Ahmed Abed Allah Abu Wattfa, (7 months old) male infant. (The 3rd child for his parents)
According to the mother, her pregnancy was pretty normal; she gained around 10 Kg by the end of the pregnancy and delivered her baby normally at the hospital.
The new-born (Ahmed) was 4 Kg in weight; he was poorly suckling and was admitted to the nursery for more than one month, and was fed by nasogastric tube insertion (NGT) due to his inability to suckle. On discharge, NGT was kept in place and was changed each week at hospital.
– Breast milk was given to Ahmed during his 1st few days after delivery through the NGT, and then bottled milk was given later on as the mother was unable to produce enough milk.
– The baby was kept on NGT feeding for 2-3 weeks after discharge from the hospital, then the mother insisted to feed him by bottle despite his weakly suckling, and due to this problem, his weight was not increased.
2 weeks before Ahmed was admitted to the program, he was at the hospital due to his failure to thrive. At the hospital he was checked by CBC, his Hgb. was 10 gm %, no other investigations were done.
Weight 2.5 Kg below -3 Z-score, Length 56 cm below- 3 Z – score, Weight for Length below – 3 Z-score, Head c.f. was 38 cm.
The baby is severely malnourished, skinny, no subcutaneous fat. He is alert, his skin is dry, and the facial feature indicates the Pierre-Robin Syndrome (Retro-gnathia, Cleft soft palate, Post. displacement of the tongue) but no cardiac anomaly or skeletal anomaly.
The baby is in need of 110 Kcal. /Kg /day, the baby was provided by supplement milk, corn flour, with addition of 1 ml of olive oil.
Fruit juice mixed with milk / one meal per day.
Vitamin A + D drops – 2 drops daily.
Ferrolet syrup 50 mg. 10 mg. – on a daily basis.
Folic acid tablet 5mg. 1/2 tablet once on a weekly basis.
-Two weeks later, Ahmed weighted 2.7 Kg., his length was 57 cm. , both weight and length were still below -3 Z score.
-10 days later, his wt. was 3.3 Kg., his length was 57.5 cm., both the weight & length were still below -3 Z score but much better than before .
At this stage the mother was giving him 180 ml supplement milk ( 3 bottles each 60 ml ,one bottle of Banana juice , 1 ml olive oil was added) plus 60 ml corn flour . This gave the child around 180 calories. (Each 100 ml milk gives 70 cal., 1 ml olive oil gives 14 cal.)
As per the next 10 days the mother was advised to increase the volume of the feed to 90 ml instead of 60 ml and to add another 1 ml olive oil.
Ahmed weighted 3.8 kg, his length increased to 59 cm.
At this stage the mother was giving the child 4 bottles of milk each 120 ml, plus 2 feeds corn-flour each 120 ml, 1ml olive oil was added to two milk feeds, plus two feeds of juice each 120 ml.
For the next 7 days the mother was advised to give the same feeds and to add 30ml to one of the milk feed for 3 days, after that she was also advised to add another 3o ml to another milk feed till the next visit.
Ferrolet (iron syrup), folic acid, vitamin A and D were stopped since they reached the acceptable levels.
The 5th visit:
The weight was 3.9 kg, Length was 60 cm.
At this stage, he received according to his mother:
Two milk feeds each 120 ml, plus two milk feeds each 120 ml added to each one 1 ml olive oil, plus 3 feeds corn flour, each 120 ml, plus one fruit juice 120 ml.
The 6th visit:
The weight was 3.9 kg, length was 62 cm. He received the same number and volume of feeds as in the previous visit. The duration between this visit and the previous one was 7 days.
The 7th visit:
He had severe pneumonia and referred urgently to hospital. He was admitted for 2 days and received I.V. fluid and antibiotics.
The 8th & 9th visit:
Wt. is 4.3 kg, length is 63 cm, both below – 3 Z score together with wt. for height but so much better than before.
Further action taken:
After consultation with the paediatrician and Caritas medical consultant, the decision was taken to extend Ahmed’s program to another 3 months.