Professional Documents
Culture Documents
Nursery Census
January May, 2010
Nursery Census
January May, 2010
January 0 55 4
February 0 60 7
March 0 45 8
April 0 42 8
May 0 52 2
Nursery Census
January May, 2010
Vital Statistics
Preterm Crude Birth Rate/ Prematurity Rate
Term Crude Birth Rate
Formula
No. of Preterm Deliveries/Total No. of Deliveries x1,000
In 1,000 population
7/283 x1,000
24.7
276/283 x1,000
975.2
7/7 x1,000
7/29 x1,000 3/283 x1,000
1,000
241.3 10.6
CAUSES OF PREMATURITY
January Infant of Diabetic Mother Severe Preeclampsia February Twin Pregnancy Preeclampsia March Chronic Hypertension Hyperthyroidism April Twin Pregnancy Infant of Diabetic Mother May Gestational Hypertension Premature Rupture of Membranes
Nursery Census
January May, 2010
Mode of Delivery
80 70 60 50 40 30 20 10 0
January Abdominal Vaginal Assisted Vaginal Spontaneous 17 1 41 Number of Deliveries
Februar y 25 1 41
March 23 2 28
April 25 0 25
May 18 0 36
Twin Pregnancy
Transverse Lie
Repeat CS
Frank breech
Failure of Induction
Nursery Census
January May, 2010
Gender of Neonates
80 70 60 50 40 30 20 10 0
Number of Deliveries
February 0 34 33
March 0 24 29
April 0 23 27
May 0 28 26
Nursery Census
January May, 2010
January 3 51 5
February 2 61 4
March 0 49 4
April 2 44 4
May 0 52 2
Nursery Census
January May, 2010
Fullterm
% N 13 % 51.1
Postterm
N %
SGA
24.1
AGA
LGA
19
1
65.5
3.44
235
6
92.5
2.36
BW(gm)
<25
500 501-750 751-1000 1001-1250 1251-1500 1501-1750 1751-2000 2001-2500 2501-2750 2751-3000 3001-3500 3501-4000 >4000
2 1 1 1 1 2
1
3 1
1
4 3 2 13 10
1
23 43 1
8(1)
1 4
71
63 8
1
8 3
Causes of Sepsis
Based on Culture Results January Blood CS: - Acinetobacter
lwoffii
TACS:
- Staphylococcus epidermidis - Stenotrophomonas maltophilia -Enterobacter aerogenes
Stool CS:
-Gram (+) Cocci -Escherichia coli
Nursery Census
January May, 2010
Fullterm
N %
Postterm
N %
Early Neonatal Death <48 hrs >48 hrs 7 days Late Neonatal Death 7 -21 days 28 days
2 4 1
57 14.2
28.5
Mortality
January B. D.
46 days old
26wks, 650g, AGA, Cephalic, Neonatal Sepsis; Neonatal 1LTCS, AS2,3,7 Pneunomia; s/p Surfactant Instillation; s/p Intubation; s/pUmbilical Catheterization
Hydrops fetalis; Neonatal Sepsis,considered; s/p Intubation
Februar B. S. 29 wks, 2.3kg, LGA, 2hrs old Cephalic, 1LTCS, AS1,3 y March
B. S.
64hrs old
24-25wks, 600g, SGA, Cephalic, Hyaline Membrane Disease; 1LTCS, AS1,3,6, 1st of Twin Neonatal Sepsis; s/p Intubation 25wks, 450g, SGA, Transverse Lie, 1LTCS, AS0,2,3, 2nd of Twin Hyaline Membrane Disease; Neonatal Sepsis; s/p Intubation
B.S.
41hrs old
Mortality
March B. T.
54 days old
Tracheo-esophageal Fistula with Esophageal Atresia; Neonatal Sepsis; Neonatal Pneumonia; GERD gr4; Bronchopulmonary Dysplasia; s/p Open thoracotomy, ligation of Distal TEF, Tube Gastrostomy; s/p Open toracotomy, Primary Repair TEF-EA; s/p Tracheostomy; s/p IV Cutdown Neonatal Sepsis; Perinatal Asphyxia, Severe HypoxicIschemic Encephalopathy; Herniation syndrome, secondary; Intracranial Hemorrhage, considered Severe Hyaline Membrane Disease; Neonatal Sepsis,
B.E.
46 hrs old
April
G. Q 4hrs.
PRENATAL HISTORY:
2 days prior to delivery
(+) Decrease in fetal movement (-) Consult (-) Medication
NATAL/POSTNATAL HISTORY:
APGAR Score Criteria Color Mnemonic 0 1 2 Appearance All blue, palePink body, All pink
blue extremities
Heart rate
Pulse
Absent None
Reflex response Grimace to nasal catheter/tactile stimulation Muscle tone Activity Respiration Respiration
Limp
Absent
*A total score of 710 at 5 min is considered normal; 46, intermediate; and 03,
low.
1st Min= 0
NATAL/POSTNATAL HISTORY:
Thickly meconium stained, pale, limp and bradycardic
Tracheal aspiration minimal meconium aspirate
NATAL/POSTNATAL HISTORY:
APGAR Score Criteria Color Mnemonic 0 1 2 Appearance All blue, palePink body, All pink
blue extremities
APGAR Score 0 1 2
All blue, pale Pink body, blue All pink extremities
Heart rate
Pulse
Absent None
Absent
Reflex response Grimace to nasal catheter/tactile stimulation Muscle tone Activity Respiration Respiration
None
Grimace
Sneeze, cough
Limp
Absent
Some Active Limp flexion of extremities Irregular, Good, crying Absent slow
*A total score of 710 at 5 min is considered normal; 46, intermediate; and 03,
low.
1st Min= 0
After 5 Min= 2
Admission to NICU
FAMILY HISTORY:
(-) Hypertension (-) Bronchial asthma (-) Diabetes mellitus (-) Food and Drug Allergy
PHYSICAL EXAMINATION:
Vital Signs: CR: 50140s RR: Continuous ambubagging at 60 cpm Temp: 35.8 36.4C Anthropometrics: Weight: 3 kg Length: 51 cm Head circumference: 37 cm Chest circumference: 31 cm Abdominal circumference: 31 cm
PHYSICAL EXAMINATION:
General survey:
Limp with poor muscle tone and activity, poor cry and pallor
Skin:
No petechiae, rashes or birth marks
HEENT:
Bulging and tense fontanels with alar flaring No caput succedaneum, molding or cephalhematoma No eye discharges No cleft lips, gums or palate
PHYSICAL EXAMINATION:
Chest:
No asymmetry or deformities Good air entry but with rales Normal cardiac rate and regular rhythm
Abdomen:
Globular, soft abdomen No masses or organomegaly noted Normoactive bowel sounds
Extremities:
Good peripheral pulses; No fractures noted
Anus:
Patent
NEUROLOGIC EXAMINATION:
GCS score/Best Response: 3 Cranial nerve: I- Not elicited II- 3-4mm pupils, isocoric, sluggishly reactive to light III, IV, VI- Not elicited V, VII- Absent corneal reflex, No facial asymmetry VIII- Not elicited IX, X- Absent gag reflex XI, XII- Not elicited Reflexes: Absent deep tendon reflexes Motors: Absent Meningeals: No meningeals Clonus: Negative
B A L L A R D S C O R E
17
ADMITTING IMPRESSION:
Preterm, 36 weeks by Ballard score, 3 kg birth weight, Large for Gestational Age, delivered Cephalic via Primary Ceasarean Section, Thickly meconium-stained
NPO
CBG q6 228mg/dL
CBC Day of Umbilical vein admission VBG Day of cannulation Hgb 5.7 admissio Hct 17.1 n D10W at 80cc/kg WBC 26.3 pH 7.438 NRBC 2 pCO2 18.1 Seg 66 pO2 58 Stb 22 HCO3 12.3 Lym 5 O2 sat 92.7 Eos 5 B.E. -9.6 Mon Meta 1 Myelo 1 Platelet 242 (m)
Blood Type A+
Chest x-ray: - Essentially negative cardio-pulmonary findings - s/p Endotracheal tube and orogastric tube insertion - X-ray of the abdomen is suggested for further evaluation
Ampicillin Ceftazidime
Limp
No spontaneous breathing
Blood-streaked vomitus
Protime CBC
Day VBG of7hrs Post- 7h Adm admission 7.438 transfusio 7.341 Clotting time pH 14.5se pCO2 c 18.1 n 21.7 Hgb 5.7 pO2 78%58 9.6 156 Prothrombin activity Hct 17.1 30.4 11.8 HCO3 12.3 INR O2 sat 1.33 18.9 99.4 WBC 26.3 92.7 NRBC 202 B.E. 39.4 -9.6 58 -13.1 APTT Seg 66 48 control Stb 22 32.5 16 Lym 5 28 Eos 5 1 Mon 4 Meta 1 3 Myelo 1 Cranial UTZ Platelet 242 (m) 192 (m)
Limp No spontaneous breathing No spontaneous eye opening Anisocoria (L-pinpoint;R-23mm) sluggishly reactive to Pediatric Neurologist light Hypotonic ..Severe Hypoxic-Ischemic
Encephalopathy..
O2 saturation: 99-100% Pale Tense fontanels Flexion of toes upon stimulation Brownish with blood streak secretion per OGT
Phenobarbital standby
24h S. electrolytes Na 130 K 3.4 Ca 1.41 BUN 5.72 Ca Crea 90.81 O2 saturation: 99-100% Glucona te Bilirubin Levels Deepening and Total Bilirubin 9.26 progression of jaundice Direct Bilirubin 0.81 up to the thighs Indirect Bilirubin 8.55
Limp Hypotonic No spontaneous breathing No spontaneous eye opening O2 saturation: 49-55% Bradycardia (CR: 7220bpm) Pallor Jaundice
D N R
BCS: No growth
Tendon reflexes Myoclonus Complex reflexes Sucking Moro response Grasping Oculocephalic (doll's eye)
Adapted from Sarnat HB, Sarnat MS: Neonatal encephalopathy following fetal distress. Archives of Neurology 33:696705, 1975.
Constricted Variable in rate and depth, periodic Low resting < 120 beats/min Common (70%) Low voltage, periodic or paroxysmal, epileptiform activity 5% 20%
< 1% < 1%
Adapted from Sarnat HB, Sarnat MS: Neonatal encephalopathy following fetal distress. Archives of Neurology 33:696705, 1975.
Final Diagnosis: Respiratory Failure Perinatal Asphyxia, Severe HypoxicIschemic Encephalopathy Herniation Syndrome, Secondary t/c Intracerebral Hemorrhage Preterm, LGA Sepsis, Early onset
(Adapted from Neonatal Resuscitation Textbook, ed. 5. American Academy of Pediatrics and American Heart Association, Appendix, p. 62, 2006.)
FIGURE 1. Algorithm for the suggested evaluation of a term newborn with hyperbilirubinemia. Information from jaundice and hyperbilirubinemia in the newborn. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of pediatrics. 16th ed. Philadelphia: Saunders, 2000:51128.