Awad 1years 4months old male child , product of FT NVD birth weight 2.5kg with no antenatal problem . Echo was done at the age of1month which showed small ASD and to follow up after 3 months but no treatment was given .
At the age of 5 months child came to ER with complaints of vomiting,following chocking and also mother gave history of recurrent chocking since birth and poor sucking since birth and associated with wheezy chest .O examination patient was FTT weight 4,2kg with dysmorphic features _Brachycephaly small Iow set ears flat nasal birdge beaked nose hypotonai and increased DTR
patient was seen by pediatric neurologist Genetist advised for MRI brain thin corpous callosum prominent ventricular system with cerebral and cerebellar atrophy TORCH chromosomal stud Sr amino acid chromatography
Dietician :advised to give high energy formula through NGT but parents refused NGT feeding
Metabolic specialist was consulted as there was increased level of lactate and advised for urine organic acid Lactate pyruvate ratio blood amino acid chromatography and Guthrie test