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What Does The Following Discharge Summary Of A Preterm Baby Indicate?
Question: HI Team
1st i would like to share my baby discharge summary then i will share problem my baby facing and question we have in our mind.
Final Diagnosis:
1. Preterm baby /32 weeks/2.14 kgs / Male
2. Meconium stained liquor and respiratory distress
3. Neonatal Hyperbilirubinemia
Neonatal Details:
A single live male baby born by FTND on 01.10.2014 at 6.35 am and birth weight: 2.14 kg. Bay cried immediately after birth, routine suction done, nostril and anal potency checked.
Physical Examination:
Birth Weight:2.14 kgs.
Appearance-preterm
Cry-normal
Colour-pink
Hips:normal
Anus:patent
Femoral:felt bilaterally
NNR-normal
Systemic examination
HR:140/min
RS:AEBE, NVBS
CVS:S1 S2+, no murmurs.
PA:Soft. No organomegaly
CNS:Moros Present
Icterus +
Treatment Given:
INj. Vitamin K1 mg IM stat
Vaccination:
OPV-Inj. BCG-Inj. HEP. B-given on 31.10.2014
Course in the hospital:
Baby was born on 20-10-14 at 5:29 am by vaginal delivery. it was a preterm baby(32 weeks)
with BW 2140 gms. Bay cried after stimulation. there was meconium stained liquor. The baby Apgar at birth 8/10. The baby shifted to NICU for new born care. Thebaby had respiratory distress in NICU required O2 for 1 day. Xray chest suggestive of streaky opacities blood culture and sensitively and CBC sent in NICU and started on antibiotics, Ampicilin and amikacin. The baby kept nill oraly for 24 hours later feeds by NGT started. However baby developed NEC in NICU, again baby was kept nil oraly for 2 days. Antibiotics changes to meropenum and amikacin. The baby improved over 2 days. Feeds started again by NGT, Stopped up and IVF tapered. The baby at the point of discharge was on brest feeds + Cup and spoon top feeds. There was weight gain of 20 gm on 2 conscecutive drugs. Baby also had neonatal jaundice and given photo-therapy for 3 days. The mother explained about the high risk newborn care at home and travel.
Condition on Discharge:
Discharge weight : 2 kgs.
HC :32 cms
Length : 46 cms
Advice on discharge:
1. Exclusive breast feeding on demand / 2-3 hours + Cup + spoon feeds.
2. Burp well after feeds.
3. Vaccination as per schedule.
4. Vysyneral drops 0.5-0-0.5
5. Jusdee drops 0.5 OD
6. Syp. Calcimax 2.5-0-2.5 ml
Above is the discharge summary
Now my baby current weight is 4 kgs (24-12-14), Now we are giving breast feed + dexolac premium 1 60 ml every 2 hrs through feeding bottle. As our pediatrician said that we should use spoon feed but baby is not comfortable with spoon or paalan feeding. Mother has lack of breast milk hence after breast milk also we used to feed feeding bottle milk(when she has delivered baby she has lack of milk now she is having decent milk).
Problem facing:
1. Baby cries while passing motion and urine some days(even loose motion also).
2. He used put more pressure while doing motion.
3. Snoring while sleeping or breathing(some days).
4. Some times crying long time, even after feeding (we have worried why he is crying ).
5. Today his motion was black(last 2 days he did not passed the motion).
6. Now a days he used to pass motion 2 days once.
7. Crying so much.
8. Its very difficult us to sleep in night time.
9. He is releasing gas frequently.
10. Now my wife having well express milk but baby is not ready to suck (he is not comfortable, he suck XXXXXXX 8 to 10 times then starts crying and after giving bottle milk he stops crying).
Our Questions
1. How many months we should continue Dexolac and Those above drops?
2. Is there any separate vaccination chart for preterm baby?If yes please share?
3. How frequently we should consult pediatrician?
4. Doctor has given this drop coliacid and neopeptin, when to use this drops?
5. Is there any special care we should take for these type babies?
6. If we should continues breast milk + dexolac, how many ml we should give for baby as wight wise?
7. Till 2 months we have used to feed feeding bottle milk than breast feed is this problem for baby in future?
8.Now we have changed the bottle that name is Philips(Avent) for reducing colic pain, shall we continue bottle feed?.
9. Is there any way to discontinue formula milk?
10. how frequently we should change pampers?
11. Shall we start hot water bath with oil massage?
I am requesting you to kindly give some suggestions to our questions and baby problems we are worrying about baby facing problem.
Thanks regards,
XXXX(Baby Father)
1st i would like to share my baby discharge summary then i will share problem my baby facing and question we have in our mind.
Final Diagnosis:
1. Preterm baby /32 weeks/2.14 kgs / Male
2. Meconium stained liquor and respiratory distress
3. Neonatal Hyperbilirubinemia
Neonatal Details:
A single live male baby born by FTND on 01.10.2014 at 6.35 am and birth weight: 2.14 kg. Bay cried immediately after birth, routine suction done, nostril and anal potency checked.
Physical Examination:
Birth Weight:2.14 kgs.
Appearance-preterm
Cry-normal
Colour-pink
Hips:normal
Anus:patent
Femoral:felt bilaterally
NNR-normal
Systemic examination
HR:140/min
RS:AEBE, NVBS
CVS:S1 S2+, no murmurs.
PA:Soft. No organomegaly
CNS:Moros Present
Icterus +
Treatment Given:
INj. Vitamin K1 mg IM stat
Vaccination:
OPV-Inj. BCG-Inj. HEP. B-given on 31.10.2014
Course in the hospital:
Baby was born on 20-10-14 at 5:29 am by vaginal delivery. it was a preterm baby(32 weeks)
with BW 2140 gms. Bay cried after stimulation. there was meconium stained liquor. The baby Apgar at birth 8/10. The baby shifted to NICU for new born care. Thebaby had respiratory distress in NICU required O2 for 1 day. Xray chest suggestive of streaky opacities blood culture and sensitively and CBC sent in NICU and started on antibiotics, Ampicilin and amikacin. The baby kept nill oraly for 24 hours later feeds by NGT started. However baby developed NEC in NICU, again baby was kept nil oraly for 2 days. Antibiotics changes to meropenum and amikacin. The baby improved over 2 days. Feeds started again by NGT, Stopped up and IVF tapered. The baby at the point of discharge was on brest feeds + Cup and spoon top feeds. There was weight gain of 20 gm on 2 conscecutive drugs. Baby also had neonatal jaundice and given photo-therapy for 3 days. The mother explained about the high risk newborn care at home and travel.
Condition on Discharge:
Discharge weight : 2 kgs.
HC :32 cms
Length : 46 cms
Advice on discharge:
1. Exclusive breast feeding on demand / 2-3 hours + Cup + spoon feeds.
2. Burp well after feeds.
3. Vaccination as per schedule.
4. Vysyneral drops 0.5-0-0.5
5. Jusdee drops 0.5 OD
6. Syp. Calcimax 2.5-0-2.5 ml
Above is the discharge summary
Now my baby current weight is 4 kgs (24-12-14), Now we are giving breast feed + dexolac premium 1 60 ml every 2 hrs through feeding bottle. As our pediatrician said that we should use spoon feed but baby is not comfortable with spoon or paalan feeding. Mother has lack of breast milk hence after breast milk also we used to feed feeding bottle milk(when she has delivered baby she has lack of milk now she is having decent milk).
Problem facing:
1. Baby cries while passing motion and urine some days(even loose motion also).
2. He used put more pressure while doing motion.
3. Snoring while sleeping or breathing(some days).
4. Some times crying long time, even after feeding (we have worried why he is crying ).
5. Today his motion was black(last 2 days he did not passed the motion).
6. Now a days he used to pass motion 2 days once.
7. Crying so much.
8. Its very difficult us to sleep in night time.
9. He is releasing gas frequently.
10. Now my wife having well express milk but baby is not ready to suck (he is not comfortable, he suck XXXXXXX 8 to 10 times then starts crying and after giving bottle milk he stops crying).
Our Questions
1. How many months we should continue Dexolac and Those above drops?
2. Is there any separate vaccination chart for preterm baby?If yes please share?
3. How frequently we should consult pediatrician?
4. Doctor has given this drop coliacid and neopeptin, when to use this drops?
5. Is there any special care we should take for these type babies?
6. If we should continues breast milk + dexolac, how many ml we should give for baby as wight wise?
7. Till 2 months we have used to feed feeding bottle milk than breast feed is this problem for baby in future?
8.Now we have changed the bottle that name is Philips(Avent) for reducing colic pain, shall we continue bottle feed?.
9. Is there any way to discontinue formula milk?
10. how frequently we should change pampers?
11. Shall we start hot water bath with oil massage?
I am requesting you to kindly give some suggestions to our questions and baby problems we are worrying about baby facing problem.
Thanks regards,
XXXX(Baby Father)
Brief Answer:
Increase the breast milk output to stop bottle feeds
Detailed Answer:
Hi
Welcome to Healthcaremagic
Greetings of the day
Dear Mr XXXXXXX
Being a parent myself ,I understand your concern and apprehension. I will answer all your ququery in detail.
1. Dexolac can slowly be reduced when weaning is started at 5 to 6 months of age. You can introduce rice water at that time.other drops to be continued especially Vitamin D and calcium drops till year of age
2. There is no separate vaccination chart for preterm baby. It's the same schedule
3. Consultation with Pediatrician once a month is sufficient
4. Colicaid drops is for intestinal colic (excessive crying and gas problem ). Neopeptin drops and colicaid drops can be used when the baby is excessively crying.
5. No other special care is required. Feeding should be on demand that is feed whenever baby is hungry. Crying is the last sign that baby is hungry. When baby is hungry it first makes lip sucking or thumb sucking, starring at breast . Do not wait till baby cries for feeds.
Continue Vitamin D and calcium supplements
6. Ideally the quantity per feeds is 10 ml per kilogram of body weight (that is the capacity of stomach ). Every feed the quantity should be atleast 40 ml. But there is no hard rule. Feed till the baby refuses
7. It should not cause any problem.
I would suggest you the following to increase breast milk output in mother
a. Capsule Lactare 2 caps thrice a day. It is Ayurvedic over the counter preparation
b. Calcium, Vitamin D , Omega 3 fatty acid and iron supplements to mother
c. Introduce dried dates or Khajur in diet
8. Yes you can continue the same bottle
9. Only way to discontinue bottle feed is by increasing breast milk output.
As you said the baby does not suck well at breast , it could be due to nasal blockage. Putting 3 to 4 drops of normal saline drops in each nose 5 to 6 times a day will help relieve blockage and help with sucking at breast
10. Pampers are to be changed whenever you notice fullness in the pampers . Ideally 3 to 4 changes per day
Also give diaper free time of 1 to 2 hours everyday
11. You should definitely stay with oil massage and hot water bath
Do get back to me if you need any further assistance, will be glad to assist you .
Take care
Best regards
Dr Deepak Kaltari
Consultant Pediatric Surgeon
Increase the breast milk output to stop bottle feeds
Detailed Answer:
Hi
Welcome to Healthcaremagic
Greetings of the day
Dear Mr XXXXXXX
Being a parent myself ,I understand your concern and apprehension. I will answer all your ququery in detail.
1. Dexolac can slowly be reduced when weaning is started at 5 to 6 months of age. You can introduce rice water at that time.other drops to be continued especially Vitamin D and calcium drops till year of age
2. There is no separate vaccination chart for preterm baby. It's the same schedule
3. Consultation with Pediatrician once a month is sufficient
4. Colicaid drops is for intestinal colic (excessive crying and gas problem ). Neopeptin drops and colicaid drops can be used when the baby is excessively crying.
5. No other special care is required. Feeding should be on demand that is feed whenever baby is hungry. Crying is the last sign that baby is hungry. When baby is hungry it first makes lip sucking or thumb sucking, starring at breast . Do not wait till baby cries for feeds.
Continue Vitamin D and calcium supplements
6. Ideally the quantity per feeds is 10 ml per kilogram of body weight (that is the capacity of stomach ). Every feed the quantity should be atleast 40 ml. But there is no hard rule. Feed till the baby refuses
7. It should not cause any problem.
I would suggest you the following to increase breast milk output in mother
a. Capsule Lactare 2 caps thrice a day. It is Ayurvedic over the counter preparation
b. Calcium, Vitamin D , Omega 3 fatty acid and iron supplements to mother
c. Introduce dried dates or Khajur in diet
8. Yes you can continue the same bottle
9. Only way to discontinue bottle feed is by increasing breast milk output.
As you said the baby does not suck well at breast , it could be due to nasal blockage. Putting 3 to 4 drops of normal saline drops in each nose 5 to 6 times a day will help relieve blockage and help with sucking at breast
10. Pampers are to be changed whenever you notice fullness in the pampers . Ideally 3 to 4 changes per day
Also give diaper free time of 1 to 2 hours everyday
11. You should definitely stay with oil massage and hot water bath
Do get back to me if you need any further assistance, will be glad to assist you .
Take care
Best regards
Dr Deepak Kaltari
Consultant Pediatric Surgeon
Above answer was peer-reviewed by :
Dr. Prasad
I have few more questions.
1. As you said my baby could has facing nasal blockage hence he is not able to sucks express milk but he sucks feeding bottle milk well till the completion of milk. some times he will cry and some times he sleep after 5 or 6 six sucks, may i know is there any reason for this?
2. Can we use Neopeptin as in daily basis for few months?
3. As you said Neopeptin and colicaid are used to reduce gas and colic pain, which one we can continue?
4. How to know baby having colic pain?
5. Can we put hot to head while doing bath?
6. last few days his motion was black like gum, and also he is used to pass motion 1 to 2 days now a days. is he facing any problem?
7. How to reduce frequently releasing gas?
8. Now days while he sleeping he scars lot. is there any scientific reason for this?
9. When my baby neck stand perfectly?
10. Can mix vitalmin d and calcium drops with milk?
11. All the 12 feeds we used to feed express milk(some times he is not sucking that time we will give only formula milk) + formula milk. is this cause baby colic pain and problem while passing motion?
Thanks,
XXXX
1. As you said my baby could has facing nasal blockage hence he is not able to sucks express milk but he sucks feeding bottle milk well till the completion of milk. some times he will cry and some times he sleep after 5 or 6 six sucks, may i know is there any reason for this?
2. Can we use Neopeptin as in daily basis for few months?
3. As you said Neopeptin and colicaid are used to reduce gas and colic pain, which one we can continue?
4. How to know baby having colic pain?
5. Can we put hot to head while doing bath?
6. last few days his motion was black like gum, and also he is used to pass motion 1 to 2 days now a days. is he facing any problem?
7. How to reduce frequently releasing gas?
8. Now days while he sleeping he scars lot. is there any scientific reason for this?
9. When my baby neck stand perfectly?
10. Can mix vitalmin d and calcium drops with milk?
11. All the 12 feeds we used to feed express milk(some times he is not sucking that time we will give only formula milk) + formula milk. is this cause baby colic pain and problem while passing motion?
Thanks,
XXXX
Brief Answer:
Do not mix drops with feeds
Detailed Answer:
Dear Mr XXXXXXX
Let me take this opportunity to wish you a very happy new year 2015. May all your dreams come true .
Let me reply to your query
1. It is easier for babies to drink from the bottle as majority of time the hole made in nipple is larger than required
Every baby is unique and have their own sleep in rhythm as per their biology clock. As long as the nutritional intake of baby is okay, baby sleeps for 8 to 10 hours a day total , weight gain is adequate, there is nothing to worry about.
2. I would not recommend Neopeptin for long term use. Only Calcium , Vitamin and Iron supplements are recommended
3. Do not continue giving anything. Colicaid and Neopeptin can be used when there is colic and excessive gas. Babies sometimes produce excessive gas especially those feed on artificial feeds . This leads to colic. Colic usually presents as excessive crying, other causes of excessive crying like hungry baby, wet diapers ,rash p r lack of sleep ruled out. So during such time colicaid will be helpful.
4. Baby who is excessively crying without other causes like hunger , wet diapers or rash is likely to be having colic especially if associated with frothy stools
5. Yes hot water can be put over head while giving bath
6. If there is no excessive crying while passing stools , no distension of abdomen and no redness in anal region then there is no cause for concern. Black stools is likely to be due to feed intolerance. Do keep the baby on exclusive breastfeeding, if the color still persist then consult your Child Pediatrician for further clinical examination.
7. Exclusive breast feed the child , it will reduce gas
8. Your question is not clear. Kindly elaborate
9. Neck holding usually starts beginning by 8 weeks of age and complete neck holding comes by 4 to 5 months of age
10. Do not mix the drops with feeds
11. If the baby is not sucking at breast , you can give expressed breast milk. It will more preferably. There are many more advantage associated with exclusive breastfeeding including less gas formation
Take care
Best regards
Dr Deepak Kaltari
Do not mix drops with feeds
Detailed Answer:
Dear Mr XXXXXXX
Let me take this opportunity to wish you a very happy new year 2015. May all your dreams come true .
Let me reply to your query
1. It is easier for babies to drink from the bottle as majority of time the hole made in nipple is larger than required
Every baby is unique and have their own sleep in rhythm as per their biology clock. As long as the nutritional intake of baby is okay, baby sleeps for 8 to 10 hours a day total , weight gain is adequate, there is nothing to worry about.
2. I would not recommend Neopeptin for long term use. Only Calcium , Vitamin and Iron supplements are recommended
3. Do not continue giving anything. Colicaid and Neopeptin can be used when there is colic and excessive gas. Babies sometimes produce excessive gas especially those feed on artificial feeds . This leads to colic. Colic usually presents as excessive crying, other causes of excessive crying like hungry baby, wet diapers ,rash p r lack of sleep ruled out. So during such time colicaid will be helpful.
4. Baby who is excessively crying without other causes like hunger , wet diapers or rash is likely to be having colic especially if associated with frothy stools
5. Yes hot water can be put over head while giving bath
6. If there is no excessive crying while passing stools , no distension of abdomen and no redness in anal region then there is no cause for concern. Black stools is likely to be due to feed intolerance. Do keep the baby on exclusive breastfeeding, if the color still persist then consult your Child Pediatrician for further clinical examination.
7. Exclusive breast feed the child , it will reduce gas
8. Your question is not clear. Kindly elaborate
9. Neck holding usually starts beginning by 8 weeks of age and complete neck holding comes by 4 to 5 months of age
10. Do not mix the drops with feeds
11. If the baby is not sucking at breast , you can give expressed breast milk. It will more preferably. There are many more advantage associated with exclusive breastfeeding including less gas formation
Take care
Best regards
Dr Deepak Kaltari
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your valuable suggestion, wish you the same.
1. Can we still give saline drops(he sucks feeding bottle well hence i m asking)?
2. Can we give bonnison drops for easy motion?
3. Baby mother can squeeze XXXXXXX 30 ml for every feed but he needs 60 ml every 2 hrs, how we can overcome from this problem?
4. Is there any drops we can use for passing painless motion?
5. How we can make baby fully depends on mother milk?
6. What are the drawbacks of feeding bottle feed with express milk or formula feed?
Thanks
XXXX
1. Can we still give saline drops(he sucks feeding bottle well hence i m asking)?
2. Can we give bonnison drops for easy motion?
3. Baby mother can squeeze XXXXXXX 30 ml for every feed but he needs 60 ml every 2 hrs, how we can overcome from this problem?
4. Is there any drops we can use for passing painless motion?
5. How we can make baby fully depends on mother milk?
6. What are the drawbacks of feeding bottle feed with express milk or formula feed?
Thanks
XXXX
Brief Answer:
Exclusive breastfeeding till 6 months
Detailed Answer:
Dear XXXXXXX
No drops likeBonnison are recommended for baby. Also there are no scientific valid drops available so that baby can pass painless motion. Pain usually occurs if there is lot of gas or redness in anal area.
You can use breast pump for expressing milk from breast which will also take care of quantity. The only way to make baby fulls dependent on breast milk is by putting baby to breast milk and avoiding giving any other feeds . Kindly avoid external milk.
Natural things are always better , so make the baby suck at breast so that he gets habituated. Use Saline drops for 2 to 3 days , there is no side effect and it will help with sucking.
Take care
Best regards
Dr Deepak
Exclusive breastfeeding till 6 months
Detailed Answer:
Dear XXXXXXX
No drops likeBonnison are recommended for baby. Also there are no scientific valid drops available so that baby can pass painless motion. Pain usually occurs if there is lot of gas or redness in anal area.
You can use breast pump for expressing milk from breast which will also take care of quantity. The only way to make baby fulls dependent on breast milk is by putting baby to breast milk and avoiding giving any other feeds . Kindly avoid external milk.
Natural things are always better , so make the baby suck at breast so that he gets habituated. Use Saline drops for 2 to 3 days , there is no side effect and it will help with sucking.
Take care
Best regards
Dr Deepak
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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