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Baby has edema and low hemoglobin. Vomiting after giving top feed. Treatment?

sir, we have a 36 days baby preterm (32 weeks/twin)born by IVF surrogate mother ,initially on top feed suddenly had vomitings bilious,baby was kept NPO presuming preterm NEC xray abbomen were done and USG done which were normal and the baby passed stool next morning normal ,baby had edema of lower limbs ,septic screen normal,urine analysis,cardiac normal,KFT,ABG normal hemogram showed low Hb-9 rest normal 15ml packed cells transfused and little edema subsided then again developed edema of B/L lower limbs,current Hb is 10.9 gms,wt:1.368 kgs ,please let me know the cause and further treatment. regards dr.vivek sharma
Asked On : Tue, 11 Dec 2012
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Pediatrician 's  Response
is all profile including liver and serum protein level are normal then edema is commonly seen in preterm baby as extracellular water content is more as compare to term baby and it will get resolve with nutrition build up and weight gain.

2nd issue is hemoglobin level, u didn,t mention abt peripheral smear of blood and retic count, if it is normal then anemia of prematurity is most likely cause,don,t panic , if baby,s vital are stable you should give only iron suppliment, vit E until 40 week of conceptional age, and your baby is sure candidate of erythropoietin therapy if your centre have facility but u can manage without this drug.

3rd issue which is most important is bilious vomiting i am sure it was not through orogastric tube distaly plasced in dudenum can have this this problem other wise kindly get contrast study to rule out surgical cause. as sepsis screen is negative gastric hypomatality is seen in preterm baby but in this condition bilious vomiting present only for 2-3 times not associated with abdominal distension.
i hope i am helpful to you than you.
Answered: Tue, 11 Dec 2012
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