മാഷ്

9 year old girl   2 nd child born out of non-consanguineous marriage  with uneventful antenatal history, with a birth weight of 2.5 kg with nohistory of  NICU admission was discharged on post natal day  2. She was readmitted with frequent episodes of non bilious vomiting and Jaundice on post natal day  3 and diagnosed as duodenal web.  Duodeno-duodenostomy was done.  She was found to have some dysmorphic facial features which were subtle. Noticeable one was   bifid thumb on left hand. There was no significant malformations in the family. She was found to have abnormal cardiac findings on follow up, was investigated and found to have Osteum secundum ASD 8mm size . She was breast fed , was attaining weight and her developmental milestones at par with her peers.  At 4 years had and episode of hematemesis  There was  no other bleeding manifestations other than malena which followed next two days. At admission her vitals were stable,no features of hepatic enceph