babies_and _babies

Somehow I always feel like sharing the things happening in my life..
I recently thought-what better way to do this than blog about my job too?
So in the end I love fashion,I’m a doctor and sometimes I write stories if I can concentrate long enough to finish them.

I’m currently doing neonatology posting ..
Its a very touchy place
A neonate is defined as a baby within the age of O-28days. (WHO definition)
In our unit however we still admit babies up to 6 weeks old.
We receive babies that are at risk of illness from their mothers wombs as soon as they are born and nurse them to health.
Basically anything that has to do with a baby within that age range is handled by the neonatology unit.

So yesterday I did a 24hour call
The obstetrics and gynaecology team had a number of elective cases that had been left undone.
They then decided to start the list in the evening.
We received the first baby at 7pm and subsequently admitted him into the unit.
The indication for his mothers ceasearean section was persistent foetal distress.
His heart rate had remained at the lower limit of normal for about two days and the pregnancy has reached term.
He wouldn’t have withstood the stress of labour and he may have come out asphyxiated(lack of oxygen to the brain which results in neurological deficits)

Term is defined as any time from 37weeks of pregnancy when a baby who is born at that time can survive on his own without external influences.

The second baby we expected was a preterm(he wasn’t up to 37weeks in the womb)
The surgery was done because the fluid he was swimming in within the uterus had markedly reduced.
Here is where the drama started.
Preterms are very prone to hypothermia
(low body temperatures) because they have absence of brown fat which is present in most term babies and helps in the generation of heat without the baby shivering.
This is called non shivering thermiogenesis.
Brown fat is found in the subcutaneous tissue of the thorax, interscapular region and the walls of the great vessels.
We had warmed up his towels and wraps and everything to receive him.
The radiant warmer was on.
Oxygen was ready..
He came out at 9pm.
Cried for one second
That made us happy.

Then we saw this–»
The baby was deformed
He had poorly developed limbs on the left side of his body..
Normal right side.
An imperforate anus but with an anal dimple.(opening)
Poorly formed and ambiguous external genitalia so it was difficult to say if this was a male or female child.

The ApGAr in the first minute was 3/10
I will explain APGAR sometime
There was no heart rate for several minutes.
We had to do CPR and got him breathing and the heart beating.
transferred him to the unit from theatre and had him on oxygen..suctioned to clear the airways
Attempts at urethral catherisation failed as only 3cm of the catheter could be advanced into the urethra .(this is the tube carrying urine from the bladder to the outside world)
Put up an infusion and wrote out the notes.
Sadly ..the baby died 3hours after birth at 12am today.
He may have needed multiple surgeries had he lived and the quality of life may have been poor..
We assume he must have had a cardiac malformation as well because he remained cyanosed whenever oxygen was taken off albeit temporarily and briefly
We think he must have had renal agenesis as well.
That would be the explanation for why he had little amniotic fluid because the fluid is made up of mostly baby pee.
Consequent to the small fluid inutero the baby may have laid on the affected side or bands of amniotic fluid prohibited normal development
This can be found in babies with potters syndrome.

He may have also had pulmonary hypoplasia and respiratory distress syndrome.the latter is a disease /condition mostly exclusive to preterms due to their immature lungs.
The father declined an autopsy which would have helped us find any other anormalies and put a name to the constellation of abnormal findings the baby had.
All the same..taking drugs early in pregnancy which are teratogenic can cause something like this..
The picture mostly brought to mind a popular drug called thalidomide which is assiociated with limb deformities.
Herbal medication has been fingered in birth deformities especially here in Nigeria.
No one can tell the constituents of these concoctions but most mothers who have deformed babies had consumed some form of these things in early pregnancy.

This patient though said she didn’t have any.
I don’t know how ethical it would be to post the pictures of this child but maybe just the affected regions without the face should do.
For learning purposes I think we’re as safe as can be.

Mothers and those trying to conceive are advised not to take any medication that is not prescribed by a doctor.
Early antenatal booking and pregnancy follow up is helpful as this patient did not register until 20weeks of pregnancy and only then because she felt reduced foetal movements.
The damage may have already been done.
However a sonologist at that time could not identify any anormalies..
Even a scan done on the day of surgery alleged baby was normal.
That’s another issue for another day.
I hope I can keep up with writing some small stuff about the interesting things I come across as I practice..

There was a final case for the night..ended at 2am.
But that baby was stable although post term.
And so I dragged my weary self to bed..
And engaged in fitful and tortured sleep.


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