Clinical Case Study II. Pharmacy

(Dobutamine is less effective in infants and may actually cause hypotension , blood culture and start of antibiotics : ampicillin gentamicin for 7-10d (Anaerobic coverage is usually not necessary unless infant is several weeks old , follow CBC , platelets , PT , PTT fibrinogen replace clotting factors products prn , frequent measurements of arterial pH and blood gas tensions , correct metabolic acidosis frequent measurements of electrolytes watch for hyperkalemia

Surgical Consideration Operative intervention is indicated for bowel perforation , evidence of necrotic bowel (fixed loop , metabolic acidosis DIC , shock , or progressively worsening

clinical condition despite intensive medical

management , a peritoneal drain may be inserted in extremely ill infants to delay or avoid laparotomy , if NEC develops in a baby with PDA , begin medical management and consider urgent operative closure of PDA . Indomethacin will not be given to Sarah if it is suspected or definite NEC

Sarah 's condition can be seen as a suspected case of NEC . Though diagnosis would have to be carried out to ascertain the level it has affected the infant Sarah according to the stages shown above . The management and treatment will then be carried out based on the severity .Finally , Sarah 's mother will be advised to be careful if she gets pregnant again . She will be advised on the general prevention strategies to avoid future NEC as follows : Intestinal priming (gut stimulation feedings : dilute , low volume feedings to stimulate GI mucosal development , advance feedings slowly in small preterm infants , she will not advance feedings if there are gastric residuals , especially if bile stained , fresh human milk appears to be protective against NEC , she will not feed infants with PDA , UAC , or UVC , she give enteral feedings during and for 48-72h after indomethacin , she will minimize antibiotic use and abuse , as they alter intestinal flora and select for resistant species epidemiologic controls...