PERINATAL MEETING

BH Diyatalawa
( June 2022 – July 2022)
Presented by - Dr.Ruchira Karavita
(HO-Paediatrics)
 JUNE JULY

Total Deliveries 111 91

Live Births 111 91

Still Births - -

Neonatal Deaths 02 03

IUD nill nill

Number of PBU Admissions According To the
Birth Weight
JUNE JULY

Total 35 28

>2.5 Kg 16 15

Low birth weight 19 13

1.5-2.5 Kg 14 08

1-1.5 Kg 03 02

<1 Kg 02 03
No. of PBU Admissions according to the
POA
POA JUNE JULY
Total 35 28
22 21
>37 wk

13 07
Pre term

10 02
34-36 wk
02 02
31-33 wk
-
28-30 wk
01 03
<28 wk
TRANSFERS
Admissions and Transfers
JUNE JULY

35 28
Total PBU
Admissions
- 01
Transfer In

- 01
Transfer Out
 Transfers In
MONTH TRANSFER IN HOSPITAL PROBLEMS

JULY B/O R.M.D BH Balangoda Extreme LBW (585g)

Rajarathna Extreme prematurity (24
weeks)
 Transfers Out
MONTH TRANSFER OUT HOSPITAL PROBLEMS

JULY B/O L.Sridevi (T1) PGH - Badulla Extreme

prematurity (27+2)
Extremely LBW
(900g )
NEONATAL DEATHS
Neonatal Deaths In JUNE – JULY 2022

December
JUNE 2

JULY 3
 1. B/O M.A.F. NUSRA
Mother Baby
Age – 26 years Baby boy
Parity – P2C1 D.O.B. 14/06/2022 at 6.54 am
POA – 39weeks+4 days T.O.D. – 16/06/2022 at 6.45pm
AnHx – nill Birth weight – 2.61kg
PMHx- nill Mode – forceps delivery (I- Fetal
Antenatal scan – NAD Bradycardia)
Blood group – A positive AB positive, DAT negative

Clinical Presentation Resuscitation not done

Baby cried at birth
Colour – Pink
Tone- Good
Breathing - spontaneous
HR -110bpm
( APGAR – 1min 10
5 min 10
10min 10 )
Problems Encountered Management
1.Low SpO2 in R/UL Incubator care with NPO2
2.Continuous machinery murmer IV antibiotics – IV C penicillin , IV
Cefotaxime
Intubated and ventilated (ETT-3mm and
Lip level at 9)
IV Adrenalin, IV normal saline boluses,
IV Dopamine infusion, IV Prostaglandin
UVC Inserted

Outcome Cause of death

Desaturations noted with bradycardia at ? Duct dependent congenital heart
5.55pm on 16/06/2022 disease
Active resuscitation started with bag and
mask ventilation. CPR started at 3:1 ratio
and continued upto 20 minutes. IV
adrenaline -3 cycles given. IV N/S bolus
given .baby expired on 16/06/2022 at
6.45pm aged 3 days.
 2.B/O K.SILOSANA
Mother : Baby :
Age : 25 years Baby girl
Parity : primi D.O.B- 15/06/2022 at 11.25am
POA : 40 weeks + 2 days T.O.D- 17/06/2022 at 4.15pm
Antenatal Hx: nill Birth weight – 2.78kg
PMHx : nill Mode of delivery – NVD
Antenatal Scan :NAD B Positive, DAT Negative
Blood group : B positive

Clinical Presentation : Resuscitation done :

Baby didn’t cry at birth
Colour- Pale
Tone-Floppy
Breathing – No spontaneous breathing
Heart rate- Not audible
Reflex irritability – Absent
Attended by SHO/HO/NO at LR.
CPR started immediately at 3:1 ratio
Intubated by 3mm ET tube secured at lip
level 8 and bag and mask ventilation started.
IV Adrenalin 3 cycles given
IV NS 2 boluses given
Baby was admitted to PBU for ventilator
support
• On admission to PBU –
Temperature 94F
HR< 100bpm
CRFT > 3 sec
CBS – 169mg/dl

18/12/2019 Perinatal Meeting - December 2019 14

Problems Encountered : Management :
Intubated and ventilated
1. Resuscitated at birth and Intubated IV Antibiotics – IV C Penicillin, IV
and ventilated Gentamycin
2.Low APGAR at birth IV fluids ,IV Adrenalin, IV Sodium
( APGAR at 1min 2 bicarbonate, IV Vitamin K, IV
5 min 2 Omeprazole, IV Dopamine Infusion
10 min 2 ) UVC Inserted
FFP transfusion (x1)

Outcome : Cause of death :

Low HR (20bpm) and low SpO2 – 40%
noted on 17/06/2022.
CPR and Ambu ventilation started. IV
adrenaline -3 cycles given. CPR given for
30 minutes.IV NS given
Baby expired on 17/06/2022 at 4.15pm ,
aged 3 days.
Possible HIE grade III
( Altered grey, white matter deformation,
could be due to cerebral edema or due to
hypoxemic ischemic insult.No
hemorrhages.Frontal horns of lateral
ventricles appear slit like)- USS done on
16/06
 3.B/O R.M.D. RAJARATHNA
Mother Baby
Age – 29 years Baby boy
Parity – primi D.O.B- 01/07/2022 at 9.00am at BH
POA – 24 weeks Balangoda
Antenatal Hx – nill T.O.D- 05/07/2022 at 8.40am
PMHx- nill Birth weight – 585 g
History of dribbling (>24h) Mode of delivery – NVD
No h/o fever O Positive, DAT Negative
Antenatal Scan – NAD
Blood group – O positive

Clinical Presentation : Resuscitation not done :

Baby has cried at birth at the LR at BH
Balangoda
Transferred to us for pre term baby care
and possible ventilator support
• On admission to PBU-
Activity- good
Colour –pink
No grunting
Mild recessions
HR- 139bpm
RR -40 /min
SpO2 98% on NPO2 2L/min

18/12/2019 Perinatal Meeting - December 2019 17

Problems Encountered : Management :
Extreme preterm On Nasal CPAP from Day 01 to 05
Extreme LBW IV antibiotics – IV C-penicillin , IV
Mild IRDS Cefotaxime ,
Presumed sepsis IV fluids , IV Vitamin K , IV Aminophyllin
Neonatal Jaundice FFP transfusions (x1)

Outcome : Cause of death :

Sudden desaturation and a bradycardia Extreme prematurity
( 80bpm) with a colour change noted at 8 Extreme LBW
am on 05/07/2022 on baby who was on Baby expired on 05/07/2022 at 8.40am ,
CPAP via the transport ventilator aged 4 days.
Started on Bag and Mask ventilation.
Intubated and ventilated .( ETT- 2.5mm,
Lip level – 7 cm)
3 cycles of Adrenaline given .
NS boluses given
Continued resuscitation upto 25 mins
 4. B/O S.KALEICHELVI
Mother
Age – 18 years
Parity – Primi
POA – 34 weeks + 3 days
AnHx –Hyperechoic enlarged kidney
( PCKD)
Antenatal Scan – NAD
No h/o dribbling or fever
Blood group – B Positive
Baby
Baby girl
D.O.B. 07/07/2022 at 5.46am
T.O.D. – 07/07/2022 at 12.15pm
Birth weight – 1.8kg
Mode – forceps delivery ( LOP)

Clinical Presentation Resuscitation done

Baby didn’t cry at birth Attended by SHO/HO/NO at LR
Colour- Cyanosis Inflation and ventilation breaths given
Tone- Floppy Intubated and ventilated (ETT-3mm, Lip
Breathing – Gasping like breathing level 7.5) .
Heart rate>100 bpm Ambu ventilation given through ET tube.
( APGAR at 1 min 6 Color improved after Intubation.
5 min 7 Transferred to PBU for ventilatory care
10 min 8 )
Problems Encountered
Late prematurity
Frequent desaturations
Congenital abnormalities
Outcome
Desaturation episode along with
bradycardia noted around 12.10
pm on 07/07/2022.
No active resuscitation done.
Baby expired on 07/07/2022 at
12.15pm , aged 1 day.
Management
Sedated and Ventilated
IV antibiotics – IV C-penicillin , IV
Gentamycin
IV fluids , IV Midazolam, IV Vit K
UVC Inserted
Cause of death
Lung hypoplasia associated with
polycystic kidney disease
(CXR- B/L air lucency seen
mediastinum shifted to R/S
DD- Congenital lobar emphysema
on L/S
Pneumothorax )
 5.B/O L.SRIDEVI (T2)
Mother Baby
Age – 31 years Baby girl
Parity- Primi D.O.B- 08/07/2022 at 5.02pm
POA- 27 weeks + 2 days T.O.D- 25/07/2022 at 12.50pm
Antenatal Hx- Nill Birth weight- 700g
PMHx- Nill Mode - NVD (Breech Presentation)
Antenatal Scan – NAD A Positive, DAT Negative
Blood Group – AB Positive

Clinical Presentation Resuscitation done

Baby not cried at birth Attended by SHO/RHO/HO/NO at LR.
Colour – Cyanosed secretions were sucked out
Tone – Good 05 inflation breaths given.
Breathing – Moderate 2 cycles of ventilation breaths given
Heart rate >110bpm Intubated by ETT 2.5mm, Lip level 6.5
Immediately taken into PBU for ventilator
support
UVC Inserted
Problems Encountered
1.Resuscitated at Birth
2.Extreme prematurity
3.Very Low birth weight
4.MCDA Twins
5.Surfactant deficient lung
disease
Outcome
Bradycardia noted around 3.30pm Extreme prematurity with
.Cardiac massage given Ambu
ventilation started.
IV Adrenaline 1mg – 3 cycles
given Heart rate was
dropping .SpO2 not readable.
Resuscitation given for 20
minutes
Baby expired on 24/05/2022 at
4.00pm, aged 5 days.
Management
Sedated and Ventilated
IV antibiotics – IV C-penicillin , IV
Cefotaxime , IV Amikacin , IV
Metronidazole , IV Meropenum ,
IV Salbactum
Surfactant given via ET tube.
IV fluids , IV Immunoglubulin , IV
Omeprazole ,IV Vit K, IV
Midozalam, IV Ig, IV
Phenobarbitone, IV Aminophyllin
FFP transfusions (x2) Platelet
transfusion (x1).
Cause of death
extremely low birth weight
 NEONATAL MORTALITY RATE – FEB 2022-
JULY 2022
At BH - Diyathalawa

NEONATAL MORTALITY RATE = No. of Neonatal Deaths x 1000

Total Live Births

= 5x 1000 /
451

= 11 per
1000 births
 THANK YOU!

18/12/2019 Perinatal Meeting - December 2019 24