Neonatal septicemia Literature & Language Case Study (Case Study Sample)

Neonatal Septicemia
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Neonatal Septcemia is a blood infection disease that occurs in infants but infection can be earlier screened and observed in pregnant women. It is caused by a bacteria known as Escherichia coli, Listeria and in other cases there can be traces of streptococcus. Mothers who are infected with the disease can go through a treatment chain whereby actions are done to avoid infection or prevent severity. Below is a treatment record of a patient who was diagnosed with Neonatal Septicemia.
* PATIENT STATISTICS
* Weight of the baby: 2.0 kilograms
* Height: 46 centimeters
* Sex: Female
* Chief complaint: Apnea, vomiting, skin discoloration
* Admitting diagnosis: Pediatric apnea, neonatal sepsis
* Significant information about the onset of illness: The symptoms were manifested after about six hours after birth
* Current medication taken at home: Rhinocort, continuous positive airway pressure (CPAP)
* PATIENT HISTORY
* Medical
The mother of the baby was a 25-year-old woman who was a primigravida. The baby was born at 36 weeks by spontaneous vaginal delivery (SVD) and had labored breathing that persisted for the remaining part of the day and night, therefore they were immediately admitted at the hospital for monitoring. The baby was then intubated because of the labored breathing and this facilitated ventilation. The baby was then placed on an invasive ventilator immediately after birth. The baby was diagnosed to have apnea and the mother was given a prescription of Rhinocort. However, the baby still had persistent apnea and now started having skin discolorations, which the mother described as ‘blue marks’ on the skin. What alarmed her most was that the baby started vomiting and therefore, she alerted the nurses. She reports that the baby has been on respiratory support using the continuous positive airway pressure.
According to the mother, this pregnancy passed by uneventfully and being a primigravida, she attended all the clinic dates that she was assigned to.
Surgical history
The mother has never had any major surgeries done on her.
Social History
The mother is married and lives with her husband and her mother. She works as an accountant at a local firm. Together with her husband, they are able to afford a decent lifestyle and even support their extended families.
Family History
There is no history of any running diseases in her family. However, her husband’s mother is diabetic.
* Laboratory Data
Admission Day
* Procalcitonin-3.0 ng / mL (≥2.5 ng/ mL signified rise in bacterial infection)(Mally et.al., 2014)
* C-reactive protein- 30mg/L (<40mg/ L signifies rise in bacterial infection) (Mally et.al., 2014)
* Serum amyloid a- 15 mg/ L ( The normal standards being at 10mg/L according to Bozena & Maria, 2014)
* Blood culture showed presence of Gram negative bacilli bacteria.
PaCO2- 40 mmHg
* CBC
* HGB- 11g/ dL
* HCT- 35%
* RBC- 4.00 *10^6/ µL
* MCV- 98fl
* MCH- 30 pg
* MCHC- 32 %
* WBC- 10.0 * 10^3/ µL
* ANC- 5K/µL
* Arterial Blood Gas
* Pa02- 65 mmHg
* Sa02- 50 mmHg
* Met Panel
* C02- 20 mmol/ L
* Blood Urea Nitrogen- 8 mg/ dL
* Glucose- 58mg/ dL
* Serum chloride- 110 mmol/ dL
* Serum potassium- 3.8 mmol/ dL
* Serum sodium- 140mmol/ dL
* X-Rays
* Rapid thyme involution was observed.
* Streaky haziness originating from the hilum
* Increased lung volume
* Other Diagnostic tests
* No other significant tests were done.
* Ventilator settings and daily ventilator changes.
The mode of the ventilator was pressure control. The rate was set at 45. Sensitivity was set at between 0 and -2 to suit the baby’s needs; not too fast (greater than 0) or too slow (less than -2). The rate was set at 40 on admission day, 42 on day 1, 43 on day 2 and 45 on day 3. Peak inspiratory pressure (PIP) was set at 20.
* Relate to changes in condition
The chest X-ray results showed increased lung volume to indicate that the body of the baby was adjusting to the external environment and therefore making more space for inhaled air.
The procalcitonin (PCT) was positive which ascertained that there was a bacterial infection, in conjunction with the negative results of the C-reactive proteins (CRP) (Simonsen et.al. 2014). However, as treatment went on and antibiotics were administered, the level of PCT reduced and the level of CRP increased, showing a decline in the number of bacterial causing germs in the body (Mahallei et.al. 2018)
* INITIAL TREATMENT AND THERAPY
On admission, the treatment regime that was used previously was stopped and investigations were carried out on the baby. Pediatric apnea was ruled out in favor of neonatal sepsis, based on the laboratory tests done. The baby was started on antimicrobials (cefotaxime) which were administered at 50 mg/ kg every 8 hours since this was the second week of this child, according to an article by Drugs.com in April 2019. This was administered from the day of admission to day 3.
The resident pediatrician was contacted to come and see the baby on day 2 and upon further investigations, the baby was said to have made improvements as even the skin discoloration was subsiding. However, the invasive ventilator was still used for the baby.
* CHRONOLOGICAL COURSE OF TREATMENT
Admission Day
Vital signs
* Temperature- 34⁰c, Pulse-98, Rate-20, Blood pressure-84/ 50, spO2- 97
* Auscultation and chest physical exam
* The chest was clear and normal heart rate.
* Ventilator setting at rate 40 with PIP at 20
Day 1
Vital signs
* Temperature- 32⁰c, Pulse-96, Rate-20, Blood pressure-82/ 45, spO2- 98
* Auscultation and chest physical exam
* The chest was clear and normal heart rate
* Ventilator settings at rate 42 with PIP at 20
Day 2
* Vital signs
* Temperature- 36⁰c, Pulse-90, Rate-18, Blood pressure-80/ 50, spO2- 98
* Auscultation and chest physical exam
* Murmurs in the chest and normal heart rate
* Ventilator settings at rate 43 with PIP at 20
Day 3
Vital signs
* Temperature- 34⁰c, Pulse-98, Rate-20, Blood pressure-84/ 50, spO2- 97
* Auscultation and chest physical exam
* The chest was clear and normal heart rate
* Ventilator settings at