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Suggest treatment for jaundice in an infant

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Posted on Fri, 19 Feb 2016
Question: Hi Doctor,


We were blessed with a baby girl on 13th XXXXXXX night. Baby was born prematurely at 33 weeks through normal vaginal delivery. Post delivery she is ina level 2 NICU for observation and care. As per treating doctor her vitals are stable. Respiratory rate-58-60/min(since birth till date). Pulse rate-110. Temp- 98.6 F( she is kept under warmer). She is under warmer care. Her CRP was also normal at time of birth. Yesterday night( 3rd day) she developed jaudice(Total bilirubin-10.5) and CRP level came 74. Doctor had already put her antibiotic care after birth. After high CRP level and jaundice she has been shifted to inj meropenam,inj ofloxacin(200mg) and calcium gluconate. She was started on maternal feed through cannula on 2nd day( 2ml/every 4 hours) and since she is digesting it well doctor has increased milk dose to 2ml/every 3 hours. Her first blood culture report will come today. I guess these kind of complications happen in newborns. But is the treatment plan correct and is there any need to shift baby to higher centre. Thank you
doctor
Answered by Dr. Sumanth Amperayani (27 minutes later)
Brief Answer:
Treatment plan seems to be correct except for Ofloxacin

Detailed Answer:
Hi....the treatment plan seems to be correct except for Ofloxacin. Meropenem covers all the organisms which Ofloxacin covers. Only if a staphylococcal infection or sepsis is suspected Vancomycin would be needed as an additional antibiotic and not Ofloxacin. So I suggest Meropenem alone will do and we can stop Ofloxacin.

If I were your treating doctor I would have done a lumbar puncture and done a CSF analysis along with CSF culture also.

To know if it's bacterial sepsis I prefer doing a serum procalcitonin level too. This is the only suggestion would make I would give at this point.

If the kid is tolerating feeds well and putting out urine and motion well then clinically the baby's improving.

If the cultures turn out to be negative I would prefer either scaling down the antibiotics to Cefotaxime and Ampicillin and the other option will get stopping the antibiotics.

I would like to know if you are a medical doctor so that in future I can correspond with you in medical terms.

Regards Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumanth Amperayani (27 minutes later)
Hi Doctor,


Thank you for your prompt revert. I am a dental surgeon. I'll discuss with treating doctor regarding your suggestions and share his feedback for your opinion along with blood c/s result.

BR,
doctor
Answered by Dr. Sumanth Amperayani (1 hour later)
Brief Answer:
Will be awaiting your response

Detailed Answer:
Hi Dr XXXXXXX ... Glad to hear that. Hereafter we can talk in medical terms itself.

By what you say I feel that your baby is improving as the feeds are being increased.

Will be awaiting your response.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumanth Amperayani (2 days later)
Hi Doctor,


My baby was shifted to a higher centre due to apnoea. Also yesterday she her platelet count was 70K which today suddenly reduced to 8000. She would be getting platelet transfusion tonight and tomorrow morning. In addition to meropenam(BD) she will be given antifungal medicine today onwards. I understand her condition is critical and that progress would come slowly. Is the treatment plan correct. Anxiously waiting for your kind opinion. BR
doctor
Answered by Dr. Sumanth Amperayani (46 minutes later)
Brief Answer:
Please answer the following questions I will be glad to guide you further

Detailed Answer:
Hi.... I understand your concern at the same time I appreciate your understanding that the child is critical and I also appreciate your hope that she will turn around in due course.

I have a few questions for you -

1. Is the baby on ventilator?
2. Have the initial blood culture reports showing any growth?
3. Was a lumbar puncture and CSF analysis done?
4. Was serum procalcitonin done?
5. What antifungal medication is the baby being started upon?

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Sumanth Amperayani

Pediatrician, Pulmonology

Practicing since :2003

Answered : 8294 Questions

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Suggest treatment for jaundice in an infant

Brief Answer: Treatment plan seems to be correct except for Ofloxacin Detailed Answer: Hi....the treatment plan seems to be correct except for Ofloxacin. Meropenem covers all the organisms which Ofloxacin covers. Only if a staphylococcal infection or sepsis is suspected Vancomycin would be needed as an additional antibiotic and not Ofloxacin. So I suggest Meropenem alone will do and we can stop Ofloxacin. If I were your treating doctor I would have done a lumbar puncture and done a CSF analysis along with CSF culture also. To know if it's bacterial sepsis I prefer doing a serum procalcitonin level too. This is the only suggestion would make I would give at this point. If the kid is tolerating feeds well and putting out urine and motion well then clinically the baby's improving. If the cultures turn out to be negative I would prefer either scaling down the antibiotics to Cefotaxime and Ampicillin and the other option will get stopping the antibiotics. I would like to know if you are a medical doctor so that in future I can correspond with you in medical terms. Regards Dr. Sumanth