NICU AUDIT

August 2014

Patient Profile

• C.A.• Live Preterm Baby Girl Delivered Via Stat

Primary Cesarean Section for Non- Reassuring Fetal heart rate pattern to a 36 y/o G2P2 (1102)

• 28 4/7 weeks AOG• MT 32, SGA• APGAR score 9,9

Anthropometrics

• Birth weight: 950 grams• Birth Length: 38 cm• Head circumference: 26 cm• Chest circumference: 21 ½ cm• Abdominal Circumference: 20 cm

• MATERNAL HISTORY: GDM since 20 weeks AOG on Diet modification; Gestational HTN at 15 weeks maintained on Methyldopa 250 mg TID

• PAST MEDICAL HISTORY: GERD; admitted 1 day prior due to chest pain.

• FAMILY HISTORY: DM• OB HISTORY: G1- Live Full term female, NSD, no

complications G2- Present pregnancy

Upon Delivery

• Good cry and activity• HR 150-160• Acrocyanotic• Good cardiac tone• Good air entry

At the NICUSubjective Objective Assessment Plan

Good cry and activitySpontaneous breathing

HR 150’sGood cardiac toneGood air entryacrocyanotic

Live Preterm Baby Girl

Place inside a plastic bag for thermoregulationHooked to 1 lpm via nasal CannulaUmbilical catheterizationNPO

Blood CultureCBCBlood TypingHgtChest Xray

D10 W TFR 80Ampicillin 105.2 mkdose q12Amikacin 17.89 mkdose q36 hrsVitamin KTobramycin

At the NICUSubjective Objective Assessment Plan

Good cry and activitySpontaneous breathing

HR 150’sGood cardiac toneGood air entryacrocyanotic

Live Preterm Baby Girl

D10 W TFR 80Ampicillin 105.2 mkdose q12Amikacin 17.89 mkdose q36 hrsVitamin KTobramycin

CBC 6th hr of life

HgbHctWBCBandNeutroLymphoMono Platelet

165496.3026035031832 nrbc/100 wbc

Blood Type O+

Blood Culture

No growth for 7 days

CRP 0.25

Chest Xray Ground glass opacities noted with some air bronchogram suggesting an element of surfactant deficiency; Pneumonia may not be excluded

UVC at the level of 9th vertebral body

Hgt 70

13th Hour of lifeSubjective Objective Assessment Plan

NPONo cyanosisNo vomiting

HR 135RR 53 O2 Sat 100% at 1 lpmGood air entrySubcostal retractions

Live Preterm Baby Girl; Neonatal Pneumonia

Discontinue Amikacin, Start Cefotaxime 52.63 mkdose q12

Day 1 of lifeSubjective Objective Assessment Plan

NPONo cyanosisNo vomitingSpontaneous breathing

HR 128RR 65O2 Sat 98% at 0.25 lpmGood air entrySubcostal and intercostal retractions

Live Preterm Baby Girl; Neonatal Pneumonia

TFR increased to 100IVF shifted to D10IMB

Ampicillin Day 2 ½Cefortaxime Day 2

Day 2 of lifeSubjective Objective Assessment Plan

3 ml of D5W given via OGT every 3 hrs then supplemental feeding was started 3 ml every 3 hrs No cyanosisNo vomitingSpontaneous breathingOccasional desaturations

HR 163RR 63O2 Sat 99% at 0.25 lpmLight jaundice to abdomenGood air entrySubcostal and intercostal retractions

Live Preterm Baby Girl; Neonatal Pneumonia; Hyperbilirubinemia, unspecified

TFR increased to 120

Single Overhead Phtototherapy started

OGT inserted

Ampicillin Day 3 ½Cefortaxime Day 3

Day 3 of lifeSubjective Objective Assessment Plan

Tolerates supplemental feeding was given 4 ml every 3 hrs No cyanosisNo vomitingSpontaneous breathing

HR 155RR 61O2 Sat 97% at 0.25 lpmPink skinGood air entrySubcostal and intercostal retractions

Live Preterm Baby Girl; Neonatal Pneumonia; Hyperbilirubinemia, unspecified

TPN started

Single Overhead Phtototherapy- discontinued

OGT inserted

Hgt 87

Ampicillin Day 4 ½Cefortaxime Day 4

The patient remained stable and was transferred to another institution at the 7th day of life.

FINAL DIAGNOSIS

Live Preterm baby girl delivered via Stat Primary Cesarean Section for Non-reassuring Heart rate pattern to a 30 year old G2P2 (1102) at 28 4/7 weeks AOG, Apgar score 9,9, Maturity Testing 32 weeks, SGA

Infant of mother with GDM and Gestational Hypertension

Neonatal PneumoniaHyperbilirubinemia, unspecified.