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CASE STUDY - Subject: Prematurity Topics: Respiratory distress


History: Baby boy Isaac has just been born. He is estimated to be 34 weeks’ gestation by the Last Menstrual Period (LMP). He was born to a G1 now P1 mother who received 4 antenatal visits before delivery. Her antenatal labs were unremarkable for infection. Spontaneous vaginal delivery (SVD) after 10 hours of labor, spontaneous rupture of membranes 1 hour before delivery. He is admitted to the neonatal unit 1 hour after birth and is placed on a warmer. Vital signs: temperature 36 C, heart rate 156 bpm, respirations 80 bpm. The pulse oximetry result was 88%. He is actively moving all extremities, nasal flaring is noted, and intercostal and substernal retractions are noted.


Please Answer:

1. What nursing care would you provide for this neonate?

2. How do you manage this case in your facility?

3. What do you say to the family


*Please answer and discuss in the comments below:



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Take care of the 5 hypos

Baby having cold stress and increased

work of breathing nurse in a neutral thermal environment, initiate on CPAP, IV access for fluid infusion and empiric antibiotics, oral gastric tube for feeds and abdominal decompression, essential new born care , supplement once on full feeds and at 2 weeks of age

Talk to the family concerning the baby's condition, and the care being provided and what is required from them.

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Thanks Susy for your write up. In my opinion, I think baby Isaac does not have risk of infection for commencement of antibiotics. Once the initial new born care on prevention has been carried out. Thanks. My opinion.

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  1. This baby has severe respiratory distress syndrome and neonatal infection risk related to premature labor therefore Start with CPAP , then insert NG Tube, insert IV line administer ampicillin 50mg/kg BID, gentamicin 3mg/kgl OD and D10% 60ml/kg/24hrs and EBM 3ml/3. Monitor vital signs 3 hourly, monitor EBM tolerance 3 hourly

  2. Start with CPAP , then insert NG Tube, insert IV line administer ampicillin 50mg/kg BID, gentamicin 3mg/kgl OD and D10% 60ml/kg/24hrs and EBM 3ml/3. Monitor vital signs 3 hourly, monitor EBM tolerance 3 hourly and do blood sampling for full blood count, CRP to rule out infection

  3. We have reassure the family telling them the reason for admission in neonatal unit, explain prognosis and possible hospital stay period. Thank you

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Thank you Pacific for your write up. I also want to add that prior commencement of antibiotics for baby Isaac, there's need to establish absence of renal injury. Hence ensure urine output prior commencement. Thanks

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Q1/2

Remarkable findings on History and Exam:

Prematurity, low temperature, fast breathing, nasal flaring,desaturations, intercoastal and substernal retractions.

Impressions:

RDS in prematurity; ?NNS


Approach:

Keep warm in a humidified incubator or warmer; KMC can be done as well;

Ensure care is family centred (FCC) by involving the mother and the next of kins; Explain procedures and expectations;

Ensure airway patency;

Trial of o2 to a max of 1l/m via NP/NC;

Initiate CPAP when trial of o2 fails to improve SPO2 and WoB remains increased - titrate fio2 to maintain spo2 strictly within 90-95%);

Assess RBS and initiate early feeding to prevent hypoglycaemia. (trophic feeds with colostrum; IVF d10. When stabilizes, gradually change to full enteric feeds - OGT);

Correct gestation…


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Nice submission, Tamba

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  1. This is a premature baby with RDS , . I will commence the baby on CPAP, prophylactic antibiotherapy and start feed after 48 hrs.

  2. In our facility, we exactly do what have said above: we nurse the babay on a wormer, antibiotics prophylaxis, CPAP, and start feed after 48 hrs. If suckling reflex is present, the mother can breastfeed, if absent, feeding via NGT .

  3. The family should know about the condition of the baby and should be part of the care. I will explain to them why the babay is having RDS, and some other complications of prematurity,

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Thank you for your response. Why do you wait 48 hr to institute feeds? And do you breastfeed a baby on CPAP? Always like to hear different ways people take care of babies.

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Attached Ngulube, thank you for you detailed neonatal care on this 34weeker. I've also learnt from your publication. In my facility, doctors site give IV drugs. With the press t training now on going in my country as a neonatal nurse, we have been taught the responsilities of administering all care to the new born.

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Thank you for complimenting the education you are receiving from a COINN team.

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