GROUP 3: Neonatal Pneumonia, Congenital Heart Disease - PDA

Date: February 8, 2022; 1820H

PATIENT’S FIRST NAME: LAST NAME:

Jose Antonio Rosales

CIVIL STATUS: Newborn GENDER: Male

OCCUPATION: None BIRTHDATE: February 7,

2022

VITALS: AGE:0Y0M1D
BP: n/a T: 36.4 P:126 R:34
O2 SAT: 93%( upon arrival) 1850H: 96%

CHIEF COMPLAINT: Cyanosis HEIGHT: 54cm

WEIGHT: 3.4kgs

HISTORY OF PRESENT ILLNESS PHYSICAL EXAM

- Born to a 28yo G3P3 mom via NSD at

a lying in-clinic. Patient had a good cry (+) good cry
and with nasal retractions hence he (+) beginning Jaundice
was transferred to District Hospital. He (+) murmurs
had two episodes of cyanosis and was Soft abdomen
noted to be nauseated hence was Pupil size: 2-3mm equally reactive to light
hooked to O2 and opted to be
transferred to another institution.

BW: 3400G HC: 34cm CC: 32cm, AGA

✓ Hep B
BCG
✓ Vit K
✓ Erythromycin
OAE
PAST MEDICAL HISTORY: N/A DIAGNOSIS- Neonatal Pneumonia, Thickly
Meconium Stained, Congenital Heart Disease
- PDA

ALLERGIES: N/A
SOCIAL HISTORY:
-Father works at PKI
-Mother stays at home, doing some online
FAMILY HISTORY: Mother had no UTI, No business
HTN, no GDM, Blood Type O+ -has 2 siblings, 1male and 1 female: 3 years
old and 1year old
-Family is living near the husband's relatives.

PHYSICIAN’S ORDER SHEET

PATIENT’S NAME: ATTENDING PHYSICIAN: HOSPITAL ROOM NO

Jose Antonio M. Rosales Dra. L. Lopez NO. 1799094 Neo-1

DATE: Updated ORDER

Problem/Progress
Notes

2/8/22 -Born to a thin 28yo -Please admit under the service of Dra. Lopez.

1850H G3P3 mom via NSD -Secure consent.

at a lying-in clinic. -Monitor VS every hour and record.

AS 8,9 BS 39 weeks, -Monitor input and output and record.

meconium stained

BW 3400g -Keep thermo regulated at 36.5C - 37.2C

CBC -Mom’s Blood type O+ -Please place in radiant warmer
result(district
hospital)

HGB- 17.8 -Noted to have -IVF: D5IMB 500 X 100CC/HR

Hct-50.8 retractions and -Hook to pulse oximeter
WBC: 19.7 cyanosis -WOF: Desaturations, cyanosis and retractions

CXR result: VS: HR- 126, RR-34 -NPO for now

Pulmonary Temp: 36C -Insert OGT F8
Hyperaeration

-Term male, AGA -Diagnosis:

1. CBC: done outside

2. Repeat CXR-AP

-Please retrieve old plate (XR from district

hospital)

-Therapeutics:

1. Ampicillin 170mg IV every 8 hours

2. Gentamicin 14mg IV OD

-Hook to O2 via nasal cannula at 1-2LPM

-Maintain O2 sat at 95%.

-Refer to Dr. Ramirez, pedia intensivist for co-

management

-Refer to Dr. Ramirez prior to giving 02

-Inform AMDs

-Refer accordingly

Dra. L. Martinez
 PHYSICIAN’S ORDER SHEET

PATIENT’S NAME: ATTENDING PHYSICIAN: HOSPITAL ROOM NO

Jose Antonio M. Rosales Dra. L. Lopez NO. 1799094 Neo-1

DATE: Updated ORDER

Problem/Progress
Notes

2/8/22 -Feed 5cc q3 via OGT

2050H -Refer

Dr. Ramirez /Dra. Martinez

2/8/22 (+) Desaturation -Hook to O2 at 0.5LPM

2230H (-) cyanosis via NC
T: 36.8 -Refer
HR: 112
RR: 56
O2 sat: 84%

2/8/22 Thank you for this referral

Neo Notes PLAN:
PE: No cyanosis,
+ Jaundice,
(-) retractions,
(+) wide spaced
nipples

2300H Diagnostics:

1. Repeat CBC PC

2. For CRP and Blood C and S

3. 2DECHO

4. For serum Na, K, Ca

Therapeutics:

1. Continue Ampicillin and Genta while waiting

for blood cs

O2 at 0.5LPM 2. Maintain O2 sat > 95%

NPO for now 3. IVF: D5IMB 500 x 14cc/hr TFI 100

 OGT to drain 4. Monitor for desaturation/apnea

5. Will ff.up.

Note: If with recurrence of desaturation despite O2

at 0.5LMP, pls refer.

-Refer accordingly

Dr. Ramirez

2/9/22 -Carry out orders of Dr. Ramirez

0640H Dra. Lopez/Dra. Martinez

2/9/22 -Continue meds

1022H Dra. Lopez

PHYSICIAN’S ORDER SHEET

PATIENT’S NAME: ATTENDING PHYSICIAN: HOSPITAL ROOM NO

Jose Antonio M. Rosales Dra. L. Lopez NO. 1799094 Neo-1

DATE: Updated ORDER

Problem/Progress
Notes

2/9/22 -Please do gastric lavage

1350H Dra. Lopez

(+) residual
3cc, yellowish

2/9/22 -Please include BT to previous extraction

1430H -May start feeding at 2cc q6.

-0.5cc clear -Ff. Up lab results

residual

-soft abdomen, Dra. Lopez

non-distended

2/9/22 Neo notes --Continue antibiotics

1800H - No murmur with -For repeat Na

occ desat

- Clear BS -Facilitate 2decho ℅ dr. Palma

A: Electrolyte -IVF shift to: MoNa3K1: D5water 82ml, D5050 11ml,

Imbalance, Nacl 4ml, Kcl- 3ml= 100cc at 10cc/hr
Hyponatremia

-O2 at 0.5LPM via nasal cannula

-Continue care.

Dr. Ramirez

2/10/22 -Feeding increase to 10cc (trial)

1200H -IVF: MoNa3K1: D5water 82ml, D5050 11ml, Nacl

4ml, Kcl- 3ml @ 10cc/hr
-Start Furosemide 0.5mg IV q12

-Continue NB care

-Refer for episodes of desaturation

Dr. Ramirez

2/10/22 -For repeat serum Na, bilirubin now

1630H Dr. Ramirez

2/10/22 -Increase feeding as follows:

1900H 9pm, 12am,3am, 6am= 20cc, IVF at 5cc/hr

9am tomorrow= 25cc feeding then d/c IVF

Dr. Ramirez

PHYSICIAN’S ORDER SHEET

PATIENT’S NAME: ATTENDING PHYSICIAN: HOSPITAL ROOM NO

Jose Antonio M. Rosales Dra. L. Lopez NO. 1799094 Neo-1
DATE: Updated ORDER
Problem/Progress
Notes

2/11/22 -Increase feeding to 25cc q3

1230H -IVF to consume

-For phototherapy with precaution in AM for 24

hours

Dr. Ramirez

2/11/22 -Feeding 9am 25cc

0808H -Feeding 12nn 30 cc

-Please re-weigh patient

Dr. Ramirez

2/11/22 NEO NOTES -Ff up 2decho

1850H (+)desat episodes -Continue meds

(-)murmur -Feeding increase to 35cc q3.

-O2 inhalation at 0.5LPM

Dr. Ramirez

2/12/22 -Continue oral feeding with caution

0625H -Continue meds

Dra. Lopez

2/12/22 -Increase oral feeding to 40cc q3

0643H -Shift Furosemide IV to 1mg/pptab q12

Dr. Ramirez

2/13/22 Neonotes -Trial room air

0749H 2DECHO: PFO -Start Sildenafil 1mg/pptab q12

CLOSING, PDA -Feeding to 40 to 50cc q3
- MAS, PPHN -O2 AT 0.5LPM via NC
with desat at -Maintain saturation at >95%
 room air -Continue Ampicillin and Genta

(-) cyanosis
(-) -murmur
Soft abdomen
Full equal pulses

2/14/22 -Continue meds

1355H O2 SAT: 97 TO 100% Dra. Lopez

ROOM AIR
(-) cyanosis

PHYSICIAN’S ORDER SHEET

PATIENT’S NAME: ATTENDING PHYSICIAN: HOSPITAL ROOM NO

Jose Antonio M. Rosales Dra. L. Lopez NO. 1799094 Neo-1

DATE: Updated ORDER

Problem/Progress
Notes

2/14/22 Neo notes -Observe for desaturation and cyanosis while on room
air

1520H -notes no desat -Increase feeding to 50cc q3

(-) retractions -Continue sildenafil and furosemide for now

Soft abdomen -may repeat 2decho 2 weeks from now to check if we

Full equal pulses can discontinue Sildenafil and Furosemide

-Signing out for now, may refer back if with problems

- Dr. Ramirez

2/15/2022 -MGH

1040H Home meds

- Ascorbic acid 0.3ml OD PO

- TCB 2/19/2022, 10am to 1pm

Dra. Lopez
2/15/2022 -MGH, D/C furosemide oral

1145H -Home meds:

1. Sildenafil 1mg/pptab 1 pptab BID for 2 weeks

-For repeat 2Decho ℅ Dr. Palma

-FF. Up ℅ Dra. Lopez

Dr. Ramirez

Laboratories 2/8/22 2300H

2/9/22 0738H
CBC

TEST RESULT UNIT REFERENCE VALUE

Hematocrit 47.7 Vol % 42-54 vol %

Hemoglobin 16.8 g% 14-18 g%

WBC Count 12,780 /cumm 5,000- 10, 0000

/cumm

Platelet 351 10^3/cumm 150- 400 x 10^3/cumm

Count

MCV 94.5 fL 80-97fL

MCH 33.3 pg 26-32 pg

MCHC 35.2 g/dL 31-36 g/dL

RDW 15.9

RBC Count 5.05 m/uL 4.20 - 6.3m/uL

Segmenters 43.9 % 40-60%

Lymphocyte 45.4 % 20-40%

Monocyte 7.1 % 2-8 %

Eosinophil 3.4 % 1-3%

Basophil 0.2 % 0-1%

TEST RESULT NORMAL VALUE

 C-Reactive 3.64mg/dl Less than 10mg/dl
Protein

TEST RESULT SI UNIT RESULT CONVENTIONAL

UNIT

Sodium 130.2 135-155 130.20 135.00 - 155.00

mmol/L mg/dl

Potassium 4.41 3.40 - 4.41 3.40 - 5.30 mg/dl

5.30
mmol/L

Calcium 2.71 2.02- 2.60 10.86 8.10- 10.42

mmol/L mg/dl

ABO Blood Group RH Type

B Positive

Specimen Taken: 2/9/22

Date Reported: 2/14/22
Specimen Result

Blood (Left Hand) Final Report: No Growth

after 5 days of incubation

2/10/22

TEST RESULT SI UNIT RESULT CONVENTIONAL

UNIT

Direct 0.30 0.00- 0.50 5.13 0.00- 8.55 umol/L

Bilirubin mg/dl

Indirect 10.17 mg/dl umol/L

Bilirubin

Total 10.47 0.00-1.00 179.04 0.00-17.10

Bilirubin mg/dl umol/L

Sodium 134.2 135.00 - 134.20 135.00 - 155.00

155.00 mg/dl
mmol/L
2/10/22
Date taken: 2/8/22
CXR-AP

Remarks: Bilateral, streaky and nodular infiltrates

2Decho
 Remarks: Patent ductus arteriosus, PFO closing

GROUP 6: RESPIRATORY DISTRESS SYNDROME

Date: January 27, 2022

PATIENT’S FIRST NAME: Ellen LAST NAME: Catapang

Address: 430 Sitio Taas San Isidro

CIVIL STATUS: Newborn GENDER: Female

OCCUPATION: N/A BIRTHDATE: 27 January

2022

VITALS: AGE: 0Y0M0D

T 36.5 P 110bpm R 90bpm

CHIEF COMPLAINT: HEIGHT: 51cm

WEIGHT: 2.55kg

HISTORY OF PRESENT ILLNESS PHYSICAL EXAM

● Born preterm (35weeks AOG by LMP)
to a 40 year old G5P4 (2122) via
repeat cesarean section secondary to
fetal bradycardia. Birthweight 2540g
APGAR 8.9
HC: 33cm
CC: 29 cm
AC: 24 cm
BL: 51cm
✓ BCG vaccine 01/27/2022
✓ Hepatitis B vaccine 01/27/22
✓ Vitamin K 01/27/22
✓ Erythromycin ointment 01/27/22
✓ Newborn Hearing Screening 02/11/22
✓ Newborn Screening 01/28/22
1. General Appearance (tone, activity,
color)
Abnormal - Acrocyanosis to pinkish
2. Skin- normal
3. Head and Neck- normal
4. Eyes- normal
5. ENT- normal
6. Chest and Lungs- Abnormal (+)
subcostal retraction, (+) grunting
7. Heart- normal
8. Abdomen (include umbilical vessels)-
normal
9. Genitalia- Female- normal
10. Extremities- normal
11. Trunk and Spine- normal

APGAR SCORE

Sign 0 1 2 1min 5
m
i
n

Heart Absent <100bp >100bp 2 2

Rate m m

Respirat Absent, Slow, good 1 2

ory Irregular crying
Effort

Muscle Limp Some Active 2 2

Tone flexion motion
of
extremiti
 es

Reflex No grimace Cough 2 2

irritabilit respons or
y e sneeze

color Blue, acrocya Complet 1 1

pale nosis ely pink

total 8 9

FAMILY HISTORY Final DIAGNOSIS:

Respiratory Distress Syndrome
G1 2009 Term CS secondary to dystocia live
birth
G2 2015 Abortion
G3 2016 Abortion
G4 2018 Term repeat CS dead
G5 2022 Preterm (35weeks) 2540 grams
APGAR 8. 9
Mother: GDM on Insulin; APAS since 2018.

Father: Hypertensive since 2015 on

maintenance of Amvasc 10mg OD.

PHYSICIAN’S ORDER SHEET

PATIENT’S NAME: ATTENDING PHYSICIAN: HOSPITAL ROOM NO.

Catapang, Ellen Dra. Lustre NO.
1920 NICU 1

DATE: ORDER

1/27/2022 ❏ Pls. admit to NICU under my service

3:07pm ❏ Pls. secure consent of admission
 ❏ Diagnostics:
(+) subcostal ● CBC
retractions ● BLOOD TYPING
(+) grunting ● CRP
● BLOOD CS
PR: 110bpm ● RBS
RR: 90bpm ● ABG
TEMP: 36.5 ❏ Therapeutics:
02 Sat: 85% ● Ampicillin 127mg IV q12
● Gentamycin 12mg IV OD
RBS: 105 ● Aminophylline 5mg IV q12 as 30minutes IV
transfusion
❏ Umbilical Cannulation:
● D5W 102ml + Heparin (1000u/ml) 0.05ml at 8ml/hr
for 12hrs x 2 doses
❏ OGT Fr 5 inserted. Once expressed milk is available, may start
OGT feeding amount (0.1ml-1ml) EBM q3hrs with SAP
❏ For possible surfactant therapy
❏ 02 via NC at 3lpm
❏ Maintain 02 sat >90%
❏ Monitor VS with 02 sat q hourly and pls record
❏ Monitor I and O q hourly and record
❏ Pls. refer accordingly

Dr. Dolor/
ROD Emergency Room
Dra. Lustre MD
Pedia Intensivist

1/27/2022 ❏ S/P Surfactant Therapy

10:40pm ❏ Intubated ET 3.5 Level 8.5cm
❏ Place on Mech. Vent with setting: Fi02-40%, RR-40, Plateau
(+)grunting Pressure 18, IT 0.4
❏ Don’t suction via ET for 6hrs post surfactant
❏ For close monitoring for now
❏ After 6 hours, may suction ET after instilling 0.3ml PNSS and
gentle ambu bagging q4hrs.
❏ For CXR AP tomorrow AM
❏ Pls. keep body thermoregulated
❏ Strict aspiration precaution pls.
❏ For expanded NBS >24th hours of life
❏ For hearing senses once stable

Dra. Lustre MD

1/27/2022 Complete Blood Count

Test Result Reference
 RBC 4.7 4.00–6.60
HGB 14.5 14.5-22.5
HCT 44 45-67
MCV 93.6 80.00-100.00
MCH 30.8 27-32
MCHC 32.9 32-36
PLATELET 215 150 – 450
WBC 24.8 9.0–35.0
SEGMENTERS 69 32–62
LYMPHOCYTES 16 19–29
MONOCYTES 7 0.00-9.00
EOSINOPHILS 2 0.00-3.00
BASOPHIL 1 0.00-1.00

1/27/2022
Blood Typing Result Form

Test Name Results

ABO Blood type O

RH blood type positive

1/27/2022 Arterial Blood Gas Result

Test Result Reference Value

pH 7.268 7.35-7.45
PCO2 46.4 35-45mmHg
PO2 168 80-100mmHg
B.E -6 (-2) to (+2)
HCO3 21.2 22-26mEq/L
TCO2 23 22-27mmol/L
SO2 99 95-100%

CHEST AP PORTABLE
RADIOGRAPHIC RESULT
 Impression:
Consider neonatal pneumonia, right infrahilar area.

IMMUNOLOGY/ SEROLOGY

RESULTS REF. UNITS

CRP <2.50 Less than 10mg/L

1/28/2022 ❏ For Na, K, Ca, ABG

5:30pm ❏ Increase feeding by 1cc q3hrs til 10ml is reached.
❏ Decrease RR to 30 then wean by 2 q2 hrs til 20 is reached
❏ Decrease P/P to 16
● (-) 02 desaturation ❏ Decrease FI02 to 30% then wean by 2% til 20 is reached
● (-) BM. After rectal ❏ Pls give VIt K 1mg IV + 20ml D5W to run for 30minutes IV
stimulation (+) BM transfusion OD x 5 days
● (+) UO ❏ Maintain O2 saturation >90%
● Good activity ❏ Keep thermoregulated at all times

RR: 65bpm
PR: 120bpm
TEMP: 36
02 sat: 87% Dra. Lustre MD

01/28/2022 Arterial Blood Gas Result

 Test Result Reference Value

pH 7.483 7.35-7.45
PCO2 23.9 35-45mmHg
PO2 48 80-100mmHg
B.E -6 (-2) to (+2)
HCO3 17.9 22-26mEq/L
TCO2 19 22-27mmol/L
SO2 87 95-100%

TEST RESULT REF. UNITS

SODIUM 132.1 135-145mmol/L

POTASSIUM 3.57 3.50-5.50mmol/L

CALCIUM 1.49 2.15-2.57

2/1/2022 ❏ S/P extubation

6:30pm ❏ Place on NIPPV with mech. Vent settings:
Fio2:25% P/P: 14/
● Good activity RR: 15 IT: 0.4
● (-) O2 desaturation ❏ For ET tip GS/CS
● (+) UO ❏ Start Salinase nasal drops 1 drop both nostrils TID
● (+) BM 2x ❏ Pls skip feeding then resume after 3 hrs.
❏ Maintain O2 sat >90%.
RR: 60bpm ❏ Strict aspiration
PR: 155bpm
TEMP: 36.3
O2 sat: 95%

Dra. Lustre MD

2/2/2022 ❏ For TB, B1, B2

2:20pm ❏ Once OGT is pulled out, try bottle feed 20ml of BF
❏ For continuous phototherapy with protective eyes and genital
● Good cry shields.
● (-) 02 desaturation ❏ Wean NIPPV to 02 via NC at 3lpm. After 6 hrs wean 02 by 0.5
● (+) BM lpm until room air.
● (+) UO ❏ Maintain O2 sat >90%
● (+) jaundice
● TFI with feeding
157
 Dra. Lustre MD

2/2/2022
SPECIAL CHEMISTRY

TEST RESULT REF. UNITS

Total Bilirubin 219.36 3.00-17.00Umol/L

Direct Bilirubin 9.83 0.00-3.00Umol/L
Indirect Bilirubin 209.53 3.00-14.00Umol/L

2/3/22 ❏ May try breast feeding to mother.

6pm ❏ Pls do Kangaroo Mother Care
❏ Pls weigh baby OD in Am
● Good activity ❏ Continue to increase feeding by 2ml q3hrs til 30 is reached
● Decrease jaundice with SAP.

Dra. Lustre MD

2/4/22 BLOOD CULTURE AND SENSITIVITY

FINAL REPORT

SPECIMEN: BLOOD

SITE OF COLLECTION: UMBILICAL CATHETER

TIME AND DATE OF COLLECTION: 0910PM, 1/27/2022

FINAL RESULT: NO GROWTH AFTER 5 DAYS OF

INCUBATION

GRAM STAIN

TYPE OF SPECIMEN: ENDOTRACHEAL ASPIRATE

RBC:
PUS CELLS: FEW/HPO
EPITHELIAL CELLS: RARE/LPO
YEAST CELLS:

CULTURE AND SENSITIVITY

SPECIMEN: ENDOTRACHEAL ASPIRATE

TIME AND DATE OF COLLECTION: 0635PM, 2/01/22
 FINAL RESULT: NO PATHOGEN ISOLATED AFTER 3 DAYS OF
INCUBATION

2/8/2022 ❏ Increase feeding to 40ml q3hrs

4:00PM ❏ Continue BF and KMC
❏ D/C phototherapy
● Good activity ❏ Sunlight express in AM
● Good suck
● Wt: 2.335kg
● 36weeks
● Ampi- D8-9
● Genta- D9

Dra. Lustre MD

2/11/22 ❏ Removal of umbicath done

7:45pm ❏ D/C IVF
❏ Increase feeding to 52ml q3hrs.
Wt. 2.4kg ❏ May go home tomorrow if without problems
❏ Home meds:
● Multivitamins drops 0.4ml OD
● Vit C + zinc drops 0.4ml OD
● FeSO4 drops 0.4ml OD
● Heraclene 1mg/cap 1cap OD mix with milk
● Doxofylline 100mg/5ml 0.3ml BID
❏ Continue breastfeeding per demand
❏ Sunlight exposure daily
❏ Daily quick warm bath
❏ Strict handwashing and asepsis at home

Dra. Lustre MD

GROUP 5: NEONATAL SEPSIS

 Date: February 7,2022

PATIENT’S FIRST NAME: Princess LAST NAME: Diokno

CIVIL STATUS: Newborn GENDER:Female

OCCUPATION: N/A BIRTHDATE: February 2,

2022

VITALS: (7:30 AM) AGE: 6 days old

BP 80/50 mmHg T 37.9 C P 165 bpm R 65

CHIEF COMPLAINT: fever, inflamed umbilical area HEIGHT: 48 cm

WEIGHT: 7.1 lbs

HISTORY OF PRESENT ILLNESS PHYSICAL EXAM

Patient was born at 37 weeks via NSD from a Neuro :
healthy mother. No complications post Primitive Reflexes Intact, (+) Upward rolling of
delivery. Mother and patient was discharged eyeballs, (+) weak cry
from this institution last April 3, 2021 (2nd day
of life) Skin, Hair and Nails:
With good skin turgor, (+) Jaundice, warm to
3 days after birth the patient was noted with touch skin, well distributed body hair, noted
inflamed umbilical area accompanied by with mongolian spots on the right buttock
redness. The mother applied Mupirocin area
ointment.
HEENT:
4 days after birth the patient exhibited fever (+) icteric sclera
with temperature of 38.5 degrees Celsius. Ears: increased cartilage, recoil, and outer ridge
The patient was given paracetamol drops 0.1 curving inward
ml every 4 hours.
Respiratory:
6 days after birth the patient now has edema RR of 65cpm, no retractions noted
of the abdomen and the sacral area. (+) Dark (+) crackles, (+) nasal flaring
Green spots at the costovertebral angle. The
stated signs and symptoms prompted the Cardiovascular:
parents to bring the patient to the nearest HR of 165 bpm, with CRT <2 secs,
hospital. (+) weak and thready pulses,
BP of 80/50mmhg.

Abdomen:
With umbilical cord present around 2 cm in
 length with inflammation on surrounding
tissue, with grade 3+ pitting edema at the
sacral up to the costovertebral angle with
some blackish discoloration at the 4th lumbar
area around 2cm in diameter.

Musculoskeletal:
Good flexion of extremities noted.
No deformities noted

Anthropometric Measurements:

HC = 36cm
CC = 34cm
AC = 35cm
L = 48 cm
Weight = 3 kgs

PAST MEDICAL HISTORY DIAGNOSIS:

Patient was given the following:
- BCG Neonatal Sepsis, Necrotizing Fasciitis
- Hep B Vaccine
- Vitamin K injection
- Erythromycin Ointment on both eyes
NBS done
OAE done

ALLERGIES
Not identified at present

FAMILY HISTORY
Mother: no gestational diabetes/
hypertension/ other medical problems
No known illnesses of father.
Paternal grandfather died of stroke in 2016.
Maternal grandparents and paternal
grandmother all living and have no known
illnesses.

SOCIAL HISTORY
-Father works as contractual carpenter
-Mother stays at home and takes care of the
baby
-has 1 male sibling: 4 years old and currently
unenrolled due to the pandemic
-Family is living near their relatives and
grandparents are visiting most of the time
-pet: 1 dog
 PHYSICIAN’S ORDER SHEET

PATIENT’S NAME: ATTENDING PHYSICIAN: HOSPITAL ROOM NO.

Princess Diokno Dra. Daisy Villestas NO. NICU-1
02-0410

DATE: ORDER

February 7, 2022 Please admit to NICU under my service.

7:30 AM Place pt. on radiant warmer.
VS q30 with O2 sat. and record.
Hook to O2 support at 0.5 lpm via nasal cannula.
BP 80/50 mmHg Maintain >95%.
T 37.9 C Refer accordingly.
P 165 bpm
R 65/min Diagnostics:
O2 sat at 7:35 AM: 92 % - For CBC with platelet and differential ct., C-
reactive protein, Blood C&S
- Na, K
- BabyGram
- Total Serum Bilirubin

Treatment
- Give Ampicillin Sulbactam 60mg IV q8 ( ) ANST
IVF: D10W 1 liter to run for 12ml/hr.
I and O monitoring q4 and record
- Paracetamol 30mg IV q4 for fever >38 c
- TSB as needed
WOF signs of seizure
Monitor abdominal circumference every 24 hours using
the same position and same time.
Dr. Villestas

February 7, 2022 - Please refer to (Dr. Salvador) pediatric surgeon

05:00pm for co-management and evaluation.
- Insert OGT then drain to gravity.
Temp 38.5 - Place the patient on NPO until further orders.
-With progression of black - Discontinue Present IVF then Start TPN as
discoloration on the sacral area follows:
up to the costovertebral angle. - Amino Acid 5% 100ml
(+) soft and hollow area on the - Calcium Gluconate 12ml
discoloration at the back - Sodium Chloride 4
-tympanitic abdomen - Potassium Chloride 8ml
- Total 120 ml @12
ml/hr
- Continue TPN infusion until further order.

- Refer accordingly.
 Dr. Villestas

TEST RESULT NORMAL VALUE

C-Reactive 120mg/dl Less than 10mg/dl

Protein

TEST RESULT SI UNIT RESULT CONVENTIONAL

UNIT

Sodium 135 135-155 135.00 - 155.00

mmol/L mg/dl

Potassium 2.65 3.40 - 3.40 - 5.30 mg/dl

5.30
mmol/L

Hematology report

TEST RESULT UNIT REFERENCE VALUE

Hematocrit 58 Vol % 42-54 vol %

Hemoglobin 15 g% 14-18 g%

WBC Count 38000 /cumm 5,000- 10, 000 /cumm

Platelet 142 10^3/cumm 150- 400 x 10^3/cumm

Count

MCV 80 fL 80-97fL

MCH 30 pg 26-32 pg

MCHC 33 g/dL 31-36 g/dL

RDW

RBC Count 4.20 m/uL 4.20 - 6.3m/uL

Segmenters 75 % 40-60%

Lymphocyte 20 % 20-40%

Monocyte 4 % 2-8 %

Eosinophil 1 % 1-3%

Basophil 0 % 0-1%
 TEST RESULT REF. UNITS

Total Bilirubin 380.20 3.00-17.00

Umol/L
Direct Bilirubin 12.07 0.00-3.00
Umol/L
Indirect Bilirubin 368.13 3.00-14.00
Umol/L

Babygram:

Impression: Bilateral Pneumonia with Paralytic Ileus

February 7, 2022 - Thank you for this referral.

09:00pm
Impression : Necrotizing fasciitis
- Patient seen and examined.
- Please schedule for debridement tomorrow
(February 8, 2022 at 6am)
- Refer to Anesth on deck.
- Suggest insertion of Central Venous Line or
PICC.

Dr. Salvador

February 8, 2022 OR Notes

8am
s/p wound debridement and PICC
insertion (right basilic vein, 4Fr)
- Debridement done with granulated
serosanguinous material obtained from the
affected area.
- For wound GS/CS.
- For repeat CBC with Platelet 6 hours post
procedure.
- Given with Benzodiazepines and Morphine Pre-
procedure.
 - May transfer patient back to NICU for close
monitoring.
- WOF signs and symptoms of excessive
bleeding.
- Maintain hydrocolloid dressing until further order.
- Will perform wound debridement every 2 days.
Kindly secure an OR schedule.
- Refer accordingly

Dr. Salvador

February 08, 2022 Hematology report

1200nn
TEST RESULT UNIT REFERENCE VALUE
Growth of Group A streptococcus
(GAS) bacteria on Day 1 of Hematocrit 55 Vol % 42-54 vol %
culture.
Hemoglobin 10 g% 14-18 g%

WBC Count 12,000 /cumm 5,000- 10, 0000

/cumm

Platelet 158 10^3/cumm 150- 400 x 10^3/cumm

Count

MCV 80 fL 80-97fL

MCH 26 pg 26-32 pg

MCHC 33 g/dL 31-36 g/dL

RDW

RBC Count 4.0 m/uL 4.20 - 6.3m/uL

Segmenters 78 % 40-60%

Lymphocyte 19 % 20-40%

Monocyte 2 % 2-8 %

Eosinophil 1 % 1-3%

Basophil 0 % 0-1%

- Shift Ampicillin-Sulbactam to Meropenem 180mg

IV q8.
- Please do strict infection control measures.
- For CBC with platelet tom. am
- Continue present management.

Dr. Villestas

February 08, 2022 - Continue present management.

08:00pm - Do ABO Blood typing
- Prepare 4 aliquots of PRBC.
Hgb of 10 g% 6 hours post OR. - Transfuse 2 aliquots now to run for 4 hours with
4 hours interval then remaining 2 aliquots during
Debridement procedure.
- Refer for any signs and symptoms of active
Bleeding at the surgical site.
- Refer accordingly.

Dr. Villestas

February 9, 2022 - Continue present management

08:00am - Schedule patients for Debridement tom am at
6am.
Blood type: O negative - Repeat CBC with platelet and potassium 6 hours
post procedure.
- Do Babygram on Day 3 antibiotic.

Dr. Villestas

February10, 2022 - s/p 2nd wound debridement.

07:30am - May bring the patient back to NICU.
- Change hydrocolloid dressing once a day using
BetaPlus dressing.
- Refer accordingly.

Dr. Salvador

February10, 2022 Hematology report

04:00pm TEST RESULT UNIT REFERENCE VALUE

Babygram result shows decrease Hematocrit 53 Vol % 42-54 vol %

in Bilateral Lung Infiltrates and
Hemoglobin 12 g% 14-18 g%
resolution of paralytic ileus.
WBC Count 12000 /cumm 5,000- 10, 0000
(+) Bowel Sound /cumm

Platelet 180 10^3/cumm 150- 400 x 10^3/cumm

Abdominal Circumference : 35cm
Count
to 33cm
MCV 82 fL 80-97fL

MCH 30 pg 26-32 pg

MCHC 32 g/dL 31-36 g/dL

RDW

RBC Count 4.1 m/uL 4.20 - 6.3m/uL

 Segmenters 65 % 40-60%

Lymphocyte 35 % 20-40%

Monocyte 7 % 2-8 %

Eosinophil 2 % 1-3%

Basophil 1 % 0-1%

TEST RESULT SI UNIT RESULT CONVENTIONAL

UNIT

Potassium 3.8 3.40 - 4.41 3.40 - 5.30 mg/dl

5.30
mmol/L

February10, 2022 - Incremental feeding: start with 0.5 ml of EBM for

05:00pm 3 feedings every for 2 hours then an increment
of 0.5 ml every 3 feedings q 2 until 10ml is
reached via OGT.
- Drain OGT 30mins prior to feeding.
- Watch out for signs of recurrence of ileus
- Hold feeding for residual greater than 70% of
previous feeding and refer
- Decrease IVF rate by 0.5 for every tolerated
incremental feeding.
- Limit blood extraction
- Limit handling
 Dr. Villestas

February11, 2022 - Prepare the patient for debridement tom am at

08:00am 6am as ordered.
- Continue present management

Dr. Villestas

February12, 2022 - s/p 3rd wound debridement.

- Refer accordingly

Dr. Villestas