Abstract
A 1,563-g, 30 weeks' gestation female infant was delivered to a mother whose pregnancy was complicated by a history of herpes, without recent outbreaks, and a history of a treated urinary tract infection and pyelonephritis in the first trimester. She developed preterm labor and was started on magnesium sulfate and antenatal steroids. Labor was halted for a few days, but when it reoccurred the infant was delivered by C-section. Membranes were ruptured at delivery and the fluid was clear. Apgar scores were 6 and 8, at 1 and 5 minutes, respectively. The infant had poor respiratory effort and was intubated in the delivery room. The infant was admitted to the newborn intensive care unit (NICU) where she received one dose of surfactant replacement therapy and was placed on assisted ventilation. An evaluation for infection was done, and Ampicillin and Gentamicin were started. On day 2 the infant was extubated and placed on nasal continuous positive airway pressure. Antibiotics were discontinued on day 2 because the blood culture was negative and the infant was asymptomatic at that point except for some apneic episodes. A contingency order was written at the time of extubation for the nurses to start caffeine if the baby began having apnea. Plaintiff experts were critical of the contingency order and stated that the doctors needed to be informed about the development of any new symptoms the infant experienced, including apnea. Only then could the physicians make an appropriate decision about the need for an evaluation and potential intervention at that point in time. Although the intervention for caffeine could be appropriate, apnea of prematurity (AOP) is a diagnosis of exclusion and the physicians needed to be informed of its development. Several hours after extubation, the nurses started caffeine for the apnea. On day 4 the nasal continuous …
Published Version
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