Friday, April 24, 2015

Thompson Scoring in HIE : Severity and Prognostic grading

Thompson Score 


Score                  0                  1                                2                                     3
Tone              normal            hyper                           hypo                          flaccid
LOC                normal         hyper alert, stare       lethargic                        comatose
Fits                 none              < 3 per day                 > 2 per day
Posture         normal            fisting, cycling            strong distal flexion       decerebrate
Moro              normal          partial                        absent
Grasp             normal          poor                          absent
Suck              normal           poor                          absent ± bites
Respir            normal          hyperventilation         brief apnea                     IPPV (apnea)
Fontanel       normal            full, not tense               tense              













Maximum Score = 22
Infants scoring 1–10 are considered to have
mild HIE, 11–14 have moderate HIE and
15–22 are considered to have severe HIE

Thompson CM, Puterman AS, Linley LL, Hann FM, van der Elst CW, Molteno CD, Malan AF. The value of a scoring system for hypoxic ischaemic encepha­lopathy in predicting neurodevelopmental outcome. Acta Paediatr 1997; 86: 757-61

Tuesday, April 14, 2015

Case of Cyanotic CHD : PGE1 saves life

A Single Male baby was born at 38 weeks of gestation with birth weight of 3.1 kg through Normal vaginal delivery. At birth the child cried immediately. At 15 minutes of life, the child had central cyanosis. There was no respiratory distress and heart rate was normal range.

Child was shifter immediately to NICU. Saturation was 70% and with oxygen reached up to 84%. On auscultation, chest was normal and there was a faint murmur on heart auscultation. Hyperoxia test was also performed, the baby failed the test.

Immediately Echo screening was done to see if there was any duct dependent circulation. ECHO showed large VSD with over-riding of Aorta with severe pulmonary stenosis. PDA was seen with 

Left to right shunt measuring 3mm. It was case of TOF with PDA (Duct-dependent ) as baby had severe PS.

Chest Xray was ordered. Xray showed oligemic lung fields with upturned apex of cardiac silhouette. 
In any scenario, Prostene would have been started but since ECHO showed patent PDA, it was with holded and monitoring was planned. On the second day, the baby was deteriorating, saturation was not maintained, reached upto 60%. Generally SpO2 above 75% is adequate for Cyanotic heart diseases. ECHO was reassessed and PDA was still patent at 2-3mm.  The desaturation was not explained by CHD. So child was kept under CPAP and finally intubated for drop in saturation.

After intubation, the problem was the SpO2 got worse to 30-40%. Since cardiologist was at the spot, reassessment was done with ECHO. PDA was patent with 2 mm size. A trial of PGE1-Prostene was given.
After 5 minutes the SpO2 came to 60%, heart rate improved from 100 to 120 and by 10 minutes SpO2 was 87% under MV and baby looked much better.


It was a case of closure or narrowing of PDA in duct depended circulation. The child was saved by PGE1 which keeps the PDA open, until the definitive management- BTS Blalock Taussing Shunt.