Pneumonia

Magno, Bb. Boy NB/M Born in Cavite On his 9 th hospital day

History of Present Illness Born pre term to a 24 G1P1 (1001) mother at St. Martin Clinic in Cavite assisted by a hilot via SVD in breech presentation. No noted complications during labor and delivery. The patient was noted to have good activity and good suck On the 10 th hour of life the hilot noted that the patient had poor suck and moderate activity. Upon close PE, they noted that the patient had an imperforate anus.

Patient was immediately brought to the PGH ER. On transit the patient was noted to be in respiratory distress with deep shallow breathing. They also noted circumoral cyanosis hence admission subsequent admission. Patient was immediately brought to the ER

Birth and Maternal History – Mother is a 24 G1P1 (1001) who had 2 PNCUs at a local health center. There was no note of any infection or illness during the entire course of pregnancy. The patient took multivitamins and Ferrous Sulfate as supplements. – There was no exposure to any teratogen and radioactive substances.

Past Medical History – As above Family History – (+) hypertension and kidney disease – maternal side – (+) asthma – paternal side – No congenital anomalies/ mental retardation in the family

Personal and Social History – Father is a 24 year old contractual construction worker – Mother is a 24 year old housewife – No one in the family smokes or drinks.

Developmental history: – (+) grasp reflex – (+) sucking reflex – (+)doll’s eye – (+) moro reflex Immunization History – None given

Nutritional History – The patient was exclusively breastfed

PE at the ER 12 th hour of life Acyanotic, poor activity, poor suck, cold clammy HR: 120s- 140s RR: 40s GP T: 36.7 – 37.2 Weight: 1900 g Length: AC: 30cm CC:31cm HC: 32cm Anicteric sclerae, Pink Conjuctivae, Anterior fontanelle open, flat, (+) alar flaring, (+) intercostal retractions, no crackles no wheezing, Dynamic precordium, no precordial bulging

Dynamic precordium, no precordial bulging, apex beat at the 4 th ICS LMCL, no murmurs, no thrills. Abdomen: soft, non tender, non distended, normoactive bowel sounds, no organomegally (+) imperforate anus, grossly male genitalia, bilaterally descended testes CRT 2 secs, FEPP

E/N neurlogic findings HGT < 40

Course in the ER 1 st Hospital Day A> Preterm32 weeks by PA, SVD in breech presentation, LBB, NID; HMD vs neonatal pneumonia; R/O neonatal sepsis; imperforate anus Management: IVF: D10 IMB (FM) Tx: Ampicillin (200) LD Amikacin (18) LD Metronidazole (30) Blood type: A+ CBC: Hgb 202, HCt 0.601, pc 149, wbc 12.57, N 0.668, L Na 138, K 5.0, Cl 101, Ca 2.12, Blood GS/CS done CXR: (+) infiltrates R upper lung field with note of coiling of OGT Referral: Pedia Sx A> Preterm32 weeks by PA, SVD in breech presentation, LBB, NID; neonatal pneumonia; R/O neonatal sepsis; imperforate anus; Esophagela Atresia with distal TEF P> for TLC, tube G, proximal esophagostomy or thoracostomy, esophago- esophagostomy, TLC (patient was immediately transferred to ward)

Course in the Ward 1 st Hospital Day BP: 80 palp RR:70s T: 36.8 note increase in intercostal and subcostal retractions, and use of abdominal muscles Assessment A> Preterm32 weeks by PA, SVD in breech presentation, LBB, NID; neonatal pneumonia; R/O neonatal sepsis; imperforate anus; Esophagela Atresia with distal TEF Management The patient was intubated with ET 3 level 8 FiO2: 60% RR 50 PIP/PEEP 16/5 IT: 0.5

2 nd Hospital day Intubated, sedated HR:140s RR: 40s T: 37.0C BP: 80 sys 2 nd Hospital Day A> Preterm32 weeks by PA, SVD in breech presentation, LBB, NID; neonatal pneumonia; R/O neonatal sepsis; S/P Right Posterolateral Thoracotomy, Esophagoesophagect omy, CTT R, TLC (Saure, ) Fluids: D10 IMB (FM) at 8 cc/hr NPO, HGT q8 TFI: Respiratory: ET: 3 Level 8 60%, 16/5, 50, 0.5 ABG: 7.39/ 32.6/ 181.6/20.4/99.5%

1 st Hospital Day – A> Preterm32 weeks by PA, SVD in breech presentation, LBB, NID; – HMD vs neonatal pneumonia; – R/O neonatal sepsis; imperforate anus – Management: – IVF: D10 IMB (FM) – Tx: – Ampicillin (200) LD – Amikacin (18) LD – Metronidazole (30) – Blood type: A+ – CBC: Hgb 202, HCt 0.601, pc 149, wbc 12.57, N 0.668, L – Na 138, K 5.0, Cl 101, Ca 2.12, Blood GS/CS : no growth – CXR: (+) infiltrates R upper lung field – Referral: Pedia Sx