Hemorrhagic Disease of the Newborn 04.27.2015

8/20/2019 Hemorrhagic Disease of the Newborn 04.27.2015

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April 27, 2015

Erin Bennett, MD, MPH, PGY-3

Morning Report


2/12

7 week old preio!"l# $e%lt$# &%le pre"ent"wit$'Br!i"ing on "tern!&, kn!(kle")o&iting, poor *eeding, let$%rg#+"!%l "t%te o* $e%lt$ !ntil d%# PAor&%l wet.dirt# di%per"M%rked irrit%/ilit#H%d /een to n"t%%re %nd to % ($iropr%(tor *or

t$e /r!i"ingent to o!t"ide ED %nd w%" noted to $%e

di(!lt# /re%t$ing %nd /r%d#(%rdi%, "o $e w%"int!/%ted %nd tr%n"*erred 4!i(kl#

Hi"tor# o* Pre"ent llne""


3/12

PMH'Born *!ll ter& o (o&pli(%tion" wit$ t$e /irt$ or pregn%n(#

Birt$ weig$t 31 kgM%tern%l l%/" nor&%lo &%tern%l &edi(%tion" d!ring pregn%n(# e6(ept it%&in"

%&il# Hi"tor#'P%tern%l *%&il# &e&/er" wit$ Heredit%r# 8p$ero(#to"i"o "igni9(%nt $i"tor# on &%tern%l "ideBot$ "ide" o* *%&il# o* E%"tern E!rope%n de"(ent

8o(i%l Hi"tor#':ie" wit$ &ot$er %nd *%t$er %t$er re(entl# in(%r(er%ted *or

dr!g" %nd %""%!lt

Hi"tor#


4/12

)it%l"' 35, P 1;0, RR ;0, BP 75.;5, 8p on 8M), r%te 35, PEEP 5, P8 10

GEERA:' nt!/%ted, "ed%ted, in p%poo"eHEAD' Anterior *ont%nelle *!ll 8$%pe' nor&%lEYE8' P!pil" "&%ll %nd "l!ggi"$ /!t re%(tie /il%ter%ll# o "(ler%l i(ter!"

EAR8' or&%l EA e6%&, no eiden(e o* e?!"ion or per*or%tion


5/12

7 week old %*e/rile &%le wit$ o&iting,let$%rg#, *!""ine"", %ltered &ent%l "t%t!", %nd/r!i"ing

A""e""&ent


6/12

8ep"i"

A

Meningiti"

He&orr$%gi( Di"e%"e o* t$e ew/orn.)it%&in De9(ient Bleeding

Heredit%r# 8p$ero(#to"i"

He&op$ili%

)on ille/r%nd $%l%""e&i%

)%"(!l%r M%l*or&%tion

:e!ke&i%

Di?erenti%l Di%gno"i"


7/12

:%/"B.di?' B 13= Hg/ 75.H(t 23, Plt" 3==H8), M) neg8' Blood#, RB 12,550, ot$erwi"e n&lMP' onl# not%/le *or /ili P, P, R %ll initi%ll# nor&%l, t$en /orderline

prolongedP)A- FProtein" ind!(ed in )it%&in A/"en(e2486 Fnor&%l 3

Mi(roBlood %nd !rine (!lt!re" neg%tie

ork +p


8/12

CT Head 1 $e /r%in %"(!l%t!re i" di"pl%(ed"e(ond%r# to t$e l%rge %&o!nt o*

"!/d!r%l %nd p%ren($#&%l /lood int$e rig$t (ere/r%l $e&i"p$ere

2 o eiden(e o* %"(!l%r inI!r# or

%"(!l%r &%l*or&%tion 3 Midline "$i*t

; Di?!"e lo"" o* gr%#-w$itedi?erenti%tion t$ro!g$o!t t$e rig$t"!perol%ter%l $e&i"p$ere %" well %"in t$e p%riet%l lo/e, te&por%l lo/e,

%nd o((ipit%l lo/e o* t$e le*t (ere/r%l$e&i"p$ere

5 n(re%"ing e?%(e&ent o* t$e/%"%l (i"tern" %" well %" "!/*%l(ine

$erni%tion n(re%"ing "(%lp "welling

&%ging


9/12

E%rl#


10/12

&&%t!re lier doe" not !tiliKe )it%&in e(ientl#

:ow )it%&in "tore" %nd "$ort $%l*-li*e%n t%ke =0 d%#" to nor&%liKe

:ow )it%&in in /re%"t &ilk&&%t!re.%ltered g!t Lor%Poor pl%(ent%l tr%n"*er o* )it%&in

$# new/orn" %re %t ri"k


11/12

:%/"Prolonged P, R, P Fin "eere (%"e"Ele%ted P)A-)it%&in leel" not &e%"!red %" o*ten

Prop$#l%6i"' )it%&in 05-1 &g M)it%&in %(ti%te" , ), @, @

re%t&ent)it%&in PRe(o&/in%nt %(tor )8!rger#

M%n%ge&ent


12/12

$ttp"'..www-!ptod%te-(o&eKpro6#li/!t%$ed!.(ontent".oeriew-o*-it%&in-k"o!r(eN"eeOlink"e(tion%&eNPreentiono*it%&inde9(ient/leedinginnew/orn"%n($orNH1=QH

8($!le, R, ord%n, :, Mor%d, A, et %l Ri"e in :%te

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Hemorrhagic Disease of the Newborn 04.27.2015