Preterm baby born at 30 weeks of gestation, baby weight 1100 grams. Mother had gestational diabetes. As patient was referred with labour pain and it was an emergency admission did not get time to give antenatal steroids. Delivery was normal and the baby was not asphyxiated . Baby developed dyspnea within one hour . Made working diagnosis of Hyaline membrane disease, surfactant was administered and was put on CPAP.
Dyspnea gradually improved and work of breathing came down and was maintaining oxygen saturation with room air. At 36 hours suddenly dyspnea worsened. Three main possibilities were considered Patent ductus arteriosus Early sepsis and Intracranial bleed. There were no risk factors for sepsis. Anterior fontanel not bulging, no pallor or jaundice to support the possibility of IC bleed. Pulse volume normal, a systolic murmur at the second left space supported the first…
