chbare Posted March 2, 2009 Author Share Posted March 2, 2009 Hmm, so why exactly are we asking for coags? Take care, chbare. Link to comment Share on other sites More sharing options...
DartmouthDave Posted March 3, 2009 Share Posted March 3, 2009 Hello, A coagulopathy is the main problem here I think. The family has not had any prenatal care/screening done....so there could be an ABO issue here. Has RhoGam been given at 7 months and after the birth?? Here is my guess; Neonatal alloimmune thrombocytopenia — Neonatal alloimmune thrombocytopenia (NAIT) occurs when fetal platelets contain an antigen inherited from the father that the mother lacks. The mother forms IgG class antiplatelet antibodies against the "foreign" antigen; these cross the placenta and destroy fetal platelets, resulting in fetal and neonatal thrombocytopenia [10]. Plasma levels of thrombopoietin in these patients are normal because the megakaryocytes and platelets that are produced bind to this growth factor [11]. In contrast to Rh sensitization, NAIT often develops in the first pregnancy of an at-risk couple. NAIT can result in severe thrombocytopenia in the fetus because platelet antigens form early in gestation and maternal antibodies cross the placenta in early midtrimester. The most serious complication is intracranial hemorrhage, which occurs in approximately 10 to 20 percent of affected newborns; one-quarter to one-half of these occur in utero [12]. The risk of severe thrombocytopenia and intracranial hemorrhage is greater in alloimmune than in autoimmune thrombocytopenia [13]. (See "Autoimmune thrombocytopenia" below). The extent and severity of NAIT was documented in 107 fetuses identified because of an affected older sibling [12]. The initial platelet count obtained by fetal blood sampling (mostly between 20 and 32 weeks gestation) was ≤20,000/microL in 50 percent, including 46 percent of the 46 fetuses studied before 24 weeks gestation. Send of a PKU as well...... David Link to comment Share on other sites More sharing options...
chbare Posted March 3, 2009 Author Share Posted March 3, 2009 You are on the right track; however, look at the labs. Is thrombocytopenia present? Let's say your coags come back: PT- 65 & aPTT-140. Somebody may have touched on one of the potential problems. Take care, chbare. Link to comment Share on other sites More sharing options...
fireflymedic Posted March 3, 2009 Share Posted March 3, 2009 Potential Rh incompatibiltiY? Link to comment Share on other sites More sharing options...
chbare Posted March 3, 2009 Author Share Posted March 3, 2009 Not in this case; however, it is always a consideration. Think about the home delivery without any care following the birth. What kinds of things are done following delivery? What things did were not done to this patient? What about the Pt and a PTT? Take care, chbare. Link to comment Share on other sites More sharing options...
scott33 Posted March 3, 2009 Share Posted March 3, 2009 http://www.nct.org.uk/info-centre/publications/view/35 Link to comment Share on other sites More sharing options...
chbare Posted March 3, 2009 Author Share Posted March 3, 2009 Nailed it. Now, what about the other problem? Vomiting, nothing to eat or drink, elevated BUN/Creat, and Ketones in the urine? Take care, chbare. Link to comment Share on other sites More sharing options...
logos Posted March 4, 2009 Share Posted March 4, 2009 Why aren't babies born with enough vitamin K? That is, where goes vitamin K come from? What other patients may need a dose of vitamin K? What specific bleeding complication is vitamin K given to prevent? That is, we really don't care about all bleeding in newborns, but someone showed that giving vit K prevents a specific sort of bleeding syndrome in kids... If the kid did did have NAIT, what would he/she look like at birth? How likely is it that this would be missed during both prenatal and newborn screens. Link to comment Share on other sites More sharing options...
chbare Posted March 4, 2009 Author Share Posted March 4, 2009 Why aren't babies born with enough vitamin K? That is, where goes vitamin K come from? What other patients may need a dose of vitamin K? What specific bleeding complication is vitamin K given to prevent? That is, we really don't care about all bleeding in newborns, but someone showed that giving vit K prevents a specific sort of bleeding syndrome in kids... If the kid did did have NAIT, what would he/she look like at birth? How likely is it that this would be missed during both prenatal and newborn screens. It boils down to three concepts: 1) Lack of neonatal intestinal bacteria 2) Undeveloped liver 3) Limited transfer of Vitamin K from mom to baby Obviously, this is a rather rare disorder, especially with newborn Vitamin K supplementation. There are three groups of Hemorrhagic Disorder/Disease of the Newborn (HDN). How would you classify this patient? What about the other problem? Take care, chbare. Link to comment Share on other sites More sharing options...
Jeepluv77 Posted March 8, 2009 Share Posted March 8, 2009 Any chance mom had undiagnosed and untreated gestational diabetes? From what I remember this can lead to serious complications in the newborn who is likely to be able to regulate their own sugar/enzyme levels. Also, I'm assuming baby has had no immunizations? Is this family in a high-risk living condition? Also, is the baby jaundiced? This is common in newborns and some require phototherapy to control it. What time of year are we talking? How much sun exposure does baby recieve? Is the baby breastfed? This can sometimes lead to problems clearing bilirubin. I'm thinking we have a case of kernicterus on our hands. S/S start with poor feeding, n/v, and drowsiness. If untreated, leads to arching of neck and back, seizures, upward eye rolling, and brain damage. Can progress to coma or death. Link to comment Share on other sites More sharing options...
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