BABY BOY MAGNO

COURSE IN THE WARDS Admitted in the NICU as a case of t/c CDH Initially hooked to O2 support at 10 lpm via hood Still with retractions Intubated ET3L9 Hooked to MV 100% 20/ Started on Meropemen and Amikacin Babygram showed CDH

2d-echo showed PA hypertension ABGS showed respiratory acidosis PIP increased to 22 Started on Dopamine 10, Vecuronium and Midazolam On the 4 th DOL, underwent repair of hernia RR successfully weaned off to 40 The following day, Vecuronium and Midazolam were discontinued

Patient was started on Dobutamine 10 Meds were shifted to Piperacillin-Tazobactam, Amikacin and Pentoxyfylline Ruling out new-onset sepsis

CIRCUMSTANCES SURROUNDING DEMISE Noted with bleeding per orem and per ET Code called ACLS initiated Not revived PCOD: Dissiminated Intravascular Coagulopathy secondary to nosocomial sepsis (S. epidermidis)

BABY BOY BRIONES

COURSE IN THE WARDS Infant of mother with uncompensated heart disease Intubated at 1 st minute of life for irregular respiration Intubated ET3L7 Hooked to MV 100% 24/ Intial ABG showed respiratory acidosis PIP increased to 30

Dopamine 10 and Dobutamine 10 started Started on Meropenem and Amikacin Transferred to Cohort for growth of gram (-) bacilli At the cohort noted hypothermic and in respiratory distress with desaturation Patient thermoregulated Pressure continually increased with no relief of the respiratory distress and desaturation

CIRCUMSTANCES SURROUNDING DEMISE Code called ACLS initiated Epinephrine IV and per ET given Not revived PCOD: respiratory distress syndrome

BABY BOY FRIAS

COURSE IN THE WARDS Born preterm to a 37 y/o multigravid Intubated due to irregular respiration Intubated ET2.5L8 Hooked to MV 60% 16/ Started on Meropenem and Amikacin Babygram showed HMD, mild Weaned off to NCPAP on the 3 rd DOL then eventually to 2 lpm via NC

Initial blood cs showed E. coli Transferred to cohort Bilirubin noted to be elevated Started on circular phototherapy Incremental feeding initated Noted tachycardic on the 6 th DOL t/c PDA, for 2d-echo Started on Dobutamine 10

Hooked back to NCPAP 30% PEEP 5 Started on Cefepime Plan is for DVET for sepsis Noted with coffee ground output per OGT on 8 th DOL Started on PPN Repeat blood CS showed K. pneumoniae, ESBL. MIC to Cefepime sent

Repeat CXR showed nosocomial pneumonia with atelectasis (10 th DOL) Put on right lung up MIC showed resistance to Cefepime Shifted to Ciprofloxacin Babygram showed dilated bowel loops FOBT was (+) A> NEC stage 1B Started on Metronidazole

Started also on vitamin K and Famotidine Noted platelet 5 and decreased Hgb 81 s/p BT of 1 aliq pRBC and 1 aliq PC Atelactasis was resolved at this point but with increassing infiltrates on babygram 14 th DOL, ABGs metabolic acidosis Dobutamine increased to 20, started Dopamine 20 TFI increased to 154

On the 15 th day of life, noted with sclerama and edematous bilateral lower extremities NCPAAP increased to 60% and 5 but still with respiratory distress Intubate ET3L7.5 Noted bleeding per orem t/c fungal sepsis To start Fluconazole

CIRCUMSTANCES SURROUNDING DEMISE Code called ALCS initiated Epinephrine per ET and per IV given Not revived PCOD: Septic shock (K. pneumoniae)

BABY GIRL MUYANO, TWIN A

COURSE IN THE WARDS Born preterm, 1 st of twins via LSCS for multiple gestation Intubated for respiratory distress Intubated ET2.5L5.5 Hooked to MV 60% 18/ Started on Meropenem and Amikacin Noted with growth of Pseudomonas putida in initial blood cs Transferred to cohort

Noted increased wbc on repeat CBC Shifted to Cefepime MIC to Meropenem, Cefepime and Ciprofloxacin sent Noted also ABGs showed persistent metabolic acidosis Started to Dopamine 10 On the 4 th DOL, noted with gr 2/6 continuous murmur in left parasternal border

t/c PDA, for 2d-echo ABGs still metabolic acidosis Started on Dobutamine 10 TFI 120 Repeat CBC showed hgb 44 s/p BT of 1 aliq pRBC x 2 doses Repeat improved to 133 MIC showed resistance to Cefepime Shifted back to Meropenem

Dopamine and Dobutamine increased 20 Started on Epinephrine 0.3 Noted deteriorating BP (MAP < 30) Epinephrine increased to 0.5 Started on Hydrocortisone t/c fungal sepsis To start Fluconazole For DVET for sepsis

CIRCUMSTANCES SUROUNDING DEMISE Code called ACSL intiated Epinephrine per ET given Not revived PCOD: Septic shock (P. putida early onset; B. pseudomallei late onset)