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Twins transported to New Cross NNU

Twins transported to New Cross NNU. Mr S Manning Dr B Muhammed (consultant). Maternal information. 32 years old 1999 NVD at 40 weeks 2002 NVD at 30 weeks 2011 NVD – gestational age not recorded 2 children live with aunt, 1 with maternal grandmother. Maternal information.

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Twins transported to New Cross NNU

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  1. Twins transported to New Cross NNU Mr S Manning Dr B Muhammed (consultant)

  2. Maternal information • 32 years old • 1999 NVD at 40 weeks • 2002 NVD at 30 weeks • 2011 NVD – gestational age not recorded • 2 children live with aunt, 1 with maternal grandmother.

  3. Maternal information • History of depression • Previous OD attempts • Admitted to Psychiatric hospital at 16 weeks of pregnancy – reason not recorded. • Social services were made aware of this hospital admission

  4. Presentation on 19/9/2013 • 24 +3 gestation twin pregnancy • Taking folic acid - no other drugs recorded • Antenatal screening bloods unremarkable • Presented in labour, given dexamethasone x2 last at 1720 • No PROM, No pyrexia • Foul smelling liquor noted during delivery

  5. Twin 1 • Cephalic presentation, spontaneous vaginal delivery born at 1959 into plastic bag. Weight 620g • 5 inflation breaths given + IPPV • H/R 90 bpm • Intubated - 2.5mm ET tube 5.5cm to lips

  6. Twin 1 • Good air entry, L=R HR >100. Sats remain 40-50% on 100% O2 • Curosurf given - 25mins of age • Improved with bag ventilation • Consultant present from 2015 • Transfered to NNU at 2040

  7. Twin 1 • Sats remain poor with ventilation CMV 23/6 at rate of 60/min on 100% O2. With bag ventilation improved to 80-90% • Re-intubated by consultant, 2.5mm ET tube, 6 cm at lips • Air entry improved. Sats >90% HR 136 good chest movements.

  8. Twin 1 • Access obtained – UVC and UAC • Started IV fluids – 0.9% saline bolus and 10% dextrose 1.5ml/hr • Later started on dobutamine and dopamine • Given vitamin K • Benzylpenicillin • Gentamicin

  9. Twin 1 • ET Tube dislodged late evening • Re-intubated by consultant • ETT 2.5cm, 6 cm at lips.

  10. Twin 2 • Breech presentation spontaneous vaginal delivery into plastic bag at 2000. Weight 600g • “Moderate condition.” APGAR 3 at 1 minute • IPPV used, HR 80-100, Sats in 30’s • Intubated - 2.5mm ET tube, 5.5cm at lips, tube became dislodged during securing – repeat intubation 6.5cm to lips

  11. Twin 2 • HR now >100 • Sats 50% • Given 120mg surfactant • Sats improved >95% HR 130 • Venous gas pH7.05. lactate 15.5 • On SIMV 18/5 Rate 60/mi FiO2 40% TV 2.3ml sats 99%

  12. Twin 2 • Mean BP 20 • IV access obtained, fluid bolus given 10ml/kg 0.9% saline • Started on IV benzylpenicillin and gentamicin • Moved to NNU at 35mins • UAC and UVC inserted by SpR at 2245 • Started on dopamine and dubutamine

  13. Twin 2 • ETT tube dislodged en route to transport • Mask ventilation used • Re-intubated size 2.5mm tube 5.5cm at lips

  14. Both babies • Neonatal consultant called New Cross NNU consultant at around 2145. Informed of gestation and condition – space identified at New Cross NNU. • Contacted NTS team around same time. Details given • Estimated arrival time of team 45 minutes

  15. Both babies • Parents spoken to twice during time at Walsall by neonatal consultant • Told twin 1 struggled initially but showed some sign of improvement • Both are in very critical condition • Extremely premature • Parents made aware of gaurded prognosis.

  16. Both babies were taken by the transport team to New Cross Hospital Neo Natal unit for further intensive care.

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