Camryn is a 34 day-old infant who was born at 26 weeks’ gestation. Her corrected age is 30 weeks, 6 days. Her birthweight was 985g (2#, 2 ¾ oz) and weight on 3/30/99 was 1310g (2# 14 ¼ oz) which is at approximately the 35^th percentile. Camryn had a blood transfusion on 3/19/99. From 3/24-3/29, she was given a steroid medication called Dexamethasone to improve her lung function. On 3/24 she also started an antacid, Ranitidine which she continues to receive. She had an eye exam on 3/24, which was within normal limits. She was taken off of the ventilator on 3/26/99 and put on nasal CPAP (Constant Positive Airway Pressure) for three days. Since yesterday, 3/29/99, Camryn has been on nasal cannula oxygen. She’s on .2L and provided with 70-93% oxygen via two pronged tubing that fits under her nose. Camryn was given the IV antibiotics, Vancomycin and Gentamicin from 3/18/99 to 3/21/99. Aminophillen, the medication given to help prevent apnea and bradycardic spells was also discontinued on 3/21/99 and Camryn started a different medication, Caffeine. Her last two apnea/bradycardic episodes were on 3/25/99. Camryn is on a prophylactic antibiotic, Ampicillen to prevent a urinary tract infection. IV supplemental fluids and nutrition were discontinued on 3/19/99. She gets extra iron called Fer-in-sol. She is receiving breast milk that’s fortified with HMF to increase the calories to 24 cal/oz. She receives 90-95cc/12 hours every 2-4 hours so each OG feeding is around 24cc. Camryn has started to demand some of her feedings.

Camryn was observed for a total of 70 minutes on 3/30/99. She was observed for 15 minutes before the caregiving. Camryn was lying on her stomach with her head facing to the left and resting against a roll at the head of her bed. She was in a light sleep and her arms and legs were tucked near her body. There were side and foot rolls positioned close to her body. She was wearing a white sleeper with a lace collar. Her skin color appeared pale in her darkened incubator. One time she arched and pushed up with her left arm so that her head was off of the surface. She made a few mouthing movements as she slept and her mouth hung slightly open much of the time. Her oxygen saturation levels were 94-100%. According to her monitors, her heart rate was steady between 150-160 beats/minute and her breathing was between 47-68 breaths/minute.

Camryn was observed for 1½ minutes while her physician listened to her lungs with a stethoscope. Then 5 minutes, 15 seconds later her nurse arrived at her bedside for 17 minutes, 40 seconds. Camryn’s heart rate went up to 172 as her physician gently pulled back her sleeper to listen to her lungs and observe her breathing pattern. She squirmed and fussed a few times. After his examination, he closed the portholes and replaced her quilt cover. Camryn opened her eyes a few times and then closed them. Her heart rate returned to the 150’s as she started to wake up. When her nurse arrived at her bedside, her eyes were half-open. Her nurse quietly talked to her as she lifted her up and turned her to her side being careful to move her body as one unit. Camryn opened her hands wide numerous times and extended her arms and legs as her nurse changed her diaper while she was on her back. Camryn brought her hand by her face, tucked her legs a few times, and yawned widely. She tried to brace her feet. After her diaper change, her heart rate was fast again at 182 beats/minute. Her nurse covered her and turned her to her right side before momentarily leaving her bedside to shut the window blinds and curtains nearest Camryn’s bedspace. Then her nurse lifted Camryn out of her incubator and held her with a blanket loosely swaddled around her. At first she blinked, yawned a few times, and looked a little overwhelmed. Then she relaxed. She was clearly hungry as she searched for something to suck on and briefly sucked on her nurse’s finger while she waited for her mother to arrive. Camryn’s skin color was pale with a somewhat webbed appearance. Her nurse laid Camryn on her right side against her mother’s breast so that Camryn could nuzzle during her OG feeding. Then her nurse started her OG feeding of 25cc before leaving her bedside. Camryn’s heart rate remained in the 170’s. Her blood oxygen levels were 87-98% and her breathing was irregular at 35-54 breaths/minute.

Camryn was observed for 30 minutes, 35 seconds following the caregiving interaction. She nuzzled at her mother’s breast while receiving her OG feeding which took 20 ½ minutes. This was a new experience for Camryn and she was restless. She opened her hands, extended her arms a few times and squirmed a lot. She was rooting a lot at her mother’s breast and making some sucking movements with her mouth. After her mother repositioned Camryn’s body and helped her hold her hands together, Camryn started to relax and go to sleep. Camryn’s oxygen saturation levels were in the upper 90’s and declined into the low 80’s after her feeding was finished. In response to her monitor alarms, her nurse returned to her bedside to turn up her oxygen. Her nurse assisted Camryn’s mother in repositioning Camryn in a reclined position on her chest. For approximately the last ten minutes of the observation, Camryn was held skin to skin on her mother’s chest. Camryn was dusky around her eyes. She was still and in a light sleep. Her heart rate was 159-180 beats/minute and her breathing was irregular between 33-71 breaths/minute.

Both of Camryn’s parents continue to kangaroo and/or hold her daily. Camryn’s mother first gave her a bath on 3/18/99 and continues to be very involved in her daily cares.

INFANT’S CURRENT GOALS:

1. Camryn is working on using less energy to breathe and on developing an even breathing pattern. She’s working on developing and maintaining an even skin color. She’s working on maintaining a more even slower heart rate during caregiving interactions, especially movement transitions.
2. Camryn is working on conserving her energy in order to grow and on easily digesting her feedings.
3. Camryn continues to work on perfecting the use of her self regulatory skills like 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.
4. Camryn is working on consistently demanding her feedings and beginning to prepare for breast-feeding.

RECOMMENDATIONS:

Environment:

Continue to adjust the lighting before lifting the quilt cover on her incubator or removing her from her incubator.

Bedspace and Bedding:

Camryn seemed to rest well and like having a roll at the head of her bed that she could rest her head against.

Caregiving Interaction:

	Continue to support Camryn in learning to demand her feedings by timing her OG feedings when she’s stirring or squirming in her bed or opening her eyes.
	Continue to support Camryn’s readiness for breast-feeding by supporting one of the following during OG feedings: 1) Nuzzling at her mother’s breast in sidelying. Position Camryn so that her head is elevated a little higher than her hips. 2) Skin to skin holding by her parents. 3) Holding and offering her pacifier during OG feedings.
	If Camryn isn’t being held, continue to stay with her while she’s in her incubator and support her during her OG feedings. If she’s uncomfortable, she may need you to slow or stop her feeding momentarily before resuming it again.
	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. Camryn seems to become the most unsettled with movement transitions (increase in heart rate and extension movements). Continue to move her slowly and offer extra support to her during these times.