• Sadunima Karunarathne,2 years & 6 months old twin baby girl from Pasyala presented to the developmental clinic with a delay in walking.

• She is premature • born at 30wks & 4 days by a normal vaginal

delivery.• No complications during pregnancy

but suddenly due to the rupture of the membrane she gave birth to twins.

• Presented in breech presentation & it has been a prolonged labour which has taken 45mins to deliver her.

• Her birth weight was 1.370gms. Liqure clear. Length - 35cm OFC – 28cm

• Baby was found to be in respiratory depressed @ birth & she was resuscitated with 2*5 inflation breaths.

APGAR SCORE

1 min 5mins 10mins

1 5 7

• Baby was kept in the SCBU for 12 days & expressed breast milk was given 2days after the birth.

• At 20 days of age - her both eyes were undergone a lazer treatment.

• At the age of 8 months she was found to have a herniaion @ the right inguinal area & @ 17 months it was surgically removed.

No past history of seizures.

• Other baby didn’t have any complications during birth & her development is appropriate to her age.

Developmental History :-• Until 1 year & 3 months, the age which she has started

commander crawling parents haven’t noticed any delay in her development.

• Due to delayed walking in March she was taken to Ragama Rehabilitation center & physiotherapy was done.

• After that Physiotherapy was given from a private place in Kadawatha,but there was no significant improvement.

• Currently Baby is capable of standing with aid but can not walk without aid.

• She is capable of making simple phrases using two or three words but doesn’t say sentences constantly. She can draw a line & plays interactively with her sister.

• Immunizations are up to date.• Drug history – At birth IV Penicillin & Amoxillin

was given for 7 days. • No known allergies.• No family history of similar conditions.• Social history :- Father -37 years,Businessman,no medical

conditions, sometimes allergic to food consuming lot of flour.

Mother-28 years,house-wife,no medical conditions.Income is Rs.40,000 per month.

• Living in a one story rented house.It is close to their grandparents house so get their support to look after the children.Examination

• Child looks alert & happy.When walking with aid Spastic gait was seen. Hip and the knees are flexed & touching each other,walks from toes.

• Lower limb examinationQuadriceps looks wasted, both ankles are planter flexed,hypertonic,exaggerated reflexes, Clones absent.

• Examination of other systems including upper limbs were unremarkable.

Investigations done :-• After 10 days from birth USS of the

brain,KUB,hips & a Chest X-Ray was done.• They all appeared to be normal.• At 2 months of age another USS of the brain

was done & was reported of having B/L periventriculer cystic lesions & was suggested to follow up in one month.

• The next scan appeared normal.