tokens: Admission Date : 2013-04-24 Discharge Date : 2013-05-11 Date of Birth : 2013-04-24 Sex : F Service : NEONATOLOGY HISTORY : Richard Williams , Twin number II , was born at 31-6/7 weeks gestation by cesarean section for rupture of membranes of Twin number I and progressive preterm labor . Mother is a 37 year old Gravida 1 , Para 0 now 2 woman whose blood type is A negative , antibody negative , rubella immune , RPR nonreactive , hepatitis B surface antigen negative and Group B Streptococcus unknown . The mother had received a complete course of betamethasone prior to delivery . This pregnancy was achieved with in Bartley fertilization . A cerclage was placed at 18 weeks gestation . Cesarean section was performed under spinal anesthesia . This infant emerged with Apgars of 8 at one minute and 8 at five minutes . PHYSICAL EXAMINATION : On admission , revealed a vigorous non-dysmorphic premature infant , with moderate subcostal retractions and some occasional grunting , normal S1 , S2 heart sounds , no murmur . Pink and well perfused . Normal hip examination and age appropriate tone and reflexes . The birth weight was 1,980 grams , 80th percentile . The birth length was 44 centimeters , the 75th percentile and the birth head circumference was 30.6 centimeters , in the 65th percentile HOSPITAL COURSE BY SYSTEMS : 1. Respiratory Status : The infant was intubated soon after admission to the CMED CSRU and received two doses of surfactant . She weaned to room air on day of life one where she has remained since that time . Her respirations are comfortable . Her lung sounds are clear and equal . She has had no apnea , bradycardia or desaturation . 2. Cardiovascular Status : She had remained normotensive throughout her CMED CSRU stay . She has a normal S1 , S2 heart sound and no murmur . She is pink and well perfused . 3. Fluids , Electrolytes and Nutrition Status : She started on enteral feeds on day of life number two and progressed without difficulty to full volume feedings by day of life five and then was advanced to calorie enhanced breast milk of 24 calories per ounce . She has been taking from 130 to 160 cc. per kilo per day on an ad lib feeding plan . At the time of discharge , her weight is 2,200 grams ; her length is 49.5 centimeters ( 19.5 inches ) and her head circumference is 30.5 centimeters . 4. Gastrointestinal Status : Her peak bilirubin occurred on day of life five and was total 12.1 , direct 0.3 ; the last bilirubin on day of life six was total 11.1 , direct 0.4 . She never required phototherapy . 5. Hematological Status : Her hematocrit at the time of admission was 45.4 , platelets were 360,000 . She is receiving supplemental iron to provide 2 mg per kilo per day as elemental iron . She has never received any blood products during this CMED CSRU stay . 6. Infectious Disease Status : The infant was started on Ampicillin and Gentamycin at the time of admission for sepsis risk factor . The antibiotics were discontinued after 48 hours when the infant was clinically well and the blood cultures remained negative . 7. Neurological Status : She had a head ultrasound on 2013-05-02 , that was completely within normal limits . 8. Psychosocial : The parents have been very involved in the infant 's care throughout her CMED CSRU stay . She is the first twin to go home . The infant 's first name is Ralph and after discharge the infant 's last name will be Neoma . CONDITION ON DISCHARGE : Good . DISPOSITION : The infant is being discharged home with her parents . Primary pediatric care will be provided by Dr. Hortencia Conner of Milton Hospital Pediatric Group , 3408 E. Fifth Rd. , Bridgewater State Hospital , Tennessee 06546 , telephone number is 433-0531 . CARE AND RECOMMENDATIONS : 1. Feedings : The infant is on breast milk with Enfamil Powder to provide 24 calories per ounce and on an ad lib feeding schedule . 2. Medications : Ferinsol 0.2 cc. to provide 5 mg a day . 3. The infant passed a car seat positioning test on 2013-05-11 . 4. State Screens were sent on 04-27 and 2013-05-08 . 5. The infant received the hepatitis B vaccine on 2013-05-09 , and Synagis on 2013-05-11 . Immunization recommended : 1) Synagis RSV prophylaxis should be considered from October through April for infants who meet any of the following three criteria : Born at less than 32 weeks ; born between 32 and 35 weeks with plans for day care during the RSV season , with a smoker in the household , with preschool siblings , or with chronic lung disease ; 2) Influenza immunization should be considered annually in the Fall for preterm infants with chronic lung disease once they reach six months of age . Before this age , the family and other care givers should be considered for immunization against influenza to protect the infant . DISCHARGE INSTRUCTIONS : 1. Follow-up appointments , the parents have an appointment with Dr. Avon on Tuesday , 05-14 . 2. Visiting Nurses Association of the L.F. Quigley Memorial Hospital will visit on Sunday , 2013-05-12 . DISCHARGE DIAGNOSES : 1. Prematurity at 31-6/7 weeks gestation . 2. Twin II . 3. Sepsis , ruled out . 4. Status post respiratory distress syndrome . Brian LT Wentzel , M.D. 96-131 Dictated By : Tammy T.K. Farless , M.D. MEDQUIST36 D : 2013-05-11 17:49 T : 2013-05-11 18:43 JOB #: 06197 Signed electronically by : DR. John Bonilla on : MON 2013-05-13 4:49 PM ( End of Report )