Question of the Week

Question :
Posted On : 12 Feb 2023
A newborn delivered at 34-35 weeks, weighing 1.8 kg, the child had MSAF also, the child was kept in NICU and observed, there were no s, s of RDS and feeds started on D2 (KC feed plus BF) as sucking was also good. The child developed slight abdominal distension {with bowel sounds normal} after 6-8 hours of feeds and an Infant feeding tube placed, the child was comfortable so started on NG feeds subsequently, the child developed fresh bleeding through NGT around 4-5ml and the feeds stopped. The child was evaluated for NEC, his platelets, Hb and Na are normal, his Abdominal circumference has not increased and the bleeding stopped. APTT, and PT done were deranged (APTT More than 120 sec, INR 2). The child is comfortable, with no bleeding, no petechiae, sucking good, no Bradycardia, tachy, no Bleeding PR. Vitamin K was given at birth. CRP counts are normal. What are the possibilities apart from the wrong APTT, and PT? What advice did you give? When should feeds be restarted?
Expert Answer :
NEC is a clinical diagnosis - supported by clinical investigations. Normal Hb and Na do not rule out Stage 1 NEC! Some babies may benefit from one more dose of Vitamin K given in these sorts of situations. Sepsis has to be kept in mind - and I would suggest STOP feeds till blood has stopped and distension resolved and reviewed - maybe at least 72 hours of feeds being stopped is better.
Answer Discussion :
hdn, feed after 24 hours, start low volume feeds and see for aspirate, if no blood,increase to full feeds
1 month ago
Sameer Chaus
Early HDN....Inj vit K should be given in therapeutic dose and then APTT AND INR reassessed after 4-6hrs... improvement will confirm vit K deficiency
feeds can be started from next day if no altered aspirates

1 month ago
DrZohdi Alhanouty
hemorrhagic disease of newborns, maybe vit k was not given at birth.
1 month ago
pooja chaubey
feeding should be restarted when no aspirate is seen in tube
1 month ago
Eda sahin
maternal blood?
vit k deficiency due to be premature

1 month ago

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