Question of the Week
Question :
Posted On : 20 Jul 2014
there is 32 week born male baby born by lscs to primi mother in eclampsia for which mother was given magnesium sulfate ,eptoin,midaz and then LSCS performed under GA. baby cried weakly after birth but soon got depressed with no spontaneous respiration and heart rate Less than 30.baby was intubated and shifted to my hospital for ventilatory management.baby was kept on CMV mode of ventilator on 3 days and weaned after day 3 .on day 3 baby developed pedal edema looking just like sclerema with CRP positive by 1:12 titer.Xray showing reticular pattern of early RDS.rest of hemogram was normal. i was giving combination of Cefoperazone and sulbactum. which will be better alternative in this case_? should i wean him off completely from ventilator as he is now on CPAP_?
photograph attached

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Expert Answer :
It appears like a typical 32 weeker born by Emergency Section for maternal emergency - hence we expect SEVERE RDS in these sort of babies who need to be managed aggressively in first few days with ventilation and surfactant. If surfactant has not been given, then these sort of babies will need few days of CPAP. Sepsis - both clinical and presumed are common - need to be treated. Cefoperazone seems to be on the top - we use baseline antibiotics - Amoxycillin and Gentamicin.
Answer Discussion :
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