Preterm baby with different challenges in resource limited setting

• Author Details:   
• Kamaldeep ^*

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A preterm baby with POG 35 weeks weight 2.6kg delivered at Civil Hospital, Gurdaspur by LSCS to a 30 years old mother (Gravida 3, Abortions 2) with H/O leaking PV for more than 24 hours. Indication of LSCS was foetal distress, bad obstetric history. Antenatal USG of mother at 20 weeks POG shown anomalous origin of right subclavian artery going behind the trachea. Baby cried immediately after birth with APGAR score 9/9 at 1/5 minutes of birth, but soon developed RDS. Baby was shifted to SNCU, put on CPAP, maintenance IV fluids and antibiotics started. After 6 hours baby developed signs of fluid overload. RBS at 6 hours of birth was 152mg/dl. Fluid restriction was done. RBS was 138mg/dl at 12 hours of birth. So D5% was started.Septic screen was positive. Baby was shifted from CPAP to nasal prongs for oxygen therapy at 24 hours of life, which was continued for 6 hours and stopped. RBS was 106mg/dl, 79mg/dl on further monitoring. On 3rd DOL baby had GI bleed about 2ml fresh. Injection Vit K 2mg was given iv stat. IV antibiotics were changed to Piperacillin/Tazobactum. When no episode of GI bleed was present for about 6 hours EBM was given to the baby. To our surprise breast milk was of chocolate color. There were no cracks on mother's nipples. Color of milk was same for 3 expressions but we continued mother's feed. On 4th DOL on CVS examination baby grade 3 systolic murmur was heard on 2nd/3rd ICS, left parasternal area which was not audible earlier. CXR was WNL.2D Echo shown dilated right atrium, patent foramen ovale and tricuspid regurgitation. Mother's milk got cleared after 3 days. Baby was discharged after 7 days on furosemide drops.

Keywords: Chocolate coloured breast milk, Rusty Pipe Syndrome, Anomalous origin of right Subclavian Artery, CPAP, hyperglycemia, Necrotising enterocolitis, respiratory distress.