Paeds Attachment Week 1

1) 11y/0 young boy, had Hx of cerebral palsy with swallowing difficulty, came in to the hospital because of aspirated pneumonia. Because of the cerebral palsy, he had distorted hand joints and severe scoliosis. His right scapula was very close to his pelvis, it was just approximately 5cm apart. His neck was extended. He was looking down all the time when he was watching tv because of his extended neck. On examination, he had crackles on auscultation. He was feeding on NG tube as he had swallowing problem. He had a slower mental development as compared to children of his age. he couldnt talk like a normal 11 y/o child. from the management point of view, he was given a course of antibiotics to treat his pneumonia and the physiotherapist came in everyday to help him to do his physiotherapy. Unfortunately, he died of sudden death on the following week due to sudden cardiac arrest, no signs of bradycardia before he died. I was so shocked when i heard the news. not feeling very sad, am i too cruel? i dun know. as he would suffer more with his on going cerebral palsy if he were to grow up. he had to overcome his physical, mental and psychosocial barrier. i felt sorry for the family. but it might be a good thing for him to be free from the sufferings earlier in his life...
2) 9m/o baby girl, came in with referral of other hospital. She has lots of chronic problems and was referred to our hospital for close monitoring. She has an undiagnosed nerological disorder, leading to bilateral diaphragm paralysis, hypotonia and left sided sensory neuronal deafness. She was suffering from chronic respi failure and bronchiectasis, was needed ventilation fron oxygen. Her main concern would be failure to thrive as she has these chronic and untreatable conditions. On examination, she was breathing with her abdomen. she did not have much expression due to low facial muscles tone. she was underweight on her first two months of life, but she was getting better after having proper amount of feeding in the hospital. she is clinically well apart from her congenital problems, is currently staying in the hospital waiting to be discharged.
3) newborn baby boy, approx few weeks old, preterm baby with normal vaginal delivery. he came in of neonatal epilepsey as he's had epilepsey since birth. according to the parents, he would have 5-6 attacks per day that last for 5-10seconds. he came into the hospital as parents complaint that there were increase in frequency and duration of his attacks. We witnessed one of the episode during the ward round. his lips were smacking and his left arm was just suddenly became stiff and it lasted only few seconds and he was return to his normal state. on examination, he was a floppy baby. his old medical notes showed that he had agenesis of corpus callosum. it might be the cause for the baby to have low muscle tone. he was given phenobarbitone to treat his epilepsy. his frequency, duration & characteristic of epileptic attacks were monitored everyday. his serum phenobarbitone level was checked everyday to ensure his has a good and safe bioavaibility of phenobarbitone in the blood circulation. however, this baby was transferred few days later to another hospital with a paeds neurologist, to have a better care and treatment on his neurological problems.