What is her Weight-for-Age percentile
What is her Weight-for-Age percentile? What is her Length-for-Age percentile? What is her Head circumference-for-Age percentile? See Figures 22.2 and 22.3 to help complete this question. (3 points) 4. What prenatal factors could have contributed to Quinn’s IUGR? (2 points) Case Study Revisited Quinn is now 24 hours old, DOL1. The neonatology team has asked you to provide recommendations for starting and advancing PN for Quinn. Her current labs are: Biochemical Data: Sodium 143 (127-143 mEq/L) Potassium 5.1 (3.5-5.0 mEq/L) Chloride 113 (98-110 mEq/L) Carbon dioxide 18 (20-30 mEq/L) Blood urea nitrogen 25 (5-17 mg/dL) Creatinine 0.55 (0.4-1.3 mg/dL) Glucose 70 (70-139 mg/dL) Clinical Data: Urine output: 4 mL/kg/hour Questions 1. The plan is to start Quinn on parenteral nutrition. What are Quinn’s estimated energy needs (kcal/kg/day) based on birth weight? Calculate her needs based on birth weight. (3 points) 2. What glucose infusion rate (GIR) would you provide and how much protein and fat (in g/kg/day) would you put in her initial PN? Calculate how much glucose, protein and fat she would be provided based on birth weight. (6 points)
Assignment 14: NICU Case Study A baby girl (Quinn) was born at 30 5/7 weeks gestational age to a 28-year-old mother with 1 other child (G2P2). The pregnancy was complicated by preeclampsia, placental insufficiency, and oligohydramnios (insufficient amniotic fluid). The mother’s obstetrician had been monitoring the pregnancy closely because Quinn was diagnosed with intrauterine growth restriction (IUGR) at 27 weeks gestation. Quinn was born via induced vaginal delivery due to her mother’s worsening preeclampsia and Quinn’s IUGR status. She admitted to the neonatal intensive care unit (NICU) on her day of birth or day of life 0 (DOL 0). Anthropometric Data: Birth Anthropometrics: Length: 36 cm Weight: 965 g (0.965 kg) Head circumference: 27 cm Clinical Data: Past Medical History: none Medications: D10W with heparin @ 80 mL/kg/day Vitals: Blood pressure: 54/33 mmHg, Temperature: 97.7 F, Heart rate: 122 beats/min Nutrition-focused Physical Exam: Overall appearance: Infant is in no acute distress, laying supine in an incubator. Continuous positive airway pressure (CPAP) in place (Figure 22.1). Moves extremities symmetrically. Palate intact, abdomen soft, not distended. Patent anus. Anterior fontanelles are open, soft, and flat. No dysmorphic features. Alert, active, normal tone for gestational age (GA). Pink skin, no rash, no petechiae noted. Dietary Data: Diet Prescription: NPO Questions 1. How would you assess Quinn’s weight at birth? Is she ELBW, VLBW, or LBW? (1 point) 2. How would you describe her growth? Is she SGA, AGA, or LGA? (1 point)
3. At what rate would you advance each of these macronutrients? (3 points) 4. What glucose, protein, and fat amounts (in g/kg/day) would recommend for Quinn’s final goal PN? Calculate her final goals based on birth weight. (6 points) 5. Considering Quinn’s GA, labs, and urine output as a reflection of her postnatal diuresis, what are Quinn’s fluid requirements? Calculate her final fluid goal based on birth weight. (2 points) 6. How would you recommend her fluid intake from PN be advanced? (2 points) 7. How would you describe her electrolytes? (1 point) 8. Which electrolytes would you monitor closely? (2 points) 9. After Quinn meets her PN goals, how would you recommend her progression to oral feeding? (3 points)
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