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Child has thromobcytosis. UVC tube given. Slight increased prominence of bowel loops. Advice?

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please see my previous questions, as i wonder if its related. is it bad if a "UVC catheter tip is in the superior RA or Low SVC? is this anything worrysome? my daughter has thromobcytosis...and acrocyanosis & ear creases- i am wondering why they wont give her an echo-- what could be a possible complication? i have been worried about her heart....pasted : Since the examination earlier this morning at 1:45 a.m., the enteric
tube has been pulled back with tip now lying near the GE junction. New
UVC catheter tip in the superior RA or low SVC. This could be pulled
back approximately 2.0 cm.
Slight increase in ill-defined hazy opacities within the perihilar
right lung as well as the right lung apex and lung base. Similar but
less marked opacities in the left lung are unchanged. Normal
cardiothymic silhouette. Slight increased prominence of bowel loops. A
few small lucencies project over the bowel in the left abdomen. This
may be due to intestinal secretions. A tiny amount of pneumatosis
could have this appearance, but is considered less likely. Continued
followup recommended
Posted Wed, 27 Mar 2013 in X-ray, Lab tests and Scans
 
 
Answered by Dr. Y V Siva Sankara Murty 1 hour later
Hi,

Thanks for writing to health care magic.

I tried to get to your previous posts and could not have a look at them. I clicked on your profile. I could see that you asked 2 premium questions but I could have the details of them. May be this is done for privacy purpose or something. So request you to copy and paste it for me so that I can have a look.

The umbilical venous catheter tip is normally placed in the inferior vena cava above the diaphragm near right atrium. It is slightly placed high. A X XXXXXXX is normally taken to have a look at its position post placement. Since it is highly placed it will be pulled back by your baby's doctor. Not to worry about that.

Thromocytosis could be because of various conditions in newborn. It could be related to stress at delivery, sepsis, prematurity, respiratory distress syndrome etc.
I can explain you in detail and in a more simpler format if I have further details regarding your baby.

Acrocynosis in babies can occur because of various causes including respiratory problems and cardiac problems. I require further details to answer your questions.

So I request you to update me with your previous posts if they contain all the details.
Some questions are required to be answered.

Was it a term or preterm delivery?
Any complications or significant history of mother?
Did the baby cry immediately after birth?
When did the seizures start?
Are they controlled now?
Is the baby on a ventilator?

Please answer the above and upload any detail you have regarding your baby so that I can answer your queries.

Hope this helps.
Take care

Dr Y V Siva Sankara Murty
M.D.(Pediatrics)
Associate Professor of Pediatrics

Above answer was peer-reviewed by
 
Follow-up: Child has thromobcytosis. UVC tube given. Slight increased prominence of bowel loops. Advice? 1 hour later
the only complications i had during pregnancy was excessive weight gain - but not diabetes. baby was 13 days late and delivered c-section after going tachycardic (they tried to make me push) I was in hard labor for a very long time without the drs coming in to check me, when they did iwas dialated to 10 fully effaced, they left again cam back 45 min later, i pushed for 10 min and babies heart rate skyrocketed- rushed to c-secion where they had to put me to sleep because i was panicking. I woke up to her in the ICU 10 lbs, 14 oz. According to the drs, her 02 was 60% for 13 min then it went to 75% at 13 min (does that cause brain damage?) they had her on cpap for two hours. she was admitted to icu to rule out an infection (she didnt have) because of the tachycardia and temperature, according to them. I have been worried about her turning blue around the mouth (not tongue or lips) and possible seizures since her birth. i was looking at her online account i found out she had thrombocytosis upon delivery and high platelet count she has from XXXXXXX 1 to this day. i would like to send two videos i wonder if its a laughing seizure and regular. ei refuse to believe her acrocyanosis and blood counts are not due to something!
WWW.WWWW.WW WWW.WWWW.WW
 
 
Answered by Dr. Y V Siva Sankara Murty 1 hour later
Hi,

Thanks for your reply.

I tried to look at the video by doing a copy paste of the link.

But I could not see them. The first link said "sorry it is private". The second link gave a message "sorry video could not be found". Can you upload them again and show me the video for a better detailed answer.

In new born period the seizures are difficult to distinguish from normal behavior of a new born. The normal behavior of a new born like lip smacking may be confused with a seizure.

An echocardiography is definitely indicated if central cyanosis (bluish discoloration of lips, tongue) are present. But you are mentioning that there is no discoloration of lips and tongue.

So from your message I understand that your baby is born in January....
1. How many days old she is now?
2. What is the progress of her till to date?
3. Is she on a ventilator or she continues to be on a CPAP (or oxygen by hood)?
4. Is she on some feeds or only IV fluids?
5. Is she on antibiotics till now?
6. Are there any seizures now? Is she on anti epileptic medication?
7. What are the other reports like?
a. Total blood counts (please mention previous and current values for all investigations)
b. CRP
c. Peripheral smear for sepsis?
d. Ultra sound cranium?
f. Serum electrolytes?
g. Blood gas analysis (ABG)
H. Serum calcium levels?

Please update me with all these and any other reports you can get access to.
Please ask all your doubts regarding your baby so that I can try and explain to you.

I request you to completely use your follow up available for asking your query.

I pray for the speedy recovery of your baby.

Hope this helps.
Take care.

Dr Y V Siva Sankara Murty
M.D.(Pediatrics)
Associate Professor of Pediatrics

Above answer was peer-reviewed by
 
Follow-up: Child has thromobcytosis. UVC tube given. Slight increased prominence of bowel loops. Advice? 1 hour later
i am so sorry, i thought i save the changes to public. please try now.
http://youtu.be/zqQZEL_AbCs
http://youtu.be/bsY-KtoZH2c
she is 4 months old, born October 24 2012.
Hemoglobin

February 12, 2013

11.7 g/dL

Show historical results
10.0 - 14.0

Hematocrit

February 12, 2013



33.3 %






Show historical results
28.0 - 42.0


Erythrocytes

February 12, 2013

4.13 x10(12)/L

Show historical results
3.10 - 4.50

MCV

February 12, 2013

80.6 fL


Show historical results
77.0 - 110.0

RBC Distrib Width

February 12, 2013

13.1 %


Show historical results
SeeComment

Reference Range: Reference values have not been established for patients who are less than 24 months of age.

Leukocytes

February 12, 2013

9.8 x10(9)/L

Show historical results
5.0 - 15.0

Platelet Count

February 12, 2013



576 x10(9)/L

Show historical results
150 - 350

Glucose(P)

February 12, 2013

89 mg/dL

Show historical results
SeeComment


Reference Range: Reference values have not been established for patients that are less than 12 months of age.

Last Intake.

February 12, 2013

5 hr
Show historical results


Hematocrit,POCT,B

January 01, 2013

33.0 %

Show historical results
28.0 - 42.0

Performed at the Point of Care

pH (FOR CALCIUM, IONIZED [B])

January 01, 2013

7.44

Show historical results
7.35 - 7.45

Performed at the Point of Care

Glucose, POCT

January 01, 2013



101 mg/dL
Show historical results

Performed at the Point of Care

Calcium,Ionized(B)

January 01, 2013

5.50 mg/dL

Show historical results
Performed at the Point of Care
Sample Site

January 01, 2013

Artstick

Show historical results

Performed at the Point of Care

P O2
January 01, 2013

94 mm Hg

Show historical results
70 - 100


Performed at the Point of Care




Neutrophils

January 01, 2013



2.03 x10(9)/L






Show historical results
1.00 - 8.50
Lymphocytes

January 01, 2013

6.86 x10(9)/L


Show historical results
4.00 - 13.50

Monocytes

January 01, 2013

0.76 x10(9)/L

Show historical results
0.05 - 1.10

Eosinophils

January 01, 2013



0.44 x10(9)/L
historical results
0.02 - 0.85
hils.

January 01, 2013
x10(9)/L


Show historical results
0.00 - 0.60

2 of 6< Prev
Next >

Sodium, B

January 01, 2013



139 mmol/L
Show historical results
Performed at the Point of Care
otassium, B

January 01, 2013



4.1 mmol/L

Show historical results

Performed at the Point of Care

P CO2

January 01, 2013

35 mm Hg

Show historical results
35 - 45
Performed at the Point of Care
pH (w/ABG)

January 01, 2013
7.44
Show historical results
7.35 - 7.45


Performed at the Point of Care




Base

January 01, 2013



-1 mmol/L
Show historical results
-2 - 2
Performed at the Point of Care
HCO3

January 01, 2013
23 mmol/L
Show historical results
21 - 25


Performed at the Point of Care
Last Intake
October 26, 2012
<1 hour
Show historical results
Site

October 26, 2012

Capillary

Show historical results
Bilirubin,Total

October 25, 2012

7.6 mg/dL
Show historical results
SeeComment

Reference Range: Reference values have not been established for patients that are less than 12 months of age.

Minn Newborn Screen

October 25, 2012
- Neg.

Show historical results

3 of 6< Prev
Next >

Sodium, B

January 01, 2013



139 mmol/L






Show historical results



Performed at the Point of Care




Potassium, B

January 01, 2013
4.1 mmol/L
Show historical results
Performed at the Point of Care
P CO2

January 01, 2013
35 mm Hg

Show historical results
35 - 45


Performed at the Point of Care




pH (w/ABG)

January 01, 2013

7.44

Show historical results
7.35 - 7.45


Performed at the Point of Care




Base

January 01, 2013

-1 mmol/L

Show historical results
-2 - 2
Performed at the Point of Care

HCO3
January 01, 2013
23 mmol/L
Show historical results
21 - 25
Performed at the Point of Care
Last Intake

October 26, 2012
<1 hour
Show historical results
Site
October 26, 2012
Capillary
Show historical results
Bilirubin,Total
October 25, 2012
7.6 mg/dL
Show historical results
SeeComment
Reference Range: Reference values have not been established for patients that are less than 12 months of age.
Minn Newborn Screen
October 25, 2012
- Neg.
Show historical results
3 of 6< Prev
Next >
Sodium, B

January 01, 2013
139 mmol/L
Show historical results
Performed at the Point of Care
Potassium, B
January 01, 2013
4.1 mmol/L
Show historical results

Performed at the Point of Care

P CO2

January 01, 2013
35 mm Hg
Show historical results
35 - 45
Performed at the Point of Care
pH (w/ABG)

January 01, 2013

7.44

Show historical results
7.35 - 7.45


Performed at the Point of Care

Base

January 01, 2013

-1 mmol/L

Show historical results
-2 - 2

Performed at the Point of Care

HCO3

January 01, 2013
23 mmol/L

Show historical results
21 - 25

Performed at the Point of Care

Last Intake

October 26, 2012
<1 hour

Show historical results
site

October 26, 2012

Capillary

Show historical results

Bilirubin,Total

October 25, 2012

7.6 mg/dL


Show historical results
SeeComment


Reference Range: Reference values have not been established for patients that are less than 12 months of age.

Minn Newborn Screen

October 25, 2012


- Neg.

Show historical results

3 of 6< Prev


Also, he cyanosis is around her mouth, not lips and inside her mouth. where a moustache would be on a man- is frequently bluish in color. im not sure how well the videos show her (poss) seizure, i have been getting better ones this weekend. when i hold her shaking limbs down, she stiffens and her shoulder raise up.
Next >
i was wondering if there is a possible complication to the uvc going too far, if the amount of time she was low 02 could cause brain damage, if thrombosis and tachycardia were from her being stuck in me & rough labor and if her ear creases and acrocyanosis deserve an echo- or what could be causing it? Also if she is seizuring, and what i should do for heart/neuro tests to rule out heart or seizure problems. I am so overwhelmed that i dont even know what to ask, I am sorry! If you see anything worth pointing out or what I should do please let me know!
 
 
Answered by Dr. Y V Siva Sankara Murty 42 minutes later
Hi XXXXXXX,

Thanks for your reply.

I went through the investigation reports and both those videos. I do not think they were seizures. What I could see is a happy playful baby. The stiffening of the body and rising of shoulders can occur if a playful baby is stopped from moving her limbs.

Regarding cyanosis around her mouth..... If it is cyanosis the lips and tongue will also be blue (I could not make any difference in color on the video). What about the color of her peripheries?

Regarding the brain damage you were worried of. I request you to stop worrying about them. Only developmental monitoring can give us a clue regarding them.
New born brain is reacts variably to damage. Surprisingly we come across babies who seem to be severely damaged at birth and their development and activity remains normal.

What is the present developmental state of your baby?
I can see her nicely holding the neck in the video. Since when is she holding the neck?
Does she sit with support? Do not worry even if your baby does not achieve this. It is normally done at 5 months of age.
Is she on any anti-epileptic medication or any other medication?
Is your baby breast feeding normally?

I request you to breast feed your baby... and do exclusive breast feeding till 6 months of age. It will help in brain growth apart from several other advantages it has got. Continue breast feeding till 2 years of age.

Please reply in detail.

Hope this helps.
Take care

Dr Y V Siva Sankara Murty
Above answer was peer-reviewed by
 
Follow-up: Child has thromobcytosis. UVC tube given. Slight increased prominence of bowel loops. Advice? 3 days later
my babys CO2 level was 70 at birth, is this cause for concern? they said that she was below 60 02 level until 13 minutes, then she was at 75...I am sorry i am not getting answers! are there any other ways to test her heart and lungs? what about a LDH test? I am frustrated that they wont give my daughter with cyanosis and ear creases an ECHO- wouldnt they usually do that for a baby with these symptoms?
Objective measurements of the severity of cerebral hypoxia depend on the cause. Blood oxygen saturation may be used for hypoxic hypoxia, but is generally meaningless in other forms of hypoxia. In hypoxic hypoxia 95-100% saturation is considered normal. 91-94% is considered mild. 86-90% is considered moderate. Anything below 86% is considered severe.[21]

with her CO2 being at 70- does this mean she had hypoxia?????
 
 
Answered by Dr. Y V Siva Sankara Murty 1 hour later
Hi XXXXXXX,

Thanks for writing to health care magic.

Do you mean to type SpO2 and typed CO2?

CO2 is carbon dioxide. It may be associated with hypoxia. But there may not be perfect correlation.

SpO2 is non invasive measurement of oxygen saturation of blood and is done with probes attached to fingers. You may also get Oxygen saturation of blood from a ABG.[Arterial Blood Gas]. (Blood is taken out from a artery and the gases are measured. They give oxygen and carbondioxide saturation.)

I request you to specify the levels and also type of gas you are talking of. Also mentioning if it is arterial blood gas measurement or non invasive measurement would be of help.

Are you talking about those levels at birth (immediately after birth)?

Sorry to ask you so many questions. But I need the correct words and values to answer you properly.

Waiting for your reply.
Above answer was peer-reviewed by
 
Follow-up: Child has thromobcytosis. UVC tube given. Slight increased prominence of bowel loops. Advice? 1 hour later
i copied and pasted the pco2- it was 70 on the day she was born. I am referring to the pulse ox, my report said that her abg was drawn but unsuccessful... they had her on cpap for two hours after that.

Test: P CO2

Normal range: 35 - 45



Your latest
test result, from XXXXXXX 01, 2013

35 mm Hg



Comments from laboratory

Performed at the Point of Care


Historical results: Sep 06, 2011 - Mar 06, 2013


Test Date

Result

Laboratory / Caregiver Comments:




Oct 24, 2012


40 mm Hg

Performed at the Point of Care




Oct 24, 2012


70 mm Hg

Performed at the Point of Care
 
 
Answered by Dr. Y V Siva Sankara Murty 2 hours later
Hi XXXXXXX,

Thanks for your reply.

I can understand your anxiety and request you to not to worry.

The Sp02 immediately after birth will not be the same of adults. It will be definitely low. The SpO2 at birth will be around 60 at one minute and there after increases. All these values are influenced by several factors and one should not be just influenced by these gadgets and just laboratory values.

Baby being placed on CPAP, SpO2 values and CO2 values may suggest respiratory distress or some other cause causing impaired oxygenation. ABG can specifically give the oxygen saturation which may indicate hypoxia or not.

One thing I can specifically mention is the damage because of hypoxia can be commented on only from the future development of the baby. Your baby seems to be developing normally. Do not worry. Enjoy the happy moments with her.

There is no bluish discoloration of the tongue or fingers. The doctors may not have found any thing abnormal on auscultation of the heart. This could be the reason why they might not have done a ECHO.

Hope this helps.
I would be more than happy to help you and request you to give further questions so that I can clarify them and reduce your anxiety.

Dr Y V Siva Sankara Murty
Associate Professor
Pediatrics
Above answer was peer-reviewed by
 
Follow-up: Child has thromobcytosis. UVC tube given. Slight increased prominence of bowel loops. Advice? 8 hours later
but she DID have hypoxia at birth? with these numbers? what are the odds, with these numbers, that she suffered damage? i do enjoy my baby, i am frustrated because i want to know! i am wasting money without getting answers
 
 
Answered by Dr. Y V Siva Sankara Murty 1 hour later
Hi,

The Spo2 of a new born baby (particularly if taken post ductally in the lower limb) may be around the range 65% at 2 minutes of life. They take variable time of 15 to 30 min and in some cases 50 min to reach the normal value of greater than 95%. So those SpO2 numbers may be found in normal new born babies.

A clue to brain damage can be obtained if a new born has features suggestive of Hypoxic Ischemic Encephalopathy (HIE). We do not say a baby has brain damage just by looking at oxygen saturations but suspect brain damage if a baby has features of HIE. Nowhere in the history, you mentioned that the doctors diagnosed her as having Hypoxic Ischemic Encephalopathy. So do not worry about brain damage.

Even in HIE a baby having features of stage 1 HIE that is mild HIE, the future outcome is about 100% normal. In stage 2 HIE (moderate HIE) 80% of the babies the future outcome is normal. In stage 3 (severe) about 50% die and rest have severe complications.

Hope I answered your query.

If you want further clarification please write to me.

Take care.
Above answer was peer-reviewed by
 
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