മാഷ്

62 days old baby born to a young couple out of non consanguineous marriage. Elder sibling four years and healthy. Pregnancy period uneventful except gestational diabetes in third trimester which was well controlled throughout. First trimester there was no exposure to teratogens. Delivery at 38 weeks at hospital .Baby weight 2450 grams,not asphyxiated. Baby passed meconium and urine normally breast feeding established normally and was discharged on third day. She was gaining weight normally up to forty fifth day. From 45 days onward   mother noticed feeding difficulty in the form of stopping and resuming in between feeds.Baby took  longer time than normal on feeding and not getting enough sleep after feeding time. She also noticed baby was breathing faster during sleep and rest and gradually losing weight. discussion at this point Points useful for the clinical analysis here are  Onset and course of the problem.Whole problem started after one and a half months of age.

Six year old girl brought with yellowish discoloration of eyes and urine for the last  one and a half months. There was no fever any time in during the illness. No abdominal pain or discomfort. Overall course was gradual onset and slow progress. No significant bleeding manifestations, through bowel urine oral mucosa or skin. She was not constipated and stool was normally colored. No skin rashes or nodules. No joint pain or swelling. No alteration of sensorium or behavioral problems.Sleep was normal. No recent weight loss.     Born out of non consanguineous marriage to 32 year old father and 25 year old mother,elder girl child is healthy. No family history of jaundice, blood transfusion,abdominal surgery. No significant neurological / psychological  problems   in blood relatives. She was born at term after normal pregnancy. Birth weight was normal, neonatal period uneventful . There was no significant jaundice at that time. All her developmental milestones were norm