NEISHA LOUISE needs you…………….

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Greetings in the Name of the Lord!

This is an earnest appeal seeking for your benevolent assistance and support for my 6-month old daughter, NEISHA LOUISE diagnosed with Chronic Respiratory Failure secondary to Pneumonia and Upper Airway Obstruction secondary to Subglottic Stenosis. She is currently admitted at the Intensive Care Unit of Lorma Medical Center with a previous history of noisy breathing or stridor that started at 3 weeks of age. At that very early age, she needed to have ventilatory support for apparent severe stridor or obstructed airways and eventually advised to have direct laryngoscopy with a possible tracheostomy.

As a single mother with only a small amount of honorarium as barangay treasurer for subsistence, Neisha’s first hospital expenses has left me with no option but to secure loans. Since her second admission on Otober 12, 2012 at the ICU of the above-named hospital, the estimated expenses is two hundred thousand Pesos and the expected expenses for the scheduled operation is more or less of the same amount.

It is at this juncture, that I am soliciting for your donation and assistance. Through Christ our Lord my sincerest thanks and gratitude. Please help me so that my Little Neisha will live.

Sincerely;
NIMFA G. EVANGELISTA
Mother
Contact# +639105784265

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CLINICAL ABSTRACT

A case of NEISHA LOUISE EVANGELISTA, 6 month old female, from Bauang, La Union who was admitted due to difficulty of breathing on October 15, 2012 at Lorma Medical Center

Patient is a known case of Chronic Partial Upper Airway Obstruction with a previous history of noisy breathing or stridor that started at 3 weeks of age. At that very early age, she needed to have ventilatory support for apparent severe stridor or obstructed airways. After extubation, patient’s stridor remain and noted to be more noticeable whenever patient was agitated. Consultation was sought with several physicians with the impression of Laryngotracheomalacia and eventually advised to have direct laryngoscopy with a possible tracheostomy. However, mother was not able to comply with the plan because of the anxiety of the possible risks of the procedure.

Neisha’s condition then persisted and complications of chronic upper airway obstruction already set-in like failure- to- thrive and Pulmonary Arterial Hypertension. She was seen by the attending physician about a month prior to this current admission. She was noted to have biphasic stridor with mild resolution of the stridor whenever she gets a comfortable position. Mother was then advised that direct laryngoscopy is necessary to document the severity of the upper airway obstruction and that a possibility of tracheostomy tube insertion was high. Mother again was hesitant to have tracheostomy and asked of other non-invasive procedure. Nasal Continuous Positive Airway Pressure was then considered to help alleviate Neisha’s obstruction but still the cost of the portable machine was limiting for the family. She was also managed as a case of Gastroesophageal Reflux Disease and was maintained on proton-pump inhibitor. Milk formula was also shifted to hypoallergenic and high-caloric preparation.

Four days prior to admission, Neisha started to have colds. Eventually, she developed febrile episodes, low-grade associated with bouts of coughing 3 days prior to admission. Night prior to admission, she had three episodes of post-tussive vomiting and more disturbed sleep thus brought to the attending the following day. Subsequently, admission was advised because Neisha was noted to have some signs of dehydration and difficulty of breathing.

On admission, she was hooked to low-flow Oxygen support since no nasal CPAP was available. Intravenous fluids and Sulbactam-Ampicillin was started. Chest X-ray showed bilateral Pneumonia. On 1st hospital day, she was observed to have more intense stridor and was noted to have increased difficulty of breathing associated with cyanosis thus eventually intubated. On intubation, the subglottic area was noted to be very narrow. Thus, referral to ENT service was done for direct laryngoscopy and possible tracheostomy.

Currently, Neisha is being treated for her Pneumonia. Antibiotic regimen was shifted to Ceftriaxone and on mechanical ventilator support. Plan of management is to wait for resolution of Neisha’s Pneumonia then schedule for direct laryngoscopy and possible tracheostomy.

Current working diagnosis:
Acute on Chronic Respiratory Failure secondary to Pneumonia and
Upper Airway Obstruction secondary to Subglottic Stenosis
Failure to thrive secondary
Pulmonary Arterial Hypertension, secondary

Ma. Elena C. Pabrua, MD, DPPS
Lic #: 0097650
Attending Pediatrician
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You may direct your donations at
LANDBANK of the Phils. – La Union Branch
Account Name: Nimfa Garcia Evangelista
Account Number: 2526 0507 81

A little help can make a difference – KK2011

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