CASE SCENARIO 1

Carmen G3P2 mother with history of pre-eclampsia delivered her baby 42 weeks AOG
female baby via emergency C-section due to arrest of labor. At birth the amniotic fluid
was green, the baby has 3 cord loops. Immediately after the deliver of the newborn the
doctor suctioned the secretions with bulb syringe. The baby was immediately handed
to the pediatric doctor and nurse. One minute APGAR score was 3/10, (with weak cry,
with limpness, cyanotic, PR of 100, with some grimace) with slow labored breathing,
with nasal flaring and with grunting sounds when breathing. The baby was wrapped
with yellow to greenish colored meconium and nails and umbilical cord were also
stained.

The baby was immediately suctioned with used of suction catheter connected to
suction machine. The doctor suctioned thick, green liquid content (meconium stained)

Oxygen support via 0xygen Hood at 10LPM was administered to the baby.
Auscultation on the lungs shows symmetrical breathing with rales and rhonchi. Five-
minute APGAR is 4/10 (with flexed arms and legs, pulse of 98, minimal response to
stimulation, cyanotic, still with weak cry) with rapid, labored breathing, with Intercoastal
Retractions, grunting and nasal flaring . Body weight at birth 2700 g, length 47 cm,
head circumference 30 cm. with peeling of nails, and reduce vernix caseosa

ABG results revealed: PaO2 of 50mmHg

PaCo2 60mmHg HCO3: 24mEq/L
pH: 7.25 SPO2: 88%

The baby was intubated with 3.5mm endotracheal tube, secretions were suctioned on
Endotracheal tube still with minimal greenish secretion and hooked in ambubag O2 at
10LPM. IVF D10 W 500cc regulated 10cc per hour.
OGT was inserted and gastric lavage was done till clear secretion.

Chest X-ray was done. The images show hyperinflation of the lung filed, with coarse
irregular patchy infiltrates and pneumothorax.

The baby was transferred immediately to NICU with continuous ambubag O2 at

10LPM. The baby was placed in radiant warmer.
The baby was Hooked in mechanical ventilator with high frequency ventilation. The baby is for
close monitoring and minimal handling.

Medications given in NICU:

➢ Methyl Predisolone 0.67mg every 12 hours
➢ Curosurf 3.4 ml bolus intratracheally without interrupting mechanical ventilator
times two doses, then
➢ Nitric Oxide delivered through ventilator circuit.
➢ Ampicillin 50mgIV every 12 hours for 7 days
Gentamycin 3.37mg IV BID for 7 days

DEMOGRAPHIC DATA
Carmen
- G3P2

HISTORY TAKING
- History of pre-eclampsia = risk factor: pre-eclampsia = placental insufficiency =
fetal hypoxia (distress) = causes fetus to take forceful gasps = inhales amniotic
fluid containing meconium**
- Delivered baby 42 weeks AOG = risk factor: post maturity = aging of the
placenta = decreased oxygen to the infant while in the uterus (?) = stress = fetus
to gasp reflexively = inhales amniotic fluid containing meconium**
- Had emergency C-section due to arrest of labor = risk factor: prolonged and
obstructed delivery (arrest of labor) (?) = fetal distress = causes fetus to take
forceful gasps = inhales amniotic fluid containing meconium**

ASSESSMENT
- Amniotic fluid was green
- Baby has 3 cord loops
 - 1 min, APGAR score: 3/10 (with weak cry, with limpness, cyanotic, PR of 100,
with some grimace) with slow labored breathing, with nasal flaring and with
grunting sounds when breathing
- Baby was wrapped with yellow to greenish colored meconium and nails and
umbilical cord were also stained
- Auscultation on the lungs shows symmetrical breathing with rales and rhonchi
- 5 min, APGAR score: 4/10 (with flexed arms and legs, pulse of 98, minimal
response to stimulation, cyanotic, still with weak cry) with rapid, labored
breathing, with Intercoastal Retractions, grunting and nasal flaring
- Body weight: 2700 g, length 47 cm, head circumference 30 cm, with peeling of
nails and reduce vernix caseosa

LABORATORY OR DIAGNOSTIC PROCEDURES

 Arterial Blood Gases
- PaO2 of 50mmHg
- PaCo2 60mmHg
- HCO3: 24mEq/L
- pH: 7.25
- SPO2: 88%
 Chest X-ray
- Show hyperinflation of the lung filed, with coarse irregular patchy infiltrates
and pneumothorax

MANAGEMENTS
After delivery
- Suctions secretions with bulb syringe
- After 1 min APGAR scoring, baby was suctioned with use of suction catheter
connected to suction machine – thick, green liquid content.
- Oxygen support via oxygen Hood at 10LPM was administered to the baby
- Baby was intubated with 3.5mm endotracheal tube, secretions were suctioned on
Endotracheal tube still with minimal greenish secretion and hooked in ambubag
O2 at 10LPM
- IVF D10 W 500cc regulated 10cc per hour
- OGT was inserted and gastric lavage was done till clear secretion

Transfer to NICU
- With continuous ambubag O2 at 10LPM
- Placed in radiant warmer
- Hooked in mechanical ventilator with high frequency ventilation
- For close monitoring and minimal handling

Medications given in NICU:

- Methyl Predisolone 0.67mg every 12 hours
- Curosurf 3.4 ml bolus intratracheally without interrupting mechanical ventilator times two
doses, then
- Nitric Oxide delivered through ventilator circuit.
- Ampicillin 50mgIV every 12 hours for 7 days
- Gentamycin 3.37mg IV BID for 7 days