Camryn is a 110-day-old infant who was born at 26 weeks gestation.  Her corrected age is 42 weeks.  Her birth weight was 2# 2 ¾ oz. (985 grams). Her weight today is 7# 12 oz. (3520 grams, 70^th % ile).  Her length is 19 inches (48cm, 25^th %ile) and her head circumference is 14 inches (36cm, 90^th %ile).  Camryn is now weaned off her nasal CPAP and is on nasal cannula oxygen.  Her oxygen level that she breathes in is between 27-42%.  During this observation, she was at 34%.  Camryn continues to receive breast milk with added fortifiers to equal 30 calories per oz.  She gets this milk pumped into her stomach through an NG tube every 3-4 hours. Camryn is now attempting to breast feed whenever she’s awake and alert.  Her breast-feedings range from 4-5 minutes of good suckles to refusing to nurse if she’s too sleepy.  Camryn continues on a prophylactic antibiotic, Ampicllin, to prevent a urinary tract infection.  She also remains on the diuretics, Aldactone and Diuril to limit fluid retention.  She gets extra iron once a day (Fer-in –Sol) to help increase her red blood cell count.

Camryn was observed during breast-feeding and while her mother held her for the rest of her NG feeding.  Camryn was being held by a nurse at the beginning of the observation and was in a quiet, alert state, intently looking at her environment.  As her mother came in and began to nurse her, Camryn fussed briefly at the change in her position.  She settled down as her mother spoke softly to her.  Camryn made several tongue extension movements and her breathing remained irregular.  Camryn was able to latch on and suck several times for a total of about 4 minutes during this breast-feeding.  Although she continues to work hard to breathe at times, Camryn was able to maintain a latch for up to 1 ½ minutes, sucking and swallowing the entire time.  She seemed to get frustrated, as her breathing was more labored and she was getting quite hungry.  Her mother gently held her in her arms and the nurse hooked up her NG feeding.  Camryn stayed awake for the next 20 minutes and then began to show suck searching signs again.  Her mother allowed Camryn to latch on again and she sucked for another 2 minutes total.  Camryn began to fuss so her mother held her up on her chest and slowly, Camryn began to drift to sleep as the rest of her NG feeding flowed into her stomach.  Camryn showed her competence today by being able to stay awake for an extended period of time and was able to maintain a latch and effective suck from her mother. Camryn uses her hands a lot to grasp and hold on, as if trying to steady her breathing.  Camryn is still working on maintain a more even color and remains pale, especially after she cries.  She has great fluctuation in her breathing, from 32-78 and she continues to work hard to breathe at times.  Her heart rate was steady at 148-175 and her oxygen saturations were 91-100%.

Camryn’s parents continue to spend time with her every day and participate in all of her cares.  Her mother has been staying at the hospital at times, overnight, so she can breast-feed Camryn more often, especially during her awake times.

1.       Camryn is working on using less energy to breathe so she can concentrate more on breast-feeding and using her energy to eat and gain weight.

2.       Camryn is working on developing her endurance so she will be able to maintain a latch and suck for 10-20 minutes to obtain a full feeding.

3.       Camryn is working on being able to tolerate position changes without becoming upset and crying, especially during breast-feeding.

1.       Continue to be mindful of the sound level in the nursery, especially when Camryn is breast-feeding, as the noise seems to distract her from concentrating on nursing.

2.       Continue to provide rest periods for Camryn during care-giving interactions like breast-feeding and vital signs so she can avoid becoming exhausted (her mother did a great job at this during breast-feeding!!)

3.       Continue to provide opportunities for Camryn to breast-feed, especially when she is awake and alert, as these seem to be the times when she does the best.

4.       Continue to swaddle Camryn (keep her arms and legs tucked) during movement transitions and try to move her slowly.