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Dr. Andrew Rynne

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Suggest treatment for fever in an infant

Answered by
Dr.
Dr. Pradeep Kumar

Pediatrician, Cardiology

Practicing since :2006

Answered : 1907 Questions

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Posted on Mon, 20 Mar 2017 in Child Health
Question: Fever in new born (2 weeks old)

please forward to Piadiatric

Our new born baby is having fever around 100 - please advice.

Let me know if required any more information.

Regards
XXXX
doctor
Answered by Dr. Pradeep Kumar 1 hour later
Brief Answer:
Fever can be environmental if baby is otherwise active

Detailed Answer:
Hello
Thanks for asking on this platform

Most common cause of mild fever in this age is warm environment or overclothing.
I won't get worried if baby is otherwise active, accepting feeds well, passing urine/stool normally and there is no rapid breathing, any cough, abdominal distension or any other significant problems.
I would suggest you to maintain the room temperature around 27-29 degree Celsius, avoid overclothing, to give frequent feeds and observe closely for any significant abnormality or persistence of fever.
If you notice any problem please consult your pediatrician for proper evaluation.

I hope this helps.
Please let me know if you have any more queries.
Regards
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Pradeep Kumar 5 hours later
XXXXXXX ji - Thanks for your lightening reply ... :-) and will take care of your valuable suggestion.

>

Further note that my baby got discharged 2 weeks before with Bilirubin level at 9.2 & was suggested in Discharge summary to have sun bath for some days. But as per latest report today - my baby still having Bilirubin level as 11.12 - pfa latest report for your reference.

>

Other info FYI -

Baby DOB : 03-Feb-17
Baby weight on 03-Feb : 2.4 KGs
Baby weight on 09-Feb : 2.2 KGs
Baby weight on 22-Feb : 2.8 KGs

Let me know if any further info required.


Please share your view on the report & next steps.


Regards
XXXX
doctor
Answered by Dr. Pradeep Kumar 21 minutes later
Brief Answer:
Let me know the thyroid report and blood group of the baby

Detailed Answer:
Hi

I have gone through the reports. The bilirubin level on 7th Feb was 9 and it is 11 today. The weight gain is normal as all babies loose weight (about 10%)of birth weight during first 7 days and there after gain weight at an average rate of 25-30 gm/day.
The common causes of raised bilirubin in this age are blood group mismatch, hypothyroidism and poor feeding.
Although the value of 11 is not very high for this age and also does not causes any harm to the baby, I would like to know if the thyroid test of the baby has been done and also the blood group of both mother and baby. As the weight gain is proper I assume that poor feeding is not the cause of raised bilirubin.
Also let me know about the feed of the baby as babies on exclusive breast feed may have persistent raised bilirubin may be upto 6 weeks.
So don't get much worried about the bilirubin report and please provide me details so that I better able to help you out.

Regards


Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Pradeep Kumar 6 hours later
Thanks again XXXXXXX ji ...

Please note blood group details as
Mother Blood Group : B+
Baby Blood Group : O+
Father Blood Group : B+

As mentioned above - PFA his TSH report using sample taken on 06-feb (note dob : 03-feb).

Further baby is completely on Breast feeding since 05-Feb and his frequency for mother feed is every 2 hours.

Am also attaching his CBC, CRP, CALCIUM, BLOOD sugar reports for your reference.


Kindly go through these reports & share your perspective.

Regards,
XXXX
doctor
Answered by Dr. Pradeep Kumar 12 hours later
Brief Answer:
To me it appears to be breast milk jaundice for now

Detailed Answer:
Thanks for providing details

I have seen the reports and apart from bilirubin level all reports are normal also as per the blood group possibility of blood group incompatibility is ruled out.
After reviewing all, to me it appears to be breast milk jaundice as per now.
I would suggest you not get worried and get a repeat bilirubin test done after few days after discussion with your pediatrician.If repeat bilirubin remains high few investigations to rule out other less commoner causes like G6PD deficiency or liver function derangement.


Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Pradeep Kumar 12 hours later
 
Thanks XXXXXXX Ji again .. !!

We have also got his G6-PD test done on 06-Feb and 23-Feb and PFA reports for your reference.


 Note - his DOB 03-Feb, 2017 (Baby Boy)


Please suggest next steps based on your analysis from G6-PD reports.


In case need any more information, Kindly let me know.


Regards,
XXXX
doctor
Answered by Dr. Pradeep Kumar 10 hours later
Brief Answer:
Report shows G6PD deficiency

Detailed Answer:
Hi

I have seen the report. The quantitative value of G6PD is low as shown in the report.
G6PD deficiency can lead to breakage of red blood cell and thus increased serum bilirubin.
As this test is not always confirmatory so once the quantitative test is positive thorough investigation should be done to confirm the diagnosis and to assess the severity of condition.
Here further investigations like complete blood count(to see hemoglobin, RBC, total leukocyte count), reticulocyte count(to see the RBC breakage), genetic test of G6PD deficiency should be done.
There are so many variant of G6PD deficiency with varying severity and thus genetic test helps in such condition.
If the diagnosis is confirmed then you should know the list of conditions, food items or drugs which may precipitate the G6PD deficiency. Avoidance of all these helps in leading a normal life.

Regards
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Pradeep Kumar 2 days later
Thanks XXXXXXX Ji for your further advise.

As mentioned in your last response - I have got the CBC and Reticulocyte count tests done at Lal Path Lab on 25-Feb - Kindly PFA reports for your reference and suggests next steps.

In case need more information, please let me know and will revert back.

Best Regards,
XXXX
doctor
Answered by Dr. Pradeep Kumar 3 hours later
Brief Answer:
CBC and reticulocyte count is normal

Detailed Answer:
Hi

Thanks for follow up

I have seen both the CBC and reticulocyte count and both are normal.
You may find some of the parameters out of range(highlighted too) but that is not much significant.
I just want to brief you something to alleviate your anxiety and also to make you more relaxed.
Actually G6PD is an enzyme glucose 6 phosphate dehydrogenase and decreased level of this enzyme causes increased breakdown of red blood cell which leads to increased bilirubin (Bilirubin in body is formed by breakdown of RBCs). Reticulocyte count helps in evaluation of increased breakage of RBC as it gets elevated in such condition.
In your baby's report there is raised bilirubin and decreased G6PD level but this does not suggests that this raised bilirubin is due to RBC breakdown as the RBC count, hemoglobin and reticulocyte count all are normal.
So although there is decreased G6PD level but don't get overly worried for this as it is not creating any problem right now.
I would suggest you to get repeat G6PD level done after 3 months and avoid all precipitating factor that may worsen the condition.

All the best
Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Pradeep Kumar 3 hours later
Thanks XXXXXXX ji for your valuable suggestion and appreciate your patience and expertise in concluding this thread ...

We can close this thread now and will connect with you in future for further advises.

Best Regards,
XXXX
doctor
Answered by Dr. Pradeep Kumar 33 minutes later
Brief Answer:
My best wishes are with you and your family

Detailed Answer:
It's my pleasure that you found my suggestions helpful. I shall be glad to help you out in future also if you need.
My best wishes are with you and your family.
Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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