case discussion

[Dolphine liu]

Dear friends:
There is a preterm baby who has stayed in our NICU almost four weeks.His gestation is 30 weeks. Shortly after birth, baby presented respiratory distress and was supported by CPAP, Chest X-ray indicated pneumonia.Because of repeated apneas,CPAP was replaced by ventilation.Meanwhile antibiotic was used.
A week later,x-ray showed pneumonia improved ,ventilator was removed. Baby did not present remarkable respiratory distress ,repeated apneas of the
baby remained. This situation lasted several days, we had to use CAPA again.
However,this measure did not reduce frequence of apneas, after a week,the baby`s statement went worse,frequence of apneas arised and heart rate was often over 150/min.We had to use ventilator. the latest Chest X-ray showed there is infection on lung.
we held a discussion in our department,the predominant opinion is that infection on lung is out of control. some staff considered CLD and malformation.CT of baby`s brain did not reveal remarkable problem.
Can you give us some advise on treatment?
thanks

[Stefan Johansson]

It seems that the baby did not have RDS and that apneas is the predominant symtom. Therefore, I think CLD/BPD is an unlikely diff diagnosis.
* Could you please upload the x-ray picture?

[manberbenitez]

Dear Dolphine :
Im agree with Stefan, the cause probably is not RDS, and I think more on congenital pneumoniae so is very important to try to see the results of the cultures to have a idea of which antibiotic use. In this case I have some questions, about it : ¿How much cpap do you used?,¿Did you combined Cpap with caffeine?,¿How is the nutritional status of your baby? this last point I think is very importante because sometimes we supposed that the baby have to breath, but the calories we give it, are too low. Probable we have an atypical pneumoniae and we have to do special cultures,¿ Does the mother has any kind of infection?, ¿Did you take a vaginal culture for strep?. Im not sure that the BPD diagnosis in this case is real, because you have a not resolve problem.
Hope this help
Your friend
Manuel Bernal

[Stefan Johansson]

Dolphine liu have mailed the following x-ray pictures.

8th of June
http://99nicu.org/images2/xray08.jpg

11th of June
http://99nicu.org/images2/xray11.jpg

14th of June
http://99nicu.org/images2/xray14.jpg

22nd of June
http://99nicu.org/images2/xray22.jpg

26th of June
http://99nicu.org/images2/xray26.jpg

[azlis]

Professor Liu is my teacher ,In our ICU this premature infant, has already treated for more than months, atnow continuously the breath machine maintenance, Frequent breath temporarily, the high-quality antibiotic treatment, as well as X-ray changes bites and clinical curative effect lets me think this premature infant is not pure was an infection, I guess am not have CLD the possibility?

[Stefan Johansson]

Do you still have a "feeling" that this is primarely a pulmonary disorder?
If so, have you considered performing a computer tomography of the lungs or a lung biopsy (histopathology)?

Or do you have any indications that the breathing problems are secondary to dysfunction in a a different organ system; such as a neurological or neuromuscular disease?

[Dolphine liu]

dear friends
There is a good news,that ventilation is removed from the baby today. The
baby`s respiratory seems stable,and skin color is well.He can eat 5ml milk/time. It seem to be a magical. the latest x-ray shows the remarkable sign of BPD and we used 6 day dexmethasone.our effort finally act.
thanks