4th Pediatric Infectious Diseases Conference
 
 
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Specialist Answers
Question
A neonate on live day 3 presents with dullness. On examination vitals are stable, crying,sucking,activity and neonatal reflexes are not satisfactory.Had pallor and hepatomegaly. IV antibiotics , iv fluids are started and CBC, CRP done.Vitamin K is also given. Hb is 10.3g/dl, TLC is 2 lacs/mm3 with normal platelets. 40% normoblasts are seen and there are no atypical WBCs seen.This high TLC was attributed to the error by cell counter, reading normoblasts as WBCs(as manual TLC later found was just 9000/cumm) . The baby showed improvement initially but on day 5 he had massive hemetemesis and the child was in impending hemorrhagic shock which was managed by FFPs and packed red cells.PT & PTT before transfusions were 35 and 100 secs respectively. What is the further line of investigations & management and what is the differential diagnosis besides neonatal leukemia?
Answer
Infection would be the first thing one needs to rule out. Also since the child had hepatomgaly and deranged PT and PTT,liver disease should also be ruled out. What are the liver function tests? Also a bleeding disorder should be ruled out.Do a USG of the skull to rule out intracranial bleed.
 
 
 
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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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