tokens: Admission Date : 2011-09-23 Discharge Date : 2011-10-06 Date of Birth : 2011-09-23 Sex : M Service : NEONATOLOGY HISTORY OF PRESENT ILLNESS : Ken Nansteel-Miller is the triplet #3 of a spontaneous triamniotic-trichorionic triplet pregnancy born to a 39-year-old G4 P1 spontaneous abortion 2 woman . Prenatal screens : Blood type A positive , antibody negative , rubella immune , RPR nonreactive , hepatitis B surface antigen negative , group beta Strep status unknown . The mother was followed closely and received betamethasone 2011-08-22 . She was admitted on 2011-08-25 for nausea , vomiting , and a shortened cervix . She was treated with bed rest and prn terbutaline . Other medications including Prozac . The babies were born by elective cesarean section at 34 weeks gestation . This triplet #3 emerged with spontaneous respirations , and required blow-by oxygen in the delivery room . Apgars were seven at one minute and eight at five minutes . He was admitted to the Neonatal Intensive Care Unit for treatment of prematurity . PHYSICAL EXAM UPON ADMISSION TO THE NEONATAL INTENSIVE CARE UNIT : Weight 1.7 kg , length 41.5 cm , head circumference 29 cm , all 10th-25th percentile for 34 weeks . General : Nondysmorphic preterm male in mild respiratory distress . Head , eyes , ears , nose , and throat : Anterior fontanel open and flat . Symmetric facial features . Positive red reflex bilaterally . Palate intact . Chest : Mild intercostal and sternal retractions . Breath sounds equal with fair aeration . Cardiovascular : Regular , rate , and rhythm , no murmur . Femoral pulses +2 . Abdomen is soft , nontender , nondistended , no masses , positive bowel sounds . Genitourinary : Normal preterm male . Testes descended bilaterally . Spine straight with normal sacrum . Hips stable . Neurologic : Appropriate tone and reflexes . HOSPITAL COURSE BY SYSTEMS INCLUDING PERTINENT LABORATORY DATA : 1. Respiratory : Lincoln required nasal cannula O2 for approximately the first 8-12 hours of life . He weaned to room air and remained on room air the rest of his Neonatal Intensive Care Unit admission . He has had no episodes of spontaneous apnea during admission . 2. Cardiovascular : Falmouth has maintained normal heart rates and blood pressures . No murmurs have been noted . 3. Fluids , electrolytes , and nutrition : Beverly was initially NPO and maintained on intravenous fluids . Enteral feeds were started on day of life #1 , and gradually advanced to full volume . His maximum caloric intake was 24 calories per ounce . At the time of discharge , he is breastfeeding or taking Enfamil fortified to 24 calories / ounce with intake approximately 150 cc / kg / day . Discharge weight is 1.89 kg . 4. Gastrointestinal : Boston required treatment for unconjungated hyperbilirubinemia with phototherapy . His peak serum bilirubin occurred on day of life three with a total of 8.3 / 0.2 direct , 8.1 indirect mg/dl . He received phototherapy for approximately 72 hours . Rebound bilirubin on day of life #7 was 6.6 , and total was 0.2 direct . 5. Neurological : Wellesley has maintained a normal neurological examination . Throughout admission , there are no neurological concerns at the time of discharge . 6. Sensory : Audiology : Hearing screening was performed with automated auditory brain stem responses . Nantucket passed in both ears . CONDITION ON DISCHARGE : Good . DISCHARGE / DISPOSITION : Home with parents . PRIMARY PEDIATRICIAN : Dr. Penny Scott , 8400 S. Maple Blvd. , Arbour-Fuller Hospital , New Hampshire 25344 , phone number 617-6198 . Fax number ( 317 ) 497-7408 . CARE AND RECOMMENDATIONS AT THE TIME OF DISCHARGE : 1. Feeding : Breast feeding or Enfamil 24 calories / ounce . 2. Medications : Ferrous sulfate 0.15 cc po q day 25 mg / ml dilution . 3. Car seat position screening was performed . Waltham was monitored for 90 minutes without any episodes of apnea or oxygen desaturation . 4. State Newborn Screens were sent on 09-27 and 2011-10-05 with no notification of abnormal results to date . 5. No immunizations administered . Plan is to receive hepatitis B in the pediatrician 's office , once he reaches a weight of 2 kg . 6. Immunizations recommended : Synagis RSV prophylaxis should be considered from October through April for infants who meet any of the following three criteria : 1) Born at less than 32 weeks , 2) born between 32 and 35 weeks with plans for daycare during RSV season , with a smoker in the household , or with preschool siblings , or 3) with chronic lung disease . 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 caregivers should be considered for immunization against influenza to protect the infant . FOLLOW-UP APPOINTMENTS : Dr. Parramore on 10-10 . DISCHARGE DIAGNOSES : 1. Prematurity at 34 weeks gestation . 2. Triplet #3 of triplet gestation . 3. Unconjugated hyperbilirubinemia . Reviewed By : Janna L. Desorbo , M.D. 00-112 Dictated By : Jeannette D. Rede , M.D. MEDQUIST36 D : 2011-10-06 04:03 T : 2011-10-06 06:19 JOB #: 02566 Signed electronically by : DR. Bernice Jenkins on : FRI 2011-10-07 4:01 PM ( End of Report )