Neonatal follow up clinic

You are the doctor running the neonatal follow up clinic. Your next patient is Davina, a baby girl now three weeks old. You review the notes to find out why she has been given an appointment in your clinic.

Pregnancy: Planned pregnancy, some mild bleeding at 18 weeks, settled with no specific intervention.
Early scans normal and anomaly scan normal.
Pregnancy induced hypertension.
Poor growth identified at 26 weeks and seen in antenatal clinic weekly since.
Abnormal Dopplers identified at 30 weeks.
Elective Caesarian at 35 weeks for poor growth, reversed dopplers

Birth: Infant born in good condition. No resuscitation needed.

Apgars: 8 at 1 minute, 10 at 5 minutes.

Auxology: weight 1.62 Kg, length 47 cm, head circumference 31.5 cm

Management: Early feeding with NGT and breast milk.
Feeding established at 7 days – breast.
No other interventions.

Discharge: Discharged home day 10 with parents. Weight 1.55 Kg. Medications – multivitamins.
Follow up – see in neonatal clinic at 2 weeks to review growth.

Davina is apparently doing well according to her parents. She is alert and interactive when awake. They think that she might be leaning to smile.

When asked specifically about the feeding, Davina is breast fed, and her mother says that this is going well, feeding for about 5 minutes before stopping. Feeding is quite painful for her mother, and her nipples are a little cracked and have bled. Davina is also hungry a lot of the time, and wants to feed every 1-2 hours.

When asked about other aspects of her health, Davina rarely vomits at all and has normal consistency stool. She has no other health problems.

On examination, Davina is small and has very little subcutaneous fat. She is alert and does not look dysmorphic.

There are no abnormal cardiovascular or respiratory signs. Her abdomen is soft and a liver edge is felt 2 cm below the costal margin.

Genatalia are normal and there is no bruising.

She is again measured, and found to have a length of 45 cm, weight of 1.60 Kg and head circumference of 31.5cm.

When you ask about the pregnancy, Davina’s parents explain that it was the opposite of what they wanted. They had planned for a home birth with no pain relief, just them and a midwife. Instead, following intensive monitoring Davina was born by Caesarian. Although they are grateful for their beautiful daughter, they wonder if it could have been done another way.

You agree to review the growth carefully over the next weeks, and to see Davina again the following week.

What else would you like to do?