1. 39 week/M by PA with note of occasional arrhythmia NICU Rotation SGD. 07 January 2009 Interns Belandres, Bombase, D. Chan, Chu, Francisco

2. 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

3. 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

4. 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

5. 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%

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

7. Course in the NICU Day 1 Was received awake, active, comfortable, HR 122-134 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

8. 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

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

10. 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

11. 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,

12. patent DUCTUS arteriosus

13. THANK YOU