Baby of Poly Barua, 10 days old, male baby, weighing 1500

gram, 2nd issue of non-consanguineous parents, belongs to low

socioeconomic condition, hailing from Raozan, Chittagong, a
diagnosed case of preterm low birth weight presented with1. Abdominal distension for 4 days
2. Passage of blackish stool for 4 days
3. Vomiting for 5 day
His mother, 25 years old, normotensive, non-diabetic, no history
of chronic renal disease or contagious disease, was on regular
antenatal checkup and was immunized as per TT schedule. Her
pregnancy was uneventful till 34th week when she developed
lower abdominal pain and ruptured membrane and delivered a
baby boy by NVD in CMCH. There was no history of prolong
rupture of membrane or passage foul smelling liquor. After bir th
baby cried spontaneously, but referred to Neonatology ward due
to prematurity and low birth weight.
After admission and proper management, baby was kept NPO
for 3 days, then NG feeding was initiated with expressed breast
milk. After 2 days of feeding, baby started vomiting 3-5 times
daily which was yellowish, non-projectile and non-related with
taking milk. He also developed abdominal distension with
passage of blackish stool for last 4 days. After that his feeding
was withheld, but distension sustained with no history of
respiratory distress or fever.

On clinical examination, baby was conscious, lethargic, colour

of the body , hand and feet was pale, R/R- 50/m, H/R- 152/m,
temp-98f , OFC-35, weight 1500 gram, weight for gestational
age above 10th centile.
Capillary blood glucose -5mmol/l
Capillary filling time- 2sec
Arms and legs- partially flexed
Head, neck- no abnormality seen
Ant. fontanelle- open
Post. fontanalle- present
Eye- normal
Ear- curved pinna, soft, slow recoil
Skin- coarse
On examination of respiratory systemSize & shape- normal
Symmetrical movement
R/R- 50b/m
Respiratory distress- absent
No intercostals and no sub coastal recession
Breath sound is vesicular with no added sounds

Breast lobule- 2mm in size

Cardiovascular examination reveals: H/R- 152/m , 1st and 2nd

sound- audible, no added sound.
Abdominal examination reveals: distended abdomen, overlying
skin is tensed and shiny, veins are visible on abdominal wall but
no visible peristalsis. Umbilicus is dry, centrally placed and
everted. Liver , spleen is not palpable, kidney not ballotable.
There is no ascites, no fluid thrill. Bowel sound was decreased.
CNS examination reveals: baby is lethargic, hypotonic and
reflexes are poor.
Back and spine are normal
Sole crease- less
Anus patent
Male genitalia- normal , testes descended, less ruggeae
There is no birth trauma and no apparent congenital anomalies
So my provisional diagnosis is: Preterm (34wk) LBW
(1500gm), AGA with suspected necrotizing enterocolities.
D/Ds: 1.Septicemia, 2. Intestinal perforation, 3. Intestinal
obstruction, 4.Food intolerance