LL HLPD OUT

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This is a case report of a preterm neonate born at 28+6 weeks gestation with complications. Here's a summarized version:

Summary of Case Report

• Gestation & Birth: 28+6 weeks, spontaneous vaginal delivery (SVD) after prelabour rupture of membranes (PROM) at 20+3 weeks. Received steroids and magnesium sulfate. Poor condition at birth, required I&V breaths, increased work of breathing (WOB), high-flow therapy (HFT) at 6L, and FiO2 30% in low-flow.
• Neonatal Issues:
  • Bleeding post-central access, possible clotting issue.
  • Jaundice <24 hours, requiring double phototherapy.
  • IVH (Intraventricular Hemorrhage): Day 1 cranial ultrasound (CrUSS) showed right Grade 1 IVH.
  • Feeding Risks: Moderate risk but antenatal scans not checked.
• Lines & Procedures: Umbilical venous catheter (UVC) removed on 23/3, PICC line placed in right leg.
• Investigations & Monitoring:
  • CXR (23/3): No abnormalities detected.
  • Anomaly scan at 20 weeks: EDF (End-Diastolic Flow) not examined; 13-week antenatal scan showed umbilical artery not examined.
  • CRP <1.3, Creatinine 112.
  • Glucose monitoring required, recorded 9.2 at midnight, then -8.
• Management:
  • Fluids & TPN: 90 mL/kg/day, 60 TPN, 30 (>5% dextrose).
  • Medications: IV benzylpenicillin + gentamicin, Vitamin K.
  • Phototherapy initiated as SBR (serum bilirubin) 10 below exchange transfusion line.
  • Blood tests pending: FBC, clotting, TPN.

Key Concerns & Considerations:

• Neonatal bleeding—potential clotting disorder.
• Prematurity-related risks: Jaundice, IVH, feeding issues.
• Monitoring needs: Glucose fluctuations, daily bloods.
• Need for antenatal scan review to assess EDF and umbilical artery status.

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