Baby of Pratibha

Baby was initially kept on CPAP support but was intubated at 26 hrs of life i/v/o detoriation . inotropic support was stated t/v/o shock and decision to  transfer baby to lndraprastha Apollo hospital was made.

Saviour Foundation Support the baby medicals

While transporting to Apollo hospital baby had cardiac arrest and was revived with CPR and single dose of adr . after reaching the Apollo hospital baby had 2^nd episode of cardiac arrest and was revived with CPR and another dose of adr. Baby was started on dopamine, dobutamine, vasopressin and adr. Infusion and antibiotic cover with meropenam and amikacin were started. on day of admission ECHO was done which suggestive of PPHN. So baby was started with HFOV with sildenafil infusion. baby was in AKI so antibiotics were given in renal adjusted doses and i/v/o coagulopathy platelets and FFP were given.

Blood culture showed candida growth for which ampho b was started After 5 days baby was shifted on conventional ventilation and was extubated after 2 days of conventional ventilation to HFNC support @ 61/min . chest x-ray was suggestive of left lower lobe coillopseystich opened up after good physiotherapy. On day14 of admission baby had rt upper lobe collapse for which good physiotherapy was started along with positional changes. but after 4days it progressed and now it was complete right lung collapse On 10/8/22 teicoplanin was added as secretions showed kleibsella which was sensitive to it. antibiotics were stopped on 16/8/22 but after. call for endoscopy was taken and done on 13/8/22 which showed thick secretions and mucus plug which was cleared and SAL was sent which showed growth of klebsiella so amikacin was started again according to sensitivity. post bronchoscopy x-ray was normal. so baby was kept on room air as baby was comfortable at room air but after 48 hrs baby had respiratory distress and was shifted back to HFNC and x ray was repeated which revealed complete right sided collapse and after discussion bronchoscopy was repeated on 20/8/22 which had 2 mucus plug. post bronchoscopy there was still it upper lobe collapse and BAL showed pseudomonas growth, ceftazidime was added and CT scan was done to look for any anatomical variation and was reintubated on 23/7/22. CT revealed complete collapse of right upper and middle lobe with volume loss with right hernithorax trachea and mediastinum shifted to right. Tapered narrowing of right upper lobe bronchus and bronchus interrnedius with few mottled foci within. Presently baby is on A/C VC mode fio2 21% , VT 14 , ti 0.40 PEEP 6.5 . IN11AMIKACIN (D30) , INJ CEFTAZIDIME (D1) , IN1 MORPHINE INF NEBULISATION (WITH MUCOMYX, 3%NS, DUOLIN, COLISTIN) .