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Regional Neonatal Conference Decision Making
- 1. © The Children's Mercy Hospital, 2014. 03/14 Dr. Steven Olsen, MD, FAAP Regional Neonatal Conference: Decision Making and Optimal Care and Outcomes April 9, 2015 Transport or Increased Care: You Decide
- 2. © The Children's Mercy Hospital, 2014. 03/142 What is your specialty? A. Mother-Baby nurse B. NICU nurse C. NNP D. Physician E. Other M other-Baby nurse NICU nurse NNP Physician Other 0% 0% 0%0%0%
- 3. © The Children's Mercy Hospital, 2014. 03/143 In which setting do you work? A. Newborn nursery B. Special Care nursery C. Level II NICU D. Level III NICU E. Other New born nursery SpecialCare nursery LevelIINICU LevelIIINICU Other 0% 0% 0%0%0%
- 4. © The Children's Mercy Hospital, 2014. 03/14 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 TransportOut IncreaseCare Continue to Observe 0% 0%0%
- 5. © The Children's Mercy Hospital, 2014. 03/14 Baby B A. Transport B. Increase Care Transport IncreaseCare 0%0% 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.
- 6. © The Children's Mercy Hospital, 2014. 03/14 A. Respiratory Distress Syndrome B. Persistent Pulmonary Hypertension C. Transient Tachypnea of the Newborn D. Hypoglycemia RespiratoryDistressSy... PersistentPulm onaryHy... TransientTachypneaof... Hypoglycem ia 0% 0%0%0% Baby B cont’d. What is your diagnosis?
- 7. © The Children's Mercy Hospital, 2014. 03/14 Baby C A. Transfer B. Increase Care Transfer Increase Care 0%0% 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.
- 8. © The Children's Mercy Hospital, 2014. 03/14 Baby C cont’d. A. Normal Saline bolus B. Increase ventilator support C. Surfactant Norm alSalinebolus Increaseventilatorsupport Surfactant 0% 0%0% If you opt to increase care, what would be your first plan?
- 9. © The Children's Mercy Hospital, 2014. 03/14 Baby D A. Transfer B. Increase Care Transfer IncreaseCare 0%0% 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.
- 10. © The Children's Mercy Hospital, 2014. 03/14 Baby D cont. A. Temp B. History C. BP D. Emesis E. Other Tem p History BP Em esis Other 0% 0% 0%0%0% Which concerns you the most about this baby?
- 11. © The Children's Mercy Hospital, 2014. 03/14 Baby E A. Prepare for discharge B. Increase care Preparefordischarge Increasecare 0%0% 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.
- 12. © The Children's Mercy Hospital, 2014. 03/14 Baby E cont. A. Warming infant B. Checking blood sugar C. Checking bilirubin D. Lactation consultation E. Discharge order being written W arm inginfant Checkingblood sugar Checkingbilirubin Lactation consultation Discharge orderbeingwr... 0% 0% 0%0%0% You decide to call the physician. What is your highest priority?
- 13. © The Children's Mercy Hospital, 2014. 03/1413