Camryn Miller was born at 8:42 February 24, 1999. She is now 2 days old. Her parents are Matthew and Corinne Miller. Camryn was born at 26 weeks gestation. Her birth weight was 985 grams or 2 pounds 2 and 3/4 ounces (54 %). Her length has not been measured. Her head circumference is 25 centimeters (40 %).Camryn's Apgar scores (score of well being) were 6 and 9 at 1 and 5 minutes respectively.

Camryn's mother Corinne began her prenatal care in the first trimester. Her pregnancy was complicated by fetal ultrasound on 12/21 showing left hydronephrosis (dilatation of kidney), worsening on 1/21 with development of hydroureter (distention of ureter with fluid d/t obstruction), along with oligohydramnosis (abnormally small amount of amniotic fluid). Corinne was admitted to the hospital on 2/19 secondary to marginal placental previa (placenta that is implanted in the lower uterine segment) Corinne was found to he positive for group B Strep and treated with ampicillin (antibiotic) and given bethamethasone (medication to help hasten lung development in baby). On the day of delivery Corinne experienced increased contractions not responding to terbutaline (medication to stop contractions) and developed increased abruption (breaking away of placenta from uterine wall. It was decided to take Corinne for an emergency C- section but she went on to have a precipitous delivery in her bed.

After Camryn was born she was given support for her breathing by bag and mask ventilation and intubated (insertion of plastic tube into windpipe) and given supplemental oxygen. On arrival in the NICU she was placed on a ventilator (special machine to support her breathing) She was given a medication called Survanta to help her lungs work better. On 2125 d/t worsening blood gases

Camryn was placed on a different breathing machine called HFOV (special ventilator that delivers very rapid short puffs of air into the lungs) to decrease damage to her lungs. Currently Camryn's ventilator settings are a NCAP of 6, amplitude of 11, and hertz of 10. She is receiving supplemental oxygen of 55%. Today they have been able to wean slightly on her ventilator settings. Camryn is on two antibiotics Ampicillin and Gentamicin in case she has an infection.

Camryn has a small plastic tube called an ET tube, which is inserted into her mouth into her windpipe and this is connected via straight hard plastic arm to the ventilator. She also has a thin soft catheter into her umbilical artery, through

which she receives fluids , medications , measurement of blood pressure and drawing of blood samples. She has an saline lock into her right hand through which medication can be given. Camryn has a feeding tube, called an OG tube, inserted into her stomach to help keep her tummy empty of air. On her lower left back is a small foil disc connected via a wire to her warmer bed that helps monitor her temperature. Her heart and breathing rates, blood oxygen levels are all being measured via patches and wires taped to her skin and then connected to monitors.

Currently Camryn is resting on her stomach on an open warmer bed dressed in a diaper. Her eyes are covered with decorated patches d/t phototherapy lights she is under to help breakdown bilirubin (yellow coloring to the skin). Several small stuffed animals and a personalized name card give her bed space a home - like feeling.

I have not met with Camryn's parents as of this time, but hope to meet with them in the next few days.

Camryn was observed for 26 minutes, before (6), during (8), and after (10) a caregiving interaction using the NIDCAP naturalistic observation of behavior. Caregiving was provided by his nurse and consisted of taking vital signs and a diaper change. One observer was at her bedside.

Before caregiving Camryn was resting on her stomach with her head to the left. She had a small roll under her hips. She had her arms tucked close to her body. Due to the IV in her right hand she had limited movement of those fingers. Her left hand was up next to her face and she was lightly grasping her ET tube occasionally sucking on this tube. She had rolls around her body and feet but these were not up close to body, so she had limited ability to use them effectively to help steady or comfort herself. Camryn's heart rate remained steady at 140 - 142 beats per minute and her blood oxygen levels were even at 94 - 95 %. Her breathing was irregular and somewhat fast with pauses noted at 60 - 64 times a minute. Her coloring was red with yellow or jaundice undertones. She was in a light sleep being responsive to noises in the unit, seen by squirming and twitches and startles in her body. Camryn helped steady and comfort herself by grasping her ET tube with her left hand and sucking occasionally on this tube. She also clasped her feet together for comfort.

During caregiving Camryn remained light but restless sleep. As caregiving went on her breathing slowed with more frequent pauses noted. Her rate varied from 64 at the beginning to only 20 times at the end of caregiving. When Camryn was being handled her skin tones became more reddened. When her nurse took her temperature Camryn braced her feet together to attempt to help steady her increasingly irregular breathing pattern. After having her temperature taken her blood oxygen level dropped to 88% and her nurse stopped to let Camryn regroup and her blood oxygen levels returned to > 92 %. With her diaper being changed Camryn had increasing difficulty regulating her breathing and she had several long pauses and her blood oxygen levels dropped to the low 80's for approximately1.5 minutes. At this time she did become pale in color. Camryn continued to brace with her legs against the bedding and briefly clasped her feet together. With her squirming her arms were now straightened and she had no energy to bring them back in close to her body or face.

After caregiving Camryn remained in a light sleep but she seemed somewhat restless unable to settle left on her own. She frequently squirmed in her bed. Her arms and legs were fairly straight in the bed and her energy level was to low to tuck them back on her own. Her breathing was steady at 52 - 64 times a minute remaining irregular with pauses. Her blood oxygen level was even at 94-96%. Her heart was steady at 144 -148 times a minute. Her coloring remained red with jaundice undertones.

Based on this observation Camryn is a sweet baby who is responsive to here environment with emerging competencies. She is able to steady herself by grasping and holding on to her tube with her hands and then sucking. With support she is able to keep tucked. She also uses leg bracing and feet clasping to help steady her breathing and comfort herself.

1. Camryn is working towards developing more effective and regular breathing patterns and even blood oxygen levels with handling.

2. Camryn is working towards having long periods of restful undisturbed sleep so she can conserve her energy to grow.

3. Camryn is working to steady and comfort herself by keeping her arms and legs tucked with proper bedding supports or hands of her caregivers or parents.

1. Consider moving Camryn to an area of the nursery where traffic flow isn't so high and away from the tube system since she is so responsive to her environment.

2 Remember to he mindful of conservation's at her bedside, speaking only in whispers. Attempt to take conversation about her medical cars away from the bedside. Support Camryn in her efforts to maintain a restful sleep by providing a restful environment.

3. When providing hands on care shut off bili lights and remove patches from her eyes so Camryn can be an active participant in her cares.

4. Consider getting Camryn on her parent's chest to kangaroo as soon as she is stable enough. This will help to support and steady her breathing patterns and maintain more even blood oxygen levels.

5. Provide high nested boundaries around her body and feet. Keep them in close to her body so she can use them effectively to stay tucked and brace against.

6. Consider positioning Camryn side lying so she can make better use of hands by keeping them midline and up close to face. Offer her your finger to grasp when providing cares as this helps her to comfort herself.