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Preterm baby with neonatal meningitis - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Child Health
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions

User :   i have a boy that was born at 28 weeks and his estmated gestatinal age is now 30 weeks and 4 days he had cotracted ecoli at 5 days old and then showed signs of mengitus but we still have not gotten a clean spinal to prove that now he has a IVH that a ventrcal tap that pulled only blood show negtive in the cultures done on it.... This poor child has been put through intabation and 3 spinals an over dose of 5 times the amount of amakacin also somthing happend to the ventaltor that cause him to get fluid in the right lung on saterday night and he clamped down and his heart rate dropped and after two shots of epinephrine he opened up and the were able to reintabate him also had stressceasures witch have been halted by Phenobarbital. Now we have seen a total of 5 neonatoligest and all have a diffrent opinon and one decied this and the other decieds that we have watch as the played with his blood pressure and heart rate and one thing this the other that we watched as one weened of dompimine and the other start it back on take hime off the phenobarbital and the other start one keep him so sadated you couldnt even tell he was alive and the other do the total oppsite i am now takling to doctor number 6 who of course want anthore spinal and now an MRI we oked the MRI but dont see the need for a spinal becuse of a high crp that has been up and down since this has all started we really need help and advice and dont know what to do next
Doctor :   Hi
Doctor :  
Give me a minute to go read through.
User :   no problem
Doctor :  
I shall help you in this.
User :   please do i am about beside myself
Doctor :  
If MRI was normal , a CSF analysis is needed not only for diagnosis but also on choosing a better antibiotics,
Doctor :   It obviously look like amikacin is not benefetting him

Doctor :   Hi
User :   sorry about that
User :   my husban and i have thought about transfreeing him out of this nicu to childrens in dallas but dont know if he is stable enough or if we will get the right care
Doctor :   what is his present condition?

User :   i have a boy that was born at 28 weeks and his estmated gestatinal age is now 30 weeks and 4 days he had cotracted ecoli at 5 days old and then showed signs of mengitus but we still have not gotten a clean spinal to prove that now he has a IVH that a ventrcal tap that pulled only blood show negtive in the cultures done on it.... This poor child has been put through intabation and 3 spinals an over dose of 5 times the amount of amakacin also somthing happend to the ventaltor that cause him to get fluid in the right lung on saterday night and he clamped down and his heart rate dropped and after two shots of epinephrine he opened up and the were able to reintabate him also had stressceasures witch have been halted by Phenobarbital. Now we have seen a total of 5 neonatoligest and all have a diffrent opinon and one decied this and the other decieds that we have watch as the played with his blood pressure and heart rate and one thing this the other that we watched as one weened of dompimine and the other start it back on take hime off the phenobarbital and the other start one keep him so sadated you couldnt even tell he was alive and the other do the total oppsite i am now takling to doctor number 6 who of course want anthore spinal and now an MRI we oked the MRI but dont see the need for a spinal becuse of a high crp that has been up and down since this has all started we really need help and advice and dont know what to do next
User :   he is 17 day old now
Doctor :   the boy was born at 28 weeks

User :   well that is the estmation
Doctor :   so he is a premature child
User :   i think he was closer to 30 weeks
User :   yes
Doctor :   the premature child at the age of 28 or 30weeks needs nicu support for the survival
User :   yes he is in the nicu as of the day he was born
Doctor :   his lungs kidney and other major organs are not mature enough to function
User :   i have already had one child in the NICU he is number 2
Doctor :   ok
User :   we need help all of this has gotton us to the point that when you touch our son just to change a dipar he desats
Doctor :  
ok
Doctor :  
what is the present condition of the child
User :   ok i am sorry to ask i havent slept in day what do you mean
Doctor :   i have understood the condition
Doctor :  
i need to no what have the neonatologist
Doctor :  
doing as of now
Doctor :  
and on what medication he is on
Doctor :   what is the present probable diagnosis?
User :   amackacin clafrin
Doctor :  
ok
User :   tpn and fat emultions, phenal
User :   blood gases have been ok
Doctor :  
ok
User :   he is responsive when you touch hime or if you talk around him he is opening his eyes and kicking feet the hands ar now starting to move a little his movement are shokie
User :   my spelling is horrable i am sorry
Doctor :  
no problem
User :   the brain sono hasent changed much after thrusday the sunday ventral tap with sono showed no more swelling of the left ventrcail and the abdoman sono showed normal
Doctor :   good
User :   the ventracal tap pulled only blood the cultrus have come back with no sign of infection
Doctor :   ok
User :   we are tring to figure out why this doc want a spinal tap expecilly with the ivh and why the mri
Doctor :   the child is extremely premature in birth ( 28 to 31 weeks)
Doctor :  
and the most common cause would be infection
User :   right but is what happend sat and sunday a reason for the high crp
User :   it went from 12 to 16
Doctor :   i shall explain you
Doctor :  
relax not to worry
Doctor :  
as i was telling
Doctor :  
the infection causing the premature birth sometime does not show up in the multiple tests also
Doctor :   the premature child born will be extremely sensitive to the infection and the infection of the brain is the most common in them
Doctor :  
so he was put on higher antibiotics to treat the infection
Doctor :  
the sequale of the infection is the csf flow irregularities- resulting in as you have noticed high csf pressure, seizures etc
Doctor :   the cause for the left ventricle swelling is obstruction to the flow of the CSF as a result of infection
Doctor :   could you follow me?
User :   yes
Doctor :   ok
User :   if the infection is what caused the obstruction then why isnt the cultrurs taken coming up positive for the ecoli infection
Doctor :   the baby is put on antibiotics from the day 1. and this culture is done to confirm the bacteria infection is cleared
Doctor :  
further to check whether the Ecoli is resistant to the present antibiotic or not
Doctor :  
if it is still persisting
User :   ok now i am confused the most resent cultrue the ventrcal and the blood done on sunday still show no ecoli
Doctor :   i shall explain you

User :   i understand the will be treating with the anitbotic for three more weeks that dosent bother me
Doctor :  
ok
Doctor :   now the focus is directed in preventing or limiting the long term disability due to this infectious brain injury
Doctor :   are you following me
User :   yes i am
Doctor :  
if you have any doubt please let me no
Doctor :  
ok
User :   the whole problem is i am not sure if infection is what cased the ivh
User :   i still go back to could the high overdose of the amakicin and the stress of the over sadation cause the ivh expessily since the ivh is common in preemies under the 32 gestational age
Doctor :   no
Doctor :  
it is not true
Doctor :  
the most common cause is the infection leading to obstruction of the csf flow
User :   what about the L and Ps
Doctor :   L and p means?
User :   lower lumbar punture
Doctor :   ok LP- it is a usual procedure to with draw the csf from the spine
Doctor :   that is one of the tests
User :   could the lp cause the ivh
Doctor :   it will infact reduce the csf volume and inturn reduce the IVH and not increase it
User :   ok
Doctor :   as i told IVH is caused by excess csf accumulation in the skul
Doctor :  
it is accumulated because there will be obstruction to the flow of the csf
Doctor :   MRI is asked to know the structural of the brain and to study the channels in which the csf flows to see whether is there any obstruction or not
Doctor :   as of now the child is opening the eyes and responding to touch

Doctor :  
this is a good and favorable sign
Doctor :  
did you discuss with the present neonatologist about his further plan of action?
User :   well she dosent seem to want to answer that
User :   becuse she is there for two days
Doctor :   ok
Doctor :   here the main focus should be to control the IVH
User :   but it isnt
Doctor :   it will take time
User :   but time we dont have
Doctor :   reason?
User :   it seems the more the do theses things the worse he gets
User :   and how many doctors do we have to see before we get to see the same one
Doctor :   so what are you planning to do?

User :   i dont know
User :   that is why we need help
User :   should we transfree him to a better nicu or should we just stay and ride theses waves
Doctor :   transferring the child is not safe at this moment.
Doctor :  
if at all you need to transfer than it has to be at the opinion of the consulting doctor
Doctor :   the transit also do have some risks, you need to keep this in mind
Doctor :   you can consult a doctor at the place were you want to transfer and give him all the details
Doctor :  
at his opinion you can proceed otherwise not
User :   i just dont want to risk his life anymore
User :   thank you i am sure that is all the advice you can give to us
Doctor :   to be honest the treatment is going in right direction at the present situation, as they are fighting with an important issue of IVH.
Doctor :  
the child will be brought back to normalcy
Doctor :  
though it is a extremely premature child
User :   well you have a blessed night thank you
Doctor :  
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