Evelina London Children's Hospital Neonatal Unit

6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

#DocTitle#
Clinical Review
22 Apr 18 11:56 by Timothy Watts

Time: 22 Apr 18 at 11:29

Reason: Ward round
Person: Watts, Timothy
Designation: Consultant
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)- feeds recommenced on 14/4
Comments: Doing well.
No nursing concerns
Obs stable in a cot
Other twin at home.

Taking full oral feeds of Peptijunior 3 hourly. Well tolerated.

Weight increasing.

O/E Very well. Normal exam. Full NIPE check completed.

Fit for discharge

Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
21 Apr 18 11:13 by Cheryl Battersby

Time: 21 Apr 18 at 11:12

Reason: Ward round
Person: Battersby, Cheryl
Designation: SpR
Parent present: No
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)- feeds recommenced on 14/4
Comments: No concerns o/n
Obs stable
Off PN yesterday
Full enteral feeds 150ml/kg/day
hourly of MEBM+ Pepti junior alternating bottle and NGT
BSL stable
PU BO yesterday morning
No aspirates , abdo soft
Plan:
continue the same
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 1 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female
 Evelina London Children's Hospital Neonatal Unit
6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

Clinical Review
20 Apr 18 09:17 by Elisabetta CAREDDA

Time: 20 Apr 18 at 09:16

Reason: Ward round
Person: CAREDDA, Elisabetta
Designation: ST (or LAT) 1-2
Currently active
consultant:
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)- feeds recommenced on 14/4
Comments: No concerns o/n
Obs stable
TPN stopped at 7 am, currently on 39 ml/3 hourly of MEBM+ Pepti junior alternating bottle
and NGT
BSL stable
PU BO
Plan:
continue the same
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
19 Apr 18 11:16 by Elisabetta CAREDDA

Time: 19 Apr 18 at 11:13

Reason: Ward round
Person: karen turnock
Designation: Consultant
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)- feeds recommenced on 14/4
Comments: Progressing well with feeds, bowels open, no vomits
No concerns
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
18 Apr 18 19:32 by Sara Al-Kadhimi

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 2 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female
 Evelina London Children's Hospital Neonatal Unit
6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

Time: 18 Apr 18 at 19:27

Reason: Ward round
Person: Al-Kadhimi, Sara
Designation: ST (or LAT) 3-8
Parent present: No
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)- feeds recommenced on 14/4
Comments: Tolerating feeds nicely, No abdominal concerns- minimal aspirates. Therefore we have increased
the enteral feeds by 3mls/12hrly. She is 2/3 enteral and 1/3 IVF at present.

Plan
1. Continue increasing feeds
2. Check if definitely needs contrast study prior to discharge
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
17 Apr 18 11:05 by Elisabetta CAREDDA

Time: 17 Apr 18 at 10:29

Reason: Ward round
Person: CAREDDA, Elisabetta
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)- feeds recommenced on 14/4
Comments: Obs stable
On 150 ml/kg d: ScamP TPN via PVL+ pepti junior 18 ml/3 hourly ( 70 ml/kg/d)
tolerating well
blood test yesterday : no concerns
PU
BO last on 15/04
abdomen soft
Plan:
continue the same plan( increase 3ml every 12 h if tolerate)
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
16 Apr 18 10:41 by Elisabetta CAREDDA

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 3 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female
 Evelina London Children's Hospital Neonatal Unit
6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

Time: 16 Apr 18 at 10:36

Reason: Ward round
Person: CAREDDA, Elisabetta
Designation: ST (or LAT) 1-2
Currently active
consultant:
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)- feeds recommenced on 14/4
Comments: warm ,well perfused,
nop signs of resp distress
abdomen soft, no t distended
Obs stable
On 150 ml/kg d: ScamP TPN via PVL+ pepti junior 12 ml/3 hourly
tolerating well
Plan:
Stop abx
chase bloods sent today
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
15 Apr 18 15:10 by Rob Nestor

Time: 15 Apr 18 at 14:51

Reason: Ward round
Person: De cunto Angela
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)- feeds recommenced on 14/4
Comments: Observations normal. Tolerating feeds. Abdomen soft.

Plan:
1. Continue to increase feeds-increase by 10 ml/kg every 12 hours
2. Once on 150 ml/kg total start reduce PN
3. Routine bloods tomorrow
4. IV Abx for 7 days
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
15 Apr 18 14:48 by Rob Nestor

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 4 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female
 Evelina London Children's Hospital Neonatal Unit
6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

Time: 15 Apr 18 at 14:45

Reason: Ward round
Person: De Cunto Angela
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)- feeds recommenced on 14/4
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
14 Apr 18 12:38 by Angela De Cunto

Time: 14 Apr 18 at 12:34

Person: De Cunto, Angela
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)
Comments: SBIA, SpO2 100%. HR 150.
Abdomen not distended, not tender, soft.

Plan:
1. start trophic feeds today (3 ml every 3 hours), DEBM or Peptijunior.
2. Continue TPN via PVL
3. Feeds to be increased to 6 ml 3 hourly if tolerated tomorrow.
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
13 Apr 18 11:02 by Patience Nalubega

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 5 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female
 Evelina London Children's Hospital Neonatal Unit
6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

Time: 13 Apr 18 at 10:55

Reason: Ward round
Person: Nalubega, patience
Designation: ST (or LAT) 1-2
Currently active
consultant:
Parent present: No
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)
Comments: No major concerns overnight
Has passed some small pallet stools
Abdominal distention less

O/E; settled, warm, well perfused

Abdomen not distended
Soft, no-tender

Active Diagnosis:
Plan;
NBM for a total of 5/7
Start 3mls/3hrly tomorrow morning
Review in 24 hours and increase by 3mls on sunday
Then review again on monday
Continue Abx up to 7/7
Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
12 Apr 18 11:30 by Patience Nalubega

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 6 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female
 Evelina London Children's Hospital Neonatal Unit
6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

Time: 12 Apr 18 at 11:10

Reason: Ward round
Person: Nalubega, patience
Designation: ST (or LAT) 1-2
Currently active
consultant:
Parent present: No
Brief clinical overview: 34 weeks twin
respiratory distress @ Birth and briefly on CPAP
presumed infection
abdominal distension and tenderness currently on on tripple Abx + ?NEC -
NBM since (09/04)
Comments: No major concerns over night
Passed small pallets of stool
Abdominal distention much less
Observations are stable#

O/E; Warm, pink, well perfused, settled

abdomen not distended, soft, non tender, no guarding,
anterior abdominal wall id healthy
umbilicus is dry

Plan;
Continue current treatment plan
D./Wconsultant regarding PN + LL

Dr Suresh
Peripheral PN
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
11 Apr 18 15:06 by Malgorzata Radomska

Time: 11 Apr 18 at 14:57

Reason: Asked to review
Person: Radomska, Malgorzata
Designation: Consultant
Brief clinical overview: 34 weeks twin
respiratory distress on CPAP
presumed infection
abdominal distension and tenderness-started on tripple Abx + NBM (09/04)
Comments: Baby discussed with surgical team: sceptical about NEC as no inflammatory markers and
currently normal abdominal examination. One of the X-rays thought to be suspicious for hiatus
hernia (stomack central and very close to heart)- the baby should have contrast study before
discharge home.
Baby discussed with a group of neonatal consultants- impression that some form of collitis is
present based on the symptoms and abnormal abdo X-Ray. Too risky not to treat.
Plan: NBM and triple antibiotics for 7 days.
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
11 Apr 18 12:15 by Patience Nalubega

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 7 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female
 Evelina London Children's Hospital Neonatal Unit
6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

Time: 11 Apr 18 at 11:03

Reason: Ward round
Person: Nalubega, patience
Designation: ST (or LAT) 3-8
Currently active
consultant:
Parent present: No
Brief clinical overview: 34 weeks twin
respiratory distress on CPAP
presumed infection
abdominal distension and tenderness-started on tripple Abx + NBM (09/04)
Comments: Main concerns, abdominal distention
However was stable overnight

V; SVIA
C; Stable
Fluids; 120mls/kg/day of 10% dext + add ons
Not opened bowels in last 24hrs
Minimal mucousy aspirates
I; Apyrexial

CRP 1->1

Active Diagnosis:
Plan;
Continue tripple Abx till tomorrow
NBM for today
Bloods today
Update parents
Review re-introducing feeds tomorrow
Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
11 Apr 18 11:16 by Patience Nalubega

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 8 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female
 Evelina London Children's Hospital Neonatal Unit
6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

Time: 10 Apr 18 at 10:58

Reason: Ward round
Person: Nalubega, patience
Designation: ST (or LAT) 3-8
Currently active
consultant:
Parent present: No
Brief clinical overview: 34 weeks twin
respiratory distress on CPAP
presumed infection
abdominal distension and tenderness-started on tripple Abx + NBM (09/04)
Comments: No major concerns over night

V; SVIA sats 100%

C; HR 130, Bp normal

F&F; NBM, on 10% dext with adds,

total aspirates 17mls in last 24 hours; mousousy
Bowels opened

O/E; setlled
Abdomen distended, soft but tender on the right side
Redness around umbilicus has reduced
bowel sounds are present

Plan;
Chase bloods
abdominal X-ray
Continue NBM, fluids and ABx

ADDENDUM:
Abdominal Xray: "NG tube in stomach which is mildly distended with gas. Previous gaseous
distension of bowel is now improved. There is gas down to the rectum. However, curvilinear
lucency along the left para colic gutter, may represent pneumatosis due to necrotising
enterocolitis. No portal venous or free gas."

CRP <1, PLT normal, WBC stable 6.2

Abdomen US discussed with radiologist: not needed now.

Active Diagnosis:
PLAN:
1. continue IV triple Abx and NBM
2. rpt FBC, CRP tomorrow am
3. rpt Abdominal Xray tomorrow morning
4. consider PN if decision to keep NBM for 7 days
Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
09 Apr 18 09:52 by Patience Nalubega

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 9 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female
 Evelina London Children's Hospital Neonatal Unit
6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

Time: 09 Apr 18 at 09:40

Reason: Ward round
Person: Nalubega, patience
Designation: ST (or LAT) 3-8
Currently active
consultant:
Parent present: No
Brief clinical overview: 34 weeks twin
respiratory distress on CPAP
presumed infection
abdominal distension
Comments: Currently settled, obs were fine
However had abdo distention since yesterday, passed loads of stool, no vomiting
Currently on 120mls/kg/day enteral feeds

O/E; settled

P/A; hyperemic ring around the umbilicus, abdomen moderately distended, tenderness on
palpation.

Active Diagnosis:
Plan;
Septic screen (BC, FBC + CRP)
Tripple IV ABxs
NBM
IV fluids
Plain abdominal X-ray
Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
08 Apr 18 09:31 by YOUSEF BASMA

Time: 08 Apr 18 at 09:31

Reason: Ward round
Person: BASMA, YOUSEF
Brief clinical overview: 34 weeks twin
respiratory distress on CPAP
presumed infection
abdominal distension
Comments: Fully enteral fed now. No nursing concerns.
Off Abx.
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
07 Apr 18 09:50 by YOUSEF BASMA

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 10 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female
 Evelina London Children's Hospital Neonatal Unit
6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

Time: 06 Apr 18 at 10:53

Reason: Ward round
Person: Sidira, Christina
Designation: ST (or LAT) 1-2
Parent present: No
Brief clinical overview: 34 weeks twin
respiratory distress on CPAP
presumed infection
abdominal distension
Comments: Step down from NICU 5/4/18

V-SVIA, off CPAP

CXR: no effusion, no consolidation

C- stable

F- 90mls/kg/d total: 30ml/kg/d IVF 10% dextrose via PVL and 60ml/kg/d C+G formula via NG
BO and PU

I- on benpen and gent for presumed sepsis (maternal sepsis)

CRP<1, WBC 10.9, BC pending

o/e
warm and well perfused
Chest: clear
HS: normal

Plan:
1 If tolerating feeds can go to full feeds at 90 ml/kg/day and if tolerating can go up to 120
ml/kg/day this evening tonight
2 Rpt CRP , if okay and BC negative stop Abx.
Active Diagnosis: Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Clinical Review
05 Apr 18 13:47 by Elisabetta CAREDDA

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 11 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female
 Evelina London Children's Hospital Neonatal Unit
6th Floor, North Wing, St.Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH. Tel: 020 7188

Time: 05 Apr 18 at 12:09

Reason: Ward round
Person: CAREDDA, Elisabetta
Designation: ST (or LAT) 1-2
Currently active
consultant:
Parent present: Yes
Brief clinical overview: 34 weeks twin
respiratory distress on CPAP
presumed infection
abdominal distension
Comments: V; CPAP in air, non respiratory distress
PCO2 5.5 PH 7.37 , SatO2 96-100%

C: MBP 41 HR 130-150
lactate 2.3

F on 60 ml/kg/d 10% Dextrose

BSL : 5

S: on benpen+Gent
Admission bloods: CRP <1, WBC 10.9
PLT 263 HB 183
Bili 31
B culture pending

Active Diagnosis:
Plan:
remove CPAP
monitor abdominal distention, consider XR
blood tes( basic profile CRP ) tomorrow
chase B culture
Complete admission summary
Prematurity (32-36 weeks), Signs of respiratory distress of newborn, Respiratory distress
syndrome, Sepsis Suspected

Full Notes Print Out Patient Name: TIA, Mawa Twin One
Page 12 of 12 DOB: 05/04/2018
Generated by BadgerNet on 27 Sep 18 at 16:21 Sex: Female