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3. Differential diagnoses
• Main diagnosis
4. Treatment
5. Supportive care
6. Monitoring
7. Plan discharge
• Follow-up, if required
What emergency and priority signs have
you noticed?
• Oxygen
– Not “respiratory distress”, but…slow breathing, periods of
apnoea
• Intravenous fluids
– Unable to feed, prevention of hypoglycaemia
• Anticonvulsants? No
• Immediate investigations?
□ Blood sugar
How to give oxygen
• His mother Sarah did not attend any antenatal clinics during
her pregnancy and she did not receive tetanus toxoid. The
pregnancy period was uneventful. There is no history of
premature rupture of membrane.
Examination
Dominic was lethargic, ill-looking, and had soft grunting
respiration.
Vital signs: temperature: 35ºC, pulse: 170/min, RR: 20/min
Weight: 2.7 kg
Chest: Sometimes periods of not breathing for 10 seconds,
bilateral air entry good, some grunting respiration
Cardiovascular: both heart sounds were audible and there
was no murmur
Abdominal examination: soft, bowel sound was present; liver
was 2 cm below the right costal margin
Ears-Nose-Throat: mouth: slightly dry, no oral thrush; ears:
clear, no discharge
Neurology: lethargic; no neck stiffness; fontanelle normal
Skin: no rash
Differential diagnoses
• List possible causes of the illness
• Main diagnosis
• Secondary diagnoses
• Use references to support diagnoses: neonate with
lethargy (Ref. p. 25)
Differential diagnoses (Ref. p. 25)
• Birth asphyxia
• Hypoxic ischaemic encephalopathy
• Birth trauma
• Intracranial haemorrhage
• Haemolytic disease of the newborn, kernicterus
• Neonatal tetanus
• Meningitis
• Sepsis
Additional questions on history
• Birth history
– Antenatal care
– Maternal tetanus toxoid
– Duration of ruptured membranes
– Maternal illness / fever
– Cord care
Cut with knife and tied with shoelace
Sepsis
How would you treat Dominic?
Treatment