1. Congenital Syphilis Garcia, Lucman, Macaraya, Malilay, Marino

2. General Data Caganda, Lorenz 1 week old/M Admitted for the 1 st time at PER-PGH last July 25, 2009

3. Chief Complaint Fever

4. History of Present Illness Born Full Term, via SVD, to a 24yo G1P0 mother at Comemebo Lying In Clinic with BW 2.5kg. Mother had PNCU c/o LHC starting at 3mos AOG. (+) UTI at 7mos AOG for which she took unrecalled antibiotics for 7 days. Mother had (+) VDRL and (+) RPR at 7 mos AOG, but was not treated due to financial constraint.

5. History of Present Illness At birth, patient was active with good cry, good activity and noted yellowish of sclera. (+) yellowish eye discharge OU. Patient was observed for 2days then advised consult to a tertiary hospital. Vitamin K given at lying-in 2 days PTA – (+) fever Tmax of 38.7, (-) cough/colds. No consult done. Paracetamol was given. (+) good suck/cry/activity.

6. History of Present Illness 1 day PTC – still with fever, pt was brought to a local hospital A> Sepsis of the Newborn, late onset. Advised transfer to different hospital hence admission at PER-PGH.

7. Review of System (at the ER) (+) Good suck/activity (+) Good UO/BM (+) “hoarse” cry (-) cough/colds (-) seizure

8. FMHx (-) BA/HPN/DM/PTB?

9. Developmental (+) Moro Reflex (+) Grasping Reflex (+) Sucking Reflex

10. Nutritional Exclusively Breastfed since birth

11. Immunization (+) HepB1

12. PSHx Pt is an only child. Mother is a 25 yo unemployed. Father is a 32 yo, works delivery boy.

13. Physical Examination (ER) Awake, alert, NICRD with Generalized jaundice and desquamation 90/60 1323438.9 Pale palpebral conjunctivae, icteric sclerae, (+) greenish discharge fom OU, (-) CLAD, (-) TPC Equal chest expansion, (-) retractions, Clear breath sounds Adynamic precordium, NRRR, (-) murmur Flat, soft abdomen, (-) masses/organomegaly Full equal pulses, (-) cyanosis/edema Neuro Exam: Essentially normal

14. Assessment (ER) t/c Neonatal Sepsis r/o Congenital Syphilis Hyperbilirubinemia prob 2 to Sepsis

15. Course at the ER Labs Facilitated - CBC with PC - Blood CS - Serum Na,K,Cl,BUN,Crea,TB,DB,IB,ALT,AST,RBS,Alb - VDRL, RPR - BT

16. Course at the ER LT was done : note of xanthochromic tap. - CSF GS/CS - CSF Q/Q - CSF VDRL, cell count, protein - CSF FTA-ABS/TPHA (confirmatory test) c/o Makati Med

17. Course at the ER Tx: - Initially stted on Pen G (50 k ‘u’/kg/d) and Amikacin (15) Referrals: Ophtha: A> Opthalmia Neonatorum P> Erythomycin eye ointment ENT: A> r/o Congenital syphilis P> for ABR

18. Laboratories CBC (wbc 27.7, rbc 3.45, hgh 121, hct 0.354, mcv 102.6, mch 34.9, mchc 340, rdw 16.1, plt 226, neut 0.58, lym 0.24, mono 0.12, band 0.04. RPR (+) Blood Chem: Glu 6.08, BUN 2.13, Crea 32, Alb 21, TB 167.8 (9.8) DB 0, IB 167.8 (9.8), AST 22, ALT 25, Ca 2.01, Na 137, K, 4.1, Cl 104)

19. Laboratories BT: A+ CSF Glu 3.19, CSF Protein 1.43 CSF Qualitative: yellow, slightly hazy, RBC 2 000, WBC 2.6, PMN 7, Lymp 0 Blood CS: NG2D CSF GS: (-) PMN, (-) Organisms/encapsulated organisms

20. Admission Admitted at W11 B36 last July 28, 2009 PWI: t/c Neonatal Sepsis r/o Congenital Syphilis Ophthalmia Neonatorum