Camryn is a 20 day-old infant who was born at 26 weeks’ gestation. Her corrected age is 28 weeks, 6 days. Her birthweight was 985g (2#, 2 ¾ oz) and weight on 3/15/99 was 1090g (2# 6 ½ oz) which is in the __ percentile. Camryn was taken off nasal CPAP (Constant Positive Airway Pressure) and returned to the ventilator on 3/8/99 due to breathing difficulties. She continues to be on the ventilator. There’s a small tube inserted into her mouth called an endotracheal tube (ET tube) that leads to her airway. She’s currently receiving 30 breaths/minute with 59-62% oxygen. Camryn was diagnosed with RSV and placed into contact isolation on 3/9/99. RSV is a virus that attacks the airway; thus, causing her breathing difficulties. She was removed from isolation today. Camryn has not needed phototherapy since 3/6/99. She’s on a prophylactic antibiotic, Ampicillen to prevent a urinary tract infection. She continues to receive supplemental fluids and nutrition via a PICC line, which is a special type of IV in her L arm. She was started on Aminophillen on 3/3, which is a medication to help prevent apnea and bradycardic spells. These are episodes where Camryn experiences breathing pauses and her heart rate slows. Her last two episodes were on 3/8. She is receiving 12 ½ cc of breast milk every three hours through her NG tube (the tiny tube that’s inserted into her nose and leads to her stomach). She didn’t receive any NG feedings from 3/7 to 3/10.

Behavioral Summary

Camryn was observed for a total of 50 minutes on 3/16/99. She was observed for 11 minutes, 45 seconds before the caregiving. She had just finished kangarooing with her mother for 3½ hours prior to the observation. She was lying on her stomach with her arms and legs tucked under her body and quietly sleeping. Her skin color was a very even reddish color and she was a little pale around her eyes. Her head was facing to the right. Just as the observation began, her nurse lifted the dark quilt cover and opened the portholes on Camryn’s incubator in order to take her temperature under her arm. Camryn was facing away from her nurse and the sink lights. Camryn squirmed and yawned one time as she continued to sleep. Within a minute, her nurse left the bedside, closing the portholes and replacing the quilt cover. Her nurse returned seven minutes later to place Camryn’s stuffed animals inside her incubator and did this without disrupting her sleep. Camryn spread her fingers apart in response to a very loud alarm that lasted 45 seconds and her oxygen saturation level dipped to 89%. She quickly returned to 95%. Her oxygen saturation levels were 97-100% prior to this alarm. Her heart rate was steady between 166-170 beats/minute. Her breathing was fairly regular and a little fast at 60-72 breaths/minute.

Camryn was observed for 18 minutes, 15 seconds during the caregiving interaction. Her nurse lifted the quilt cover and opened the port holes. Loud voices at he desk could be heard. Camryn opened her eyes and quickly closed them. She made a few mouthing movements prior to her nurse checking for residual formula in her stomach. Camryn extended her legs and squirmed as her nurse gently lifted her head in order to access her NG tube. Then she started Camryn’s feeding of 12½ ccs. Her nurse adjusted the roll at the foot of Camryn’s bed and offered her hand for Camryn to brace her feet against. Camryn’s skin color suddenly switched from reddish to a dusky dark color and her oxygen saturation levels dropped to 71%. She gasped and it was clear she was having trouble breathing so her nurse quickly disconnected her feeding and came around to the other side of her bed in order to suction her. Camryn became briefly actively aroused with this as she moved her arms and legs and braced her feet. After suctioning Camryn two times, her nurse listened to her lungs, closed the portholes and returned to the other side of her bed where she resumed her NG feeding. Camryn’s breathing was fast, 72-88 breaths/minute, during and after suctioning until the end of her feeding. Camryn settled immediately back to sleep and actively tucked her arms and legs in close to her body. Her skin color returned to red with a more webbed appearance. When her feeding was done, her nurse offered Camryn her hand to brace her feet against and made sure that Camryn’s feet could easily brace against the roll at the foot of her bed before she left Camryn’s bedside. Her heart rate was steady during caregiving, ranging between 164-170 beats/minute.

Camryn was observed for 20 minutes following the caregiving interaction. During this time she remained in a light sleep and kept her arms and legs tucked underneath her body as she lie on her stomach with her back rounded. She had the hiccoughs for a few minutes and her body often twitched a few times at the end of a breath. She brought her hand in close to her mouth and was quite still as she slept. Her skin color was red with a webbed appearance. She was pale around her eyes and nose. Her breathing was more irregular and ranged between 48-71 breaths/minute. Her oxygen saturation levels were between 96 and 100%. Her heart rate was steady between 165 and 170 beats per minute.

Family Summary

Both of Camryn’s parents continue to kangaroo her daily. Usually her mother holds her in the morning and her father in the evening. Camryn’s nurse states that she doesn’t have any difficulty with temperature instability during or after kangarooing. I have been talking with Camryn’s mother on a regular basis and she is glad that Camryn is out of isolation and looking forward to Camryn getting off of the ventilator.

INFANT’S CURRENT GOALS:

1. Camryn is working toward breathing on her own with less support from the ventilator. She’s working on maintaining the even skin color she often has with kangarooing.
2. Camryn is working on conserving her energy in order to grow.
3. Camryn is working on using tucking of her arms and legs, holding on and keeping her hands by her face, and bracing her feet in order to be an active participant during caregiving interactions. She is working on using these techniques on her own with bedding or caregiver support in order to keep herself relaxed so she avoids getting worn out.
4. Camryn is working on smoothly transitioning into and out of sleep. When she’s transitioning out of sleep and showing signs of wakefulness, she’s working on being stable, without becoming overwhelmed.

Environment:

	Consider the noise level within the nursery and help support Camryn’s restful sleep by promptly attending to alarms and talking in whispers near her bedspace.
	Consider the lighting before lifting the quilt cover on her incubator. Shield her eyes from the sink light if she’s facing in that direction.

Caregiving Interaction:

	To support Camryn in learning to demand her feedings, try to time her NG feedings when she’s stirring or squirming in her bed or opening her eyes.
	Consider offering her pacifier during NG feedings and continue to support her parents in daily skin to skin holding during NG feedings.
	If Camryn isn’t being held, continue to stay with her while she’s in her incubator and support her during her NG feedings.
	Continue to stay with Camryn after caregiving until she’s settled into a restful sleep.
	Continue to support Camryn to use tucking, bracing of her feet, holding on and keeping her hands by her face so that she can continue to be relaxed during caregiving and avoid getting worn out after caregiving.