THE MEDICAL CITY Department of Obstetrics and Gynecology: Section of Perinatology and the

1. PERINATAL/NICU CONFERENCEMonthly Statistics Report February 2014Khlaire D. Pioquinto, MD3rd Year Resident – PediatricsPaolo Augusto U. Campos, MD3rd Year Resident – Obstetrics and Gynecology THE MEDICAL CITY Department of Obstetrics and Gynecology: Section of Perinatology and the Department of Pediatrics

2. TOTAL BIRTHS

3. Total Births, February 2014

4. Total Births, February 2014

5. Total Births, February 2014

6. Total Births, February 2014

7. Nursery admissions

8. January 2014 vs February 2014

9. February 2013 vs February 2014

10. Deliveries by Levels

11. Admission to NICU Referral

12. NICU Isolation

13. Neonatal Morbidities

14. Neonatal Morbidities, January 2014

15. Top 5 Conditions Occurring Among High Risk Mothers, February2014

16. Top 5 Maternal Conditions Associated with Neonatal Morbidities, February 2014 LGA - 1

17. Top 5 Maternal Conditions Associated with Neonatal Morbidities, February 2014 LGA - 2

18. Top 5 Maternal Conditions Associated with Neonatal Morbidities, February 2014 LGA – 2 Prematurity – 7 Low birth weight - 1

19. Top 5 Maternal Conditions Associated with Neonatal Morbidities, February 2014 LGA – 1 Prematurity – 1

20. Top 5 Maternal Conditions Associated with Neonatal Morbidities, February 2014 Prematurity 1

21. CONGENITALANOMALIES

22. NEONATES WITH1 minute APGAR <=6

23. Neonates with APGAR <=6, February 2014

24. CASE 1: APGAR 3, 6, 7 • 143/79, HR 96, RR 18, 37.5C • SE: pooling of clear amniotic fluid • IE: 2cm, 50%, floating, (-) BOW • s/pPBE • Male APGAR 3, 6, 7 830 g MT 28 weeks AGA • R.R.G • 39, G2P1 (0-1-0-1), 25 1/7 weeks • CC: watery vaginal discharge • Past Medical: G1 – NSD at 33 weeks AOG • Personal/Social History: U/R • Family History: (+) Hypertension, Asthma, Diabetes

26. Birth History Baby Boy Live, preterm Delivered via Normal Spontaneous Delivery 39 y/o (G2P2) (0202) 25 4/7 weeks AOG MT: 26 weeks, AGA

27. Anthropometrics BW 830g BL 32 cm HC 24 cm CC 21 cm AC 18

28. APGAR SCORE (1st minute) = 3 Positive Pressure Ventilation

29. APGAR SCORE (5th minute) = 6 Positive Pressure Ventilation

30. APGAR SCORE (10th minute) = 7 Free Flow O2 Thermoregulation

31. Admitting Impression Extreme Prematurity, Very Low Birth Weight Sepsis Unspecified

32. PLANS • Insert UVC • O2 support via nasal cannula at 2 lpm • Diagnostics: • CBC, CRP • Blood Culture • Hgt • CXR • Therapeutics: • IVF at TFR 80 • IV antibiotics (Ampicillin, Amikacin) • Aminophylline

33. PROBLEMS 1. Prematurity 2. Sepsis 3. Pneumonia 4. Apnea 5. Jaundice 6. Anemia

34. Problem 1: Prematurity • Thermoregulation: • The patient was placed in an isollette and wrapped in plastic to keep thermoregulated. • Temperature maintained at 36.5-37.5C

35. Feedings: • Upon delivery patient was on NPO, IVF started at TFR 80 • Aminosteril started • On the 3rd day of life, NGT was inserted and patient was started on Glucose water then Breast milk

36. Problem 2: Sepsis • Diagnostics: • CBC • CRP • Blood culture • Patient was started on the following medications: • Ampicillin • Amikacin

37. CRP 0.04 Blood Culture: No growth (7 days)

38. Problem 3: Pneumonia Start Cefotaxime Pneumonia in the left lower lung UVC at level of T7 to T8

39. 11th day of life Awake Active Persistent desaturations T 37C HR less than 100 O2 sats 40s-50s Pink Minimal effort on respiration No alar flaring sounds Regular cardiac rhythm Full pulses Apnea Probably secondary to progressing Pneumonia or Electrolyte Imbalance Ambubagging EG7 Chest Xray O2 support

40. Antibiotics Shifted to Meropenem Progressing Pneumonia with Consolidation, bilateral

41. Problem 4: Jaundice 2nd day of life Awake Active No desaturations T 37.1 HR 140 RR 49 O2 sats 96 Generalized Jaundice No alar flaring Good air entry Harsh breath sounds Regular cardiac rhythm Full pulses Prematurity Sepsis Unspecified Hyperbilirubinemia Unspecified Start double phototherapy

42. Problem 4: Jaundice 4th day Awake Active T 37 HR 130 RR 50 O2 sats 98 Pink No alar flaring Good air entry Harsh breath sounds Regular cardiac rhythm Full pulses Prematurity Sepsis Unspecified Hyperbilirubinemia Unspecified, resolved Phototherapy discontinued

43. Problem 5: Apnea First hour of life Awake Active No desaturations T 37 HR 130 RR 49 O2 sats 97 Generalized Jaundice No alar flaring Good air entry Harsh breath sounds Regular cardiac rhythm Full pulses Prematurity Sepsis Unspecified Start Aminophylline

44. 2nd day of life Awake Active Episodes of desaturations and bradycardia T 37 HR Less than 100 O2 sats 70s Generalized Jaundice No alar flaring Good air entry Harsh breath sounds Regular cardiac rhythm Full pulses Apnea of Prematurity Continue Aminophylline Stimulation during periods of apnea

45. 11th day of life Awake Active Persistent desaturations T 37C HR less than 100 O2 sats 40s-50s Pink Minimal effort on respiration No alar flaring sounds Regular cardiac rhythm Full pulses Apnea Probably secondary to progressing Pneumonia or Electrolyte Imbalance Ambubagging EG7 Chest Xray O2 support

46. Na correction with NaCl incorporation

47. Progressing Pneumonia with Consolidation

48. 11th day of life Awake Active Persistent desaturations T 37C HR less than 100 O2 sats 40s-50s Pink Minimal effort on respiration No alar flaring sounds Regular cardiac rhythm Full pulses Apnea Probably secondary to progressing Pneumonia or Electrolyte Imbalance For intubation Mech Vent settings: FiO2 60 PIP 18 PEEP 4 RR 50 iT 0.45 Repeat CBC and EG7 Shift IV antibiotics to Meropenem Cranial Ultrasound

50. Cranial Ultrasound Intraventricular and Germinal Matrix Hemorrhage (Grade II intracranial hemorrhage)