07/07/99 Developmental Care Plan

Developmental Care Plan for Camryn Miller

07/07/99

Medical Summary

Camryn is a 133-day old infant who was born at 26 weeks gestation. Her corrected age is 5 weeks old. Her birth weight was 2# 2 ¾ oz. (985 grams). Her weight today is 9 lbs. (4080 grams, 60^th %ile). Her length is 20 inches (50.5cm, 20^th %ile) and her head circumference is 14 ½ inches (36.5cm, 75^th %ile). Camryn has remained on nasal cannula oxygen and has been between .2 and .4 L per minute. The oxygen level that she breathes in has been between 38-24%. During this observation, she was at 24%. Camryn is now attempting only bottle feedings and her NG supplements have been discontinued for about 24 hours. Camryn is alternating between taking 20kcal. breastmilk and breastmilk with added fortifiers to equal 30 kcal., every other bottle. Her parents and medial team are going to see if Camryn can take enough milk in by mouth to gain weight in the next couple of days. If she can do this, the plan is to send her home. Camryn continues on the prophylactic antibiotic, Ampicillin, to prevent a urinary tract infection. She had 2 tests done last week, a nuclear scan and VUCG, which showed her kidneys are working well enough and there is no reflux of urine back into her kidneys. Her diuretics were discontinued several weeks ago and she still receives the iron (Fer-in-sol) to help increase her red blood cell count.

Behavioral Summary

Camryn was observed during a feeding by her mother today. Camryn was observed for 12 minutes prior to caregiving interaction. She maintained a quiet, alert state, sucking eagerly on her pacifier. Two times, she lost the pacifier from her mouth and began to fuss when she couldn’t find it again. Camryn maintained a quiet, alert state while her mother picked her up and began to feed her. Camryn made several suck searching and tongue extension movements before the bottle was placed in her mouth. She sucked on the nipple for about 45 seconds and then coughed and grunted. Her mother took the bottle out of her mouth and sat her up to burp her. Camryn quickly recovered and began to drink from the bottle for the next 7 minutes (she took 30cc in that time). During this time, her breathing was quite irregular, fast at times and her heart rate was steady at 154-168. Camryn was pale and her arms became slightly webbed towards the end of the feeding. After several more burps, Camryn’s mother tried to put the bottle back into her mouth but Camryn refused, fussed and turned her head. Camryn’s mother held her in her arms for several minutes, giving her a rest. Camryn’s eyes started to close and she appeared sleepy. She smiled several times as she looked at her mother. Soon, she began to root for the bottle again and Camryn’s mother offered the bottle. Camryn sucked a few times and then began to fuss and turn her head. After several more attempts to offer the bottle to Camryn and her refusing, her mother held her while she drifted slowly to sleep. Her oxygen level stayed steady from 94-98%. Her arms lay limply by her sides and she was pale and webbed in her arms.

Family Summary

Camryn’s parents continue to stay with her every day and are her primary caregivers. They have moved to the NICU annex and stay in their own room with Camryn. They are anxious to get her home.

INFANT’S CURRENT GOALS:

1. Camryn is working on developing endurance so she will be able to consistently take a bottle (60-90cc) without becoming exhausted and needing NG supplements.

2. Camryn is working on taking all of her feedings by mouth and still being able to gain weight and grow.

3. Camryn is working towards maintain a quiet, alert state throughout her feedings and not become upset and fuss.

RECOMMENDATIONS:

Caregiving Interaction:

1. Continue to provide rest periods for Camryn during feedings so she doesn’t become exhausted.

2. Try to feed Camryn as soon as she shows signs of hunger so she doesn’t use a lot of energy crying or fussing.

3. Continue to work with medical team, including OT, for further feeding evaluation.