le fed (Rewa powder)

 Immunisa on: uptodate (mch card not sighted)

Past Medical hx, drug hx and allergies: unremarkable

Family hx: no one is sick at home

Social hx: Lives in rakiraki with family of 9. Dad works in Fiji water, mum stays home. Father smokes
at home. Water source is well and has flush toilet.

O/E: comfortable, nil respiratory distress, alert, awake, orientated.

Vitals:
T 36.1, HR 98, RR 26, SpO2 99% RA
Wt 12.8 kg

HEENT: No pallor, no jaundice , no nasal flaring, moist oral mucosa

Chest: Good air entry, clear lung fields.

Cvs: S1S2 regular

Abdo: so , non tender

Ext: well perfused, capillary refill <2s

Genitalia: right sided inguinal swelling 3x3cm noted, hard, firm and tender to touch and fluctuant .

Inv:
FBC
 WBC 20900
 HB 8.8
 MCV/PCV 28/57
 PLT 521K

Assessment:
1.Right inguinal abscess
2. Mucrocy c anemia

Plans:
1. Admit to children's ward
2. Bloods c, uecr, xmatch and blood culture
3. Meds:
Cloxacillin 50mg/kg IV Q6H
Gentamicin 5mg/kg IV OD
4. Co- manage with surgical
5. Secure BTF consent, see repeat Hb than decide on PRBC +/- 15mls/kg over 4hrs early morning
6. For incision and drainage by surgeon than +/- transout to rakiraki hospital
7. Monitor Vitals and refer prn
CASE 5- Afebrile fi ng episode? Cause

1yr 4month IT male refered from nadi hospital with c/o of

 fi ng episode at around 8am.

HPI:
According to dad baby was well a day prior to admission un l today in the morning , when the child
was playing he suddenly fell from ground in si ng posi on and started to have sudden s ffening of
all 4 limbs. As per dad, the fi ng episode lasted for 2-3mins. There was no upward rolling of the eye
and frothing of the mouth. Post-fi ng episode the child was unresponsive for 10mins. In addi on to
this, 2 days ago child had hx of fall from bed where he hit his head on the floor, hence child was
refered from nadi hospital and wad ini ally for LP and review. However upon hx, was found to have
hx of head injury hence LP to withhold and pa ent was admi ed.

Ros:
+fi ng episode
One episode of vomi ng
Hx of fall
Post-ictal confusion
Occasional cough.

Paeds hx:
 Antenatal: Nil complica ons during pregnancy
 Natal: child was born via ECS at lautoka hospital at 40 wks 5 days. Birth weight of 4.05kg,
APGAR of 8,9,9.
 Postnatal: baby was kept for observa on for 24hrs than discharged at weight of 4kg.

 Developmental: all milestones appropriate for age

 Nutri on: bo le feed and family food.

Past Medical hx, drug hx and allergies: unremarkable

Immuniza on: all uptodate for age (baby mch card was sighted).

Family hx: no one is sick at home

Social hx: Lives in navo with family of 7. Both parents are employed, no one smokes at home.

O/E: comfortable, nil respiratory distress, alert and awake.

Vital: T 36.7, HR 158, RR 46, Spo2 98% RA CBG 6.3mmol/L Wt 13kg
Heent: No pallor, no jaundice, no nasal flaring, + PEARL, no sign of head injury

Chest: clear lung fields, good air entry

CVS: S1S2 regular

Abdo: so , non-tender

Ext: well perfused, CR <2s

Inv:
FBC
 WCC 9800
 HB 11.8
 MCV/PCV 74/35
 PLT 364K

Assessment:
Afebrile fi ng episode? Cause

Plans:
1. Admit to children ward
2. FBC, UECR, MINERAL, BLOOD CULTURE
3. Keep for neuro observa on
4. For eye review tomorrow morning + CT head
5. +/- LP a er ruling out contraindica ons. Concern secured.
6. Withhold an bio cs for now since afebrile
7. Closely monitor for peaks if any fi ng episode overnight load with phenytoin or phenobarbital
8. Place 2 drops of tropicamide tomorrow morning at 8am to dilate eye. To inform a er 30mins to Dr
Tomasi once dilated for fundoscopy.
9. Monitor Vitals and refer prn
10. Dad updated
11. Plot head circumference
12. Take wt and ht
CASE 6- Transient Tachypnea of Newborn
Admi ng baby of Li a Kabe, 19y/o, primp, A+, sero nega ve. AOG of 39 weeks 1 day, delivered via
NVD.

Antenatal Hx:
-Booked at 15 weeks 6 days. High of 11.5
-A ended total of 9 ANC

Outcome: Received baby cried well at birth was tachycardic and tachypneic, maintaining Sp02 at RA
as per staff Reauc oned and placed under head box at 5L 02 HR se led, baby was slightly tachypneic
65, and sucking hand. Advice to breast feed and to repeat R.R.
- APGAR 8,9,9 at 1, 5, 10 mins

O/E: Comfortable Nit obvious distress

Vitals: HR-167bpm, RR 68. T- 36.5 Sp02-99% RA CBG 4.6

Physical examina on:

HEENT: Normotensive AF/ PF, Nil caput/moulding, no pallor conjunc va, no jaundice.

Chest: CLF, no indrawing. S1 & S2 normal no murmur appreciates.

ABDO: so . No abdominal distension. Umbilical cord: 3 blood vessels. 2 arteries & 1 vein.

EXT. CR< 2 secs,GVP, no cyanosis & nil tallipes.

Hips: Nil DDH and nil spinal bifida.

Genitalia: Normal female genital. No abnormali es.

Assessment:
1. Live term female neonate.
2. Tachypnelc a er birth- TTN

Plans:
1. Admit to PNW
2. Ini al breast feed Q2-Q3H and on demand.
3. Repeat R.R. If RR is > 60 consecu ve 3X, to inform.
4. Cord care.
5 Monitor and inform PRN
 CASE 7- PNW (TPROM >48 hrs r/o NNS) / (R/o ABO compa bility sec
to O+ mum, r/o NNJ)/ (Prolonged 2nd stage labor- NNS)

Admi ng b/o Ashika Kawar, 40 y/o G2P1 now, sero-neg, 0+, Hx of miscariage in 2022, TPROM 248Hrs
& prolonged and 2ns stage, delivered a live term neonate via EMCS.

Antenatal Hx
-Mum was booked ?, total of ?? ANC a ended
- Hx miscarriage in 2022

Outcomes:
-Recieved a floppy baby, gave a weak cry at birth later was not voluntarily breathing and floppy
booking.
-Baby brought to warmer, dried, s mulated and suc oned nasopharynx, clear secre on noted. PPV
ini ated for 15 s, few Grimace noted. Resuc oned, PPV for 15 secs done, s mulated, gave a loud cry
Placed under headbox, satura on well now @ SpO2 of 99-100% in RA
Apgar: 6,8,9 in 1,5,10 mins

O/E: Comfortable. Nil obvious distress

Vital RR: 60 HR: 154 T: 36.1 CBG: 83 SpO2: 100% in 10L O2

HEENT: nil pallor conjunc vator, nil jaundice, nil cle palate, normal AF/PE, (+)caput occiput,
(+) some moulding, nil tracheal tug, nil nasal flaring.
CHEST: CLF, S1S2 regular, (+) mild occassional indrawing.
ABDO: So , not distended, UC intact- 3 BV a ached
EXT: GVP, CR<2secs
Assessment:
1. Live term male neonate
2. TPROM >48 hrs r/o NNS
3. R/o ABO compofibility sec to O+ mum, r/o NNJ
4. Pronlonged 2nd stage labour- NNS

Plan:
D/w Dr Sheenal (ROC)
1) Admit to PNW-MICU ( if not satura ng well then admit to NICU]
2) Do Bloods (FBC/BC)-done
3) Med: Ampicillin 50mg/kg IV BD, Gentacin 5mg/kg IV OD
4) Monitor RR<60 SpO2: >94% in RA, if abnormal, Inform.
5)Monitor HR- if tachycardic- Inform
6) Breas eed Q2-3H and on demand
7) Monitor CBG, if drops- Inform.
CASE 8- Acute Bronchiol s v/s pneumonia

Admi ng this 5 month old, FID, female, referred from Rakiraki hospital with the complaints of.
 -cough x 1/7
 fever X 1/7
 decreased appe te x 1/7

HPI.
According to mum, baby was well 4 days prior to admission un l when she no ced child to have
sneezing and runny nose. The cold flu symptoms resolved however from yesterday, child.
started to have cough, fever, and decreased appe te. As per mum, the cough was produc ve in
nature with whi sh sputum. There were no associa ve symptoms such as vomi ng, diarrhea. The
mum did not give any medica ons to the child at home. She presented to Nanukula HC from where
she was referred to Rakiraki Hospital. Was assessed in Rakiraki hospital and case was discussed with
Lautoka and trans-out.

ROS:
(+) fever, (+) produc ve cough, (+) cough, (-) runny nose, (-) fast breathing, (-) fi ng episodes, (-)
dairhea, () vomi ng, PU, BO, decrease appe e

Pediatric History
Informant - Mum

 Antenatal: G2P1A1, had gesta on hypertension during pregnancy Was on adequate

management
 Natal: child was born via NVD at Lautoka Hospital at Term. Birth weight of 3.2 kg Apgar
score of 8.9.9.
 Postnatal: Baby was kept for observa on for 24 hours and then discharged with a discharge
weight of 2.75 kg Was breas eding well post term.
 Developmental: milestones are appropriate to age. child is able to reach for things, child
shows affec on to care givers, child does respond to surounding sounds, child makes eh , ou
vowel sounds, does roll over in both direc on, child laughs .
 Nutri on: Exclusively breasfeeding 6 mes a day + on demand

Past medical illness:

no previous admissions. This is the child's first presenta on.

Drug History:
not on any regular medica ons

Allergies: no known allergies

Immuniza on:
all Immuniza on uptodate for age ll 14 weeks.MCH card sighted.
FHX.
2 people at home are sick with flu like symptoms. No family history of Asthma.

SHX.
Lives in Baruto, Rakiraki with a family of 4, mum, dad, grandma, and the child. Dad works in Farm.
Mum stays at home (domes c worker). Father smokes at home but outside the house
Uses mosquito coil and uses firewood to cook at home. Pets at home. Lives in a n house with good
ven la on however dusty area, Government water supply at home + flush toilet. Everyone
home is dual vaccinated against COVID 19.

O/E: comfortable, nil respiratory distress, awake, alert, pink looking.

Vital in Rakiraki: T-37.4 HR- 157 RR-48 SPO2-100%RA Wt-8kg

HEENT: (-) pallar, (-) jaundice, () nasal flaring, (-) tracheal tug, moist oral mucosa

Chest Bilateral wheezing, Inspiratory stridor with trasmi ed breath sounds. (-) indrawing.

CVS: $1S2 regular, no murmur heard.

Abdomen: so , non-tender, no masses felt.

Ext: well perfused, cap refll (central and peripheral) <2sec, warm, no edema noted.
Chest X-ray done in Rakiraki- X-ray showed Tracheal devia on towards right side
Meds given at Rakiraki Hospital: 50,000mgl/kg IV Q6H-stat given
Gentamycin 5mg/Kg IV OD-stat given
-Paracetamol 15mg/kg PO Q6H
Saline Nebs- Q1hrs

Assessment
1. Acute Bronchiol s v/s pneumonia

Plan:
1.Admit to CHWD.
2. FBC/U&CRILFTS/ Minerals/TFTs/ Blood flm/ BC done
3. NPS Done
4.Start on meds:
 XPEN- 50,000mg/kg IV Q6H
 Gentamycin- 5mg/kg iv OD
 Prednisone 2mg/kg IV OD
 Note: if IV line comes Out stop IV an bio c and cont oral an bio cs.
4.Repeat chest X-ray and review
5. Monitor vitals and refer prn if any issues
7.Con nue breas eeding
8.Mum updated.
9. Monitor for any worsening respiratory status.
 CASE 9- INDICATION: SROM>24HRS R/O MAS 2 to Moderate-Mec
R/O NNJ 2 to ABO Incompa bility
Admission from Labour ward
Admi ng this B/O G3P3, A pos, SN, born via NVD at AOG 41 Weeks

Antenatally
-Booked at AOG 20 weeks
-A ended 9 ANC
-OGTT: Normal

OUTCOME:
-Received a live male neonate, cried well at birth, moderate meconium upon birth
-APGAR 8,9,9
-No ac ve resus. required

PE:
-Weight:4.30kg -Height:58cm -HC:35cm -CC:36cm
-Maturity es mated: 41/40
-Ac vity: Normal, Ac ve
-Tone: Normal
-Color: Pink
-Nutri on: Breas eeding
-Cry: Loud and vigorous
-Skin: Smooth
-Head: No caput, No moulding
-Fontanelle: Normal AF/PF
-Eyes: Patent, opening spontaneously
-Ears: Patent
-Mouth: No cle
-Nose: Patent, no flaring
-Heart: S1S2 regular
-Peripheral pulses: Felt
-Lungs: Clear Lung fields
-Abdomen: So , no masses
-Cord: 3 blood vessels seen, clamped
-Genitalia: Normal male
-Anus: Patent
-Trunk: No spina bifida
-Extremi es: No talipes
-Hip Joints: No DDH
-Reflexes:
Moro-present
Grasp-present
Suck-present
Roo ng-present
ASSESSMENT:
1-Live Male neonate
2-R/O MAS 2 to moderate Meconium
3-R/O NNJ 2 to ABO Incompa bility

PLANS:
1- Admit to PNW
2-Withold screening for now as baby is clinically stable
3-Monitor Vitals: Inform if RR>60 OR <30 or T<36.5 or >37.5
4-Inform if any worsening resp. distress
5-Encourage breast feeding Q2H-Q3H plus on demands
6-Rou ne newborn care
7-Rou ne Cord Care
8-Inform if any issues
9-Refer PRN
CASE 10- Neonatal jaundice- above phototherapy
7-day old FID male referred from ba hospital with c/o:
 Jaundice x 4/7

HPI: according to mum, she delivered 7 days ago in lautoka hospital and was not lacta ng well which
was the issue from me of birth, she was discharged on Saturday a ernoon, she no ced that the
baby cried alot and had short naps which she assumed was due to her breas eeding.on Saturday
night she took the baby to Ba Aspen and was advised on proper a achment and educated since she
was a primip mum, by Sunday the lacta on has improved but the baby was s ll irritable. By Tuesday,
the baby started to appear yellow thus mum presented to ba Aspen again and SBR was below
phototherapy range however recent SBR was elevated and in phototherapy range however Aspen ba
didn't have lights for phototherapy.

ROS: nil fever, vomi ng, coughing, diarrhea, rashes and tachypnea
PU BO normal

Antenatally: G1P1 A posi ve sero nega ve mum

A ended all antenatal clinics.
Had GDM during pregnancy thus was taking me ormin and insulin.
Delivered at lautoka hospital.
Nil complica on at birth

Natal: Term at birth 39 weeks

Normal vaginal delivery (induced)
Birth weight- 2.7kg
Hc- 33cm CC- 31cm L- 53cm
No resuscita on interven on was needed at birth.
APGAR: 8,9,9

Neonatal: no superficial or congenital abnormality noted

Child has been breas ed since birth.
Mum has poor lacta on since birth.

Developmental History:
Birth weight- 2.7kg

Discharge weight- 2.6kg

Current weight- 2.62kg

Weight loss- 2.96%

Nutri on: baby is currently breas ed as well and is on top up as well (SMA)
Immuniza on: recieved all un l birth, MCH card sighted

Family Hx: unremarkable

Social Hx:lives with mum and dad, has access to tap water and flush toilet, no one smokes at home
and no one is sick at home

On examina on, nged, non-syndromic non dysmorphic looking baby, comfortable and in nil
obvious distress.

Vitals
HR- 134 Spo2- 97% Ra temp- 36.4
RR- 48

HEENT: jaundiced no nasal flaring no tracheal tug, no cle palate or lip.

Chest: clear lung fields, good air entry bilaterally

CVS: S1S2 regular

Abdo: so and non-tender

Cord clamped- clean and dry.

Extremi es: warm and well perfused, good volume pulse, no tallipes or polydactyl

Back: no spina bifida

Inves ga on:
 Wcc- 11200
 Hb- 17.4
 Plt- 305k
 U- 6.6
 Cr- 39
 Na- 152
 K- 6.4
 Cl- 109
 SBR:
 TB- 255
 DB- 10
 IB- 245
 DCT- nega ve
 BC- NG48Hr(from ba aspen)

Uecr in lautoka
 U- 3.3
 Na- 138
 K- 6.3
 CI- 106 ( mildly hemolysis)
SBR: TB- 368 IB- 19
Baby received gentamycin for 3/7 and Ampicillin 4/7 at ba Aspen
Kramer- 3

Assessment:
1. Neonatal jaundice- above phototherapy ( cutoff- 350)
2. R/o breas eeding jaundice
3. R/o sepsis

Plan: D/w Dr Asnit

1. Admit to CHWD
2. Blood done: c, uecr, sbr, BC done in ba Aspen
3. Con nue meds: ampicillin 50mg/kg iv BD x 3/7
4. Start baby on phototherapy
5. Mum advised to con nue with exclusive breas eeding plus EBM
6. For EBM at 60mls q3hrly
7. Repeat SBR and TFT 6 hrs a er star ng phototherapy
8. Take CBG
9. Advised on rou ne cord care
10. Monitor vitals and inform if vitals:
RR>60 HR>160 Spo2<95%
11. Parents updated
Case 11- AGE no dehydra on

Admi ng shivansh chand, 2months 4 days FID, Male with C/O:

 fever for 1 day
 LBM for 1 day (had 7 episodes)

HPI-According to mum she men oned that baby was well a week prior when the mum started
having sore throat in Friday last week and was given an bio cs (amoxicillin) a er which she no ced
that baby started having LBM 2 mes in a day a er she started taking an bio cs. Baby was well ll
today when mum no ved baby started fever since midday today and had 7 episodes of LBM. Mum
later men oned that she started feeding baby SMA when baby was a month old wasnt tolera ng
well and was irritable so they switched baby on S26 about 2 weeks ago, tolera ng well now.

ROS
(+) fever
(+) LBM 7 episode
No vomi ng
No fast breathing
No cough
No rashes
No tachypnea
Normal PU

Antenatal
-G1P1, AB posi ve, sero nega ve mum
-All antenatal bookings were a ended at Lautoka Aspen
-Delivered at Lautoka Hospital
-No other complica ons during pregnancy

Natal
- birth at term - 39weeks
-NVD
- BW 3.1kg
- HC 31cm CC 30cm. L47cm
-no resuscita on interven ons at birth
- APGAR 8 9 9

Neonatal
- no superficial and congenital abnormali es noted
- child had been breas eed from birth
- mum had good lacta on upon discharge

Growth/ development history

- baby has acheived all milestones ll 8 weeks- is able to respond to sound, smiles at people, brings
hands to mouth
Bwt 3.1kg Discharged weight 3kg Current weight 5kg
Nutri on
- baby is on S26(180mls/k) and breas ed as well
Tolera ng feeds as well
Ini ally started baby on SMA at 1 month old but was not tolera ng therefore switched to S26 about
2 weeks ago.

Immuniza on
The baby has received all Immuniza ons at birth- MCH card sighted.

Family History
Unremarkable

Social hx
- lives together with parents at FSC quarters
- no one smokes near baby
-access to flush toilet and government water supply
- no one is sick at home
- father 31 is an IT officer
-Mother 28 is an accountant

O/E- pink, non-syndromic, no dysmorphic looking baby, comfortable, nil distress, irritable but
consolable

Vital
T38.4. P174. RR53. SPO2 100% on RA

HEENT
- no pallor
-No jaundice
- no sunken eyes
- no nasal flarring
- no tracheal tug

Chest
Clear lungs field
Equal air entry Bilaterally
No indrawing

CVS
S1S2
Nil murmurs

Abdo
- so
No disten on
No masses/ orgnomegaly
Extremi es
CR <2s
Good volume pulse
Warm and well perfused

Inves ga on
FBC/ UECR- pending.

Assessment
1. R/O clinical sepsis sec to AGE
2. AGE no dehydra on

Plan
1. Admit to childrens ward
2. Bloods - FBC/ UECr/ BC done
3. Meds xpen 30mg/kg IV Q6H and Gentamicin 5mg/kg IV OD
4. Con nue with EBF
5. Take CBG
6. review with blood results- consider adding IVF of uecr are sugges ve of dehydra on
7. Send stool same - M/C/S
8. Send CSU
9. monitor ongoing losses
10. Monitor vitals
11. Parents updated on current status and treatment plan