neonatology - Neonatal problems
Under Category :  Neonatal problems
Posted By :  Dr.  SUNDEEP NIGAM
Posted On : 5/4/2013 8:33 AM
starting antibiotrics in rising CRP new born ?
a preterm ,lbw {1.85 kg}baby having TSB-14 CRP on day 2 -17,and on day 3 -27,othervise aby is asymptomatic, should we start antibiotic just on rising CRP from 17 to 27 even if TLC ,DLC ar wnl_?_?when C, S facility is not available_?_?
 
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thanks for excellent exlpanation Sir, as
the blood culture facility was not there ,
i started antibiotics on D3 now all is well, baby has been discharged
Dr. SUNDEEP NIGAM says,
5/14/2013 6:26:39 AM
Dr. PURUSHOTHAMAN says,
5/12/2013 5:40:56 PM
Thank you Sundip for your nice words... I am more of a learner than teacher .. like both , that is why i am in this forum
This baby is preterm , small for gestational age , ie prematurity part is not much worrying ..
No risk factor for sepsis from what you mentioned.
He is prone for hypoglycemia , due to low birth weight factor and mothers feeding problem.. and he has developed hypoglycemia and hypothermia , both can be explained that way .
Jaundice seems occured from second day , without group incompactibility . No associated pallor , spleen , no cephal hematoma or additional risk factors.. Even though it is a bit higher Phototherappy is enough .
Neither jaundice , hypoglycemia , hypothermia need be explained as manifestations of sepsis , clinically because ....
a. No risk factor of sepsis and the manifestations occured on second day . .
b. Clinically baby is active , taking spoon feeds..
The second argument is more valid.. A sepsis significant enough to causey hypoglycemia , hypothermia, and jaudice ,,very unlikely to take spoon feeds ,,,,
There are no golden rules . in medicine . .Nothing is impossible in medicine But in practice we use the logic ,, and rarely only bypass this

When clinically no points for sepsis .. i ll ignore all lab results.. especially screening ones.. You may ask back .. , In the above case if multiple sepsis screening are possible ....specificity goes high.. Still my answer ll be NO
If you get a blood culture _? positive... I ll check back once again ,, is there a possibilty of contamination .. , what method.of culture ..BACTAC _?, what is the previous experiences of microbilogical report from our institution.. Should i follow up , repeat culture...
Just one message .. Dont rely too much on investigations ,,even if that is said to be gold standard...When the patients clinical condition is arguing against..More weight should be given for clinical condition...investigation results are always supporing your clinical judgements..
THANKS SIR, YOU ALWAYS EXPLAINED THINGS
LIKE A GOOD TEACHER,this baby was 35
weeks, 1.85 kg wt, cry immediate, blood
group of baby and mother was same, baby had an episode of hypoglycemia and
hypothermia , jaundice was noticed on
D2,cbc crp tsb was done , cbc was wnl,
crp 17 , tsb 12.5, hence PT was
started,on day 3 crp was 27 tsb was
14.5 .baby was accepting spoon feed
well, but not able to suck mother`s
milk due to retracted nipple.On that
day there was dilema whether to start
antibiotics or not_?_?
Dr. SUNDEEP NIGAM says,
5/12/2013 4:36:38 AM
Dr. PURUSHOTHAMAN says,
5/9/2013 7:56:50 AM
1. Please give clinical details before your doubt.. Here your doubt is whether to put the patient on antibiotics............
Antibiotic is a drug given to save a person from bacterial infection..There should be evidence of infection {not colonisation...},clinically or lab support.. To answer this question how far you rely on lab report . The fasion now a days is to ignore clinical evidence., ignore the patient. look at the gadgets or lab reports or images or what not....
Here lot of basic facts are not looked in to ..
A two day old baby. .. . , preterm low birth weight .. how preterm..._?.
is there any risk factor for sepsis _?
Did he, she had any problem with maturiey or low birth weight .. _?
Any interventions done on this patient.._?
You said the baby is active feeding ...jaundiced 14 mg..any patient with jaundice mention the blood group . of patient , parents.........No mention about pallor or spleen..how can you judge the reason for jaundice..how can you take that jaundice due to sepsis...

why should anybody Prick a newborn without justification...............Why should you send for routene Sepsis screen...
2.Dont treat the investigations...............Treat the patient............Dont do investigations especially they are costly , especially they are invasive.............



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