4th Pediatric Infectious Diseases Conference
 
 
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Specialist Answers
Question
This is a case for section "Diagnostic Dilemma". Full term Neonate born by LSCS--Indication-- Primi breech,was severly asphysiated at birth. After resuscitation by usual protocols she was found to have the following cong anamolies; Joint contractures at hip and knee joints, dislocated wrist joints, muscle hypoplasia, generalized hypotonia, B/L undesended testis with poorly developed scrotum ,low hair line with short neck, high arched palate. On second day she developed a systolic murmur without cyanosis or failure- probably VSD. On Fourth day she developed progressively increasing jaundice with acholic stools. Investigations so far:CBC+platelets-Normal CRP-1:16, S.Bilirubin-27mg%Direct-20.4mg%,SGPT-30IU/L,S.Alk Phospatase-141IU/L,TORCH IgM Negative,S.Urea Creatinine-Normal, USG Abd and Brain is normal ,Kiddigram -absent fibula Rt. What could be the probable diagnosis? How can rpt SGPT be normal despite such high direct bilirubinemia?
Answer
One must rule out Zellweger syndrome. The direct jaundice without raised liver enzymes is suggestive of obstruction most likely Biliary Atresia or Choledochal cyst. A USG of abdomen (especially look at gall bladder), MRCP and HIDA scan would be useful.

Regarding all the congenital anomalies, a karyotype would be required.

 
 
 
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Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?
No, it should be used only after drug sensitivity report
Yes, under guidance of an infectious disease expert
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