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NICU Case Discussion: Baby Calingasan

NICU Case Discussion: Baby Calingasan. Pelayo -Samson. GENERAL INFORMATION. Baby Boy of J. C.

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NICU Case Discussion: Baby Calingasan

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  1. NICU Case Discussion: Baby Calingasan

    Pelayo-Samson
  2. GENERAL INFORMATION Baby Boy of J. C. Patient is born full term 37 weeks by PA 2600 grams AGA cephalic presentation delivered by repeat LSCS to a 23 year old G2P1(1001) mother. Mother had a stable primary antenatal condition, had 2 pre-natal check-up c/o PGH. No maternal illnesses, no vices, no medications during pregnancy.
  3. PHYSICAL EXAMINATION
  4. DIFFERENTIALS
  5. LABS
  6. DIAGNOSIS Full term 37 weeks by PA 2600 grams AGA cephalic presentation delivered by repeat LSCS, AS 9,9 Meconium Pneumonitis Hyperbilirubinemia w/o set-up r/o Nosocomial sepsis
  7. Born at the PGH Nursery on May 7, 2009 with APGAR score 5, 9 Started on Piperacillin-Tazobactam (75mkd) 195 mg IV q12 Started on Amikacin (15mkd) 40 mg IV OD Ordered CBC with PC, Blood typing, ABG, Na, K, Cl, Ca, CXR APL, Blood CS Venoclysis started with D10W (80) @ 9cc/hr NPO, Hgt q8 O2 support at 10 lpm/hood COURSE IN THE WARDS
  8. ABGs
  9. COURSE IN THE WARDS Admitted at NICU 3 on May 7, 2009 Received with fair pulses BP 30-40/20’s Given total of 50 cc/kg PNSS IV bolus, BP improved to 40-50/30’s but still with fair pulses Started on Dopamine @ 10mcg/kg/min to run for 1cc/hour (Dopamine 0.9cc + D5W 23.1cc) UVC inserted
  10. COURSE IN THE WARDS Due to persistent desaturation (O2 sats 80’s), patient intubated with MV settings 100%, 18/3, RR 60 LT 0.4 O2 sats improved to 98-100% ABGs ordered D10W increased to run for 10 cc/hour STAT NaHCO3 5 meqs given ABGs ordered
  11. ABGs after intubation
  12. ABGs after NaHCO3
  13. COURSE IN THE WARDS 1st HD, 1st DOL PWI: FT 37 weeks PA, 2600g, AGA, ceph, repeat LSCS, LBB, AS 5,9; Neonatal Pneumonia vs MAS; PPHN precaution r/o sepsis MV settings maintained IVF shifted to D10 1MB Ca 300 @ 10cc/hr
  14. CBC and Blood Type
  15. ABGs
  16. COURSE IN THE WARDS Decrease RR to 50 then decrease by 2 q2 until 30 Decrease FiO2 by 5 q2 until 60%
  17. COURSE IN THE WARDS 2nd HD, 2nd DOL MV setting at 80%, 18/3, 44, 0.4 ABGs ordered Once FiO2 60%, may start feeding with 5cc EBM q3/OGT with SAP
  18. ELECTROLYTES
  19. COURSE IN THE WARDS Start feeding 5cc EBM as ordered, if tolerated 3x, start increments: increase 5cc every feeding until 30cc MV setting: 60% 18/5 26 0.4 Wean FiO2 by 5 q2 til 21% Wean RR by 2 q2 til 10 Extract ABGs at RR=10
  20. COURSE IN THE WARDS 3rd HD, 3rd DOL Prepare for extubation Prepare O2 hood FiO2 30% MV settings at 21%, 18/3, 14, 0.4 Revise inotropes: Dopamine 0.5cc + D5W 23.5 cc to run at 1cc/hour then consume then discontinue
  21. COURSE IN THE WARDS s/p extubation Placed on O2 hood FiO2 30% Racemic epinephrine nebulization started to continue 2 more doses 15 minutes apart Patient noted to be jaundiced up to thighs For TB DB IB Increase feeding to 35cc q3/OGT
  22. COURSE IN THE WARDS For CPT with proper shields Dopamine discontinued NCPAP 30% PEEP 5 ABGs Noted vomiting with feeding; abdomen soft but distended Feeding decreased to 30cc
  23. ABGs
  24. COURSE IN THE WARDS 4th HD, 4th DOL Increased feeding to 35cc TB DB IB noted Maintain on phototherapy PWI: FT 37 wks by PA, 2600 g, AGA, cephalic, delivered via primary LSCS, LBG, AS 5,9; Neonatal pneumonia; Hyperbilirubinemia no set-up
  25. TB DB IB
  26. COURSE IN THE WARDS 13cc of feeding residual noted; no abdominal distention Feeding deferred Wean FiO2 by 5 q2 until 21% Coffee-ground noted NPO Start Famotidine 1mg IV q12 Give Vit K 2mg slow IV push ABGs ordered at 25% PEEP 5
  27. ABGs
  28. COURSE IN THE WARDS 5th HD, 5th DOL PWI: FT, 37 wks by PA, 2600g, AGA, cephalic, rpt LSCS, LBG, AS 5,9; neonatal pneumonia; hyperbilirubinemia with no set-up; rule out nosocomial sepsis Still with jaundice and coffee ground material
  29. COURSE IN THE WARDS For repeat CBC with PC, blood CS, eletrolytes To start Ceftazidime (50mkd) 130mg IV q12h NPO IVF revised to: D10 1MB Ca 400 @ 13cc/hr CXR: meconium pneumonitis with atelectasis on the right Please put patient on right side up
  30. DISCUSSION
  31. MAS
  32. MAS
  33. HYPERBILIRUBENEMIA
  34. THANK YOU!
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