© The Children's Mercy Hospital, /14 Dr. Steven Olsen, MD, FAAP Regional Neonatal Conference: Decision Making and Optimal Care and Outcomes April 9, 2015 Transport or Increased Care: You Decide

© The Children's Mercy Hospital, /14 2 What is your specialty? A.Mother-Baby nurse B.NICU nurse C.NNP D.Physician E.Other

© The Children's Mercy Hospital, /14 3 In which setting do you work? A.Newborn nursery B.Special Care nursery C.Level II NICU D.Level III NICU E.Other

© The Children's Mercy Hospital, /14 Baby A Baby A Infant born at 37 weeks to a G1P0 mother after a long labor complicated by a tight nuchal cord. Sent to NICU for observation. Infant is pale, CR 4 sec, RR 75, minimal intercostal retractions, Sats 96%, mean BP 40. ABG 7.20/30/85/-15 A.Transport Out B.Increase Care C.Continue to Observe

© The Children's Mercy Hospital, /14 Baby B A.Transport B.Increase Care 39 week infant delivered by repeat C/S to a mother with GDM. Infant with grunting respirations, moderate subcostal retractions, Sats 94% under 50% oxyhood. ABG 7.22/60/52/-2.

© The Children's Mercy Hospital, /14 A.Respiratory Distress Syndrome B.Persistent Pulmonary Hypertension C.Transient Tachypnea of the Newborn D.Hypoglycemia Baby B cont’d. What is your diagnosis?

© The Children's Mercy Hospital, /14 Baby C A.Transfer B.Increase Care Infant born 30 minutes ago at 30 weeks GA, BW 1400 grams. Temp 97.5, HR 140, Sat 97%, CR 3 sec. Just intubated, on 30% oxygen. CXR c/w RDS. Umbilical lines placed. ABG 7.22/60/68/-4. Mean BP from UAC 24.

© The Children's Mercy Hospital, /14 Baby C cont’d. A.Normal Saline bolus B.Increase ventilator support C.Surfactant If you opt to increase care, what would be your first plan?

© The Children's Mercy Hospital, /14 Baby D A.Transfer B.Increase Care 37 week male delivered vaginally. Mother UDS +Meth, no prenatal care, bloody fluid noted at delivery. Infant being observed. Temp 35, RR 60, mean BP 35. After about 2 hours of age, had a 10mL emesis which was dark green-brownish.

© The Children's Mercy Hospital, /14 Baby D cont. A.Temp B.History C.BP D.Emesis E.Other Which concerns you the most about this baby?

© The Children's Mercy Hospital, /14 Baby E A.Prepare for discharge B.Increase care 35 week infant, DOL 3, has been in well newborn nursery. Mother reports BF fine. Diapers past 24 hours: 3 wets, 1 stool. Discharge assessment – T 36.5, sleepy but arouses, some jaundice.

© The Children's Mercy Hospital, /14 Baby E cont. A.Warming infant B.Checking blood sugar C.Checking bilirubin D.Lactation consultation E.Discharge order being written You decide to call the physician. What is your highest priority?

© The Children's Mercy Hospital, /14 13