XVII Annual Conference of IAP Maharashtra State (Mahapedicon 2006, Solapur, 3-5th November 2006)

Dr. Atul A. Kulkarni, M.D. (Paed), Dr. Sachin M. Andhalkar, Resident
Department of Paediatrics, Ashwini Sahakari Rugnalaya & Research Centre, Solapur.

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Case History: A full term Female neonate born to 23 years primigravida with birth weight 2.8 kg and evidence of delayed cry after birth.  Antenatally, ultrasound reveals fetal ascites at 28 weeks of gestation and termination of pregnancy was advised at Pune. TORCH screening was negative. Pregnancy was continued and at term ultrasound showed increase in fetal ascites with? partially obstructed umbilical venous flow with IUGR, done at Solapur.

After normal vaginal delivery baby required resuscitation and about 200ml of clear ascitic tap was done immediately and baby shifted to NICU. Basic support with IV Fluids and Oxygenation was given.

About 1.5 litres. of ascitic fluid was tapped gradually over 48 hours, by the end of second day weighing the baby only 1.6 kg.

• Complete blood count was normal,
  
• Retic count 3% with no evidence of hemolysis
  
• Blood urea – 16 mg /dl, Sr. Creatinine - 0.4 mg /dl,
  
• SGPT and Sr. Proteins are within normal limits.
  
• X-ray reviewed homogenous opacity in abdomen.
  
• USG reviewed minimal ascitic fluid after tapping, with no organomegaly. Liver and kidney was normal with no obstructive signs like hydroureter, hydronephrosis, hypertrophic bladder. No chyle was seen. Ascitic fluid was transudative in nature.
  
• Colour doppler was normal

After general condition stabilized, baby accepted the feeds and gradually showed improvement with no recurrence of ascites and was discharged.
After 1 month baby was normal, with weight 2.3 kg, no ascitis, only abdominal wall weakness present.
Now the patient is 10 years old with normal mental, social, behavioural development and scholastic performance.