39 week/M by PA with note of occasional arrhythmia NICU Rotation SGD. 07 January 2009 Interns Belandres, Bombase, D. Chan, Chu, Francisco

Circumstances of Delivery Born Full Term 37 1/7 weeks by LMP 39 weeks by PA 2500g AGA Cephalic via primary LSCS due to NRFS

PRENATAL: Maternal Profile (+) 9 x PNCU’s c/o a midwife’s clinic (-) cough/colds, HTN, BA, PTB, DM/GDM, PROM, alcohol intake, hep B, drugs, smoking

Course of Labor, Resuscitation 14 hours PTC, (+) watery vaginal d/c with irregular mild uterine contractions. On admission, FHT noted to be 124/min, regularly irregular. On delivery, thermoregulation, suctioning, tactile stimulation done/given HR noted 130, RR 140, clear of meconium with good color, tone and cry

Resuscitation Further thermoregulation, suctioning, tactile stimulation done/given; 30 secs  Good cry, tone and color noted.  HR 130s, RR 40, Apgar 9. 4 mins supportive care  HR 130s, RR 40. Apgar 9. Occasional arrhythmia noted.  O2 sats taken: 98-99%

Post-natal course Roomed-in, monitored  Persistent arrhythmia noted Admitted to NICU 2

Course in the NICU Day 1 Was received awake, active, comfortable, HR irregular, RR 50-60, O2Sat 98%. AP, DHS, (-) murmurs, good pulses hooked to cardiac monitor (+) occ’l PVC’s noted thermoregulation done, feeding with EBM started, 3xBM noted, good UO A>> r/o CHD

Day 2 Feeding increased (-) murmurs on auscultation Good cry, activity Day 3-5 (-) PVC’s on monitor (-) murmurs good cry/activity. Course in the NICU

Day 6 still (-) PVC’s 15-L ECG done>> (N) good suck noted sent home

Discharge PE pink conjunctivate, anicteric sclerae, (-) molding/caput, anterior fontanelle open and soft, (-) overlap of sutures, (-) anterior neck mass, (-) CLAD, head circumference 33cm equal chest expansion, (-) alar flaring, (-) retractions, clear breath sounds, chest circumference 31.4cm adynamic precordium, (-) heaves/thrills, normal rate/regular rhythm, (-) murmurs appreciated

Discharge PE slightly globular soft abdomen, nonpalpable liver edge, (-) masses, umbilical cord stump clean and dry penile shaft straight, testes (B) descended peripheral pulses full and equal, pink color, skin with good moisture and turgor,

patent DUCTUS arteriosus

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