FIMR Project Area: AL7

Case Summary # 1

FIMR Project Area: AL7 FIMR ID: AL700

FIMR Case #: AL700

Case Type Type Death : Infant Gender: male Age unit: days Days baby lived: 19 Primary Cause of Death: SIDS Cause of death: SIDS

Info Sources General Completeness of Records: Adequate Sources of Information CMS EMS Hospital records Prenatal Care provider Vital Stats Issues EMS Hospital records

Maternal Interview Maternal Interview Declined Type Contact: Letter Type Contact: Phone Type Contact: Phone

Notes Information obtained from prenatal care provider, care coordination record, hospital record, pediatrician’s office record, EMS record and ER records. Program card sent and returned. Follow-up phone call X 2. Spoke with patient by phone and patient declined maternal interview. No documentation of sleep position noted in EMS or hospital death record.

Parental Demographics Mother’s Race: black or African American Hispanic/haitian: Not applicable Marital Status: Single Age at delivery: 21 Education: College no degree Father’s Race: Black of African American Hispanic/Haitian: Not Applicable Marital Status: Single Age at delivery: 22 Education: College no degree

Psychosocial Overview Life Course Perspective Mother was in foster care from age 10-12. Income Employment Household Info- No Info Mom’s Employment – Student Dad’s Employment – Student Housing House Transportation Owns car Financial Assistance Prior to Pregnancy Family members WIC Received Referrals/ Assistance with WIC Social Support Church members Family members Father of baby Friends Home Visitor

Violence/Abuse No issues

Payment of care Prenatal: Medicaid HMO Labor and delivery: Medicaid HMO Pediatric: Traditional Medicaid Reimbursement Issues No Issues

Notes Mother lives at home with her mother and siblings. Has been in relationship with father of baby for several years. Both are third year college students. Record indicate strong family support and clergy support. Home visit completed by care coordinator. Mom’s Medical History Dental/gum infection: wisdom teeth extraction Gastrointestinal condition: cholecystectomy Other: repair of broken nose Mom’s OB History Pregnancy History # children – 0 # live births – 0 # SABS/IUFDs/TOPS – 0 FAMILY Planning Gravida – 1 Intention of pregnancy – unplanned

Pregnancy Prenatal Care Provider – OB Week entered prenatal care : 9 # Visits – 15 Initial PN labs 9 weeks 3 days AB0 – AB + negative AB screen Hemoglobin and hematocrit: Hgb 10.2 Hct 32.8 Hepatitis B – negative HIV – negative PAP – WNL Rubella – Immune Syphilis – RPR nonreactive Vaginal Culture – GC negative, Chlamydia negative Routine second Trimester Labs Declined AFP/triple/Quad screen Labs 2 nd and third trimester 28 weeks and three days 3 hour GTT 86, 139, 153, 124 31 weeks 24 hour urine details: 332 gm protein

Fetal Assessment 10 weeks 0 days Office ultrasound + cardiac activity estimate dates 19 weeks 2 days Office ultrasound + cardiac activity Fetal anatomy WNL

Mom’s Weight & BMI Pregravid weight (lbs); 205 Height – 5 feet 5 inches Total inches 65 BMI – 34.1 BMI ranking – obese Weight at delivery: 213 Weight change: 8 Weight gain result: inadequate

Substance Abuse Smokes < 1 ppd

Conditions During pregnancy Hypertension (pregnancy induced) Obesity

Education during pregnancy Common discomforts/relief measures Complications/danger signs Signs/symptoms of genitourinary infection Signs/symptoms preterm labor Signs/ Symptoms ruptured membranes Signs and symptoms that should be reported immediately Who to call after hours and weekends Bedrest and PIH symptoms

Prenatal Care notes Patient entered prenatal at 9 weeks gestation. Initial labs values were WNL. Pt developed increased in blood pressure and was placed on bedrest at 30 weeks gestation. Patient was admitted at 35.1 weeks gestation for bedrest observation due to increase in BP with headache and visual spotting.

Admission Admission Information Gestation 35 weeks 1 day Level of hospital: B Temp – 98.5 Pulse 81 Resp 18 BP 150/100 Presenting Symptoms and Previous Treatments: Increased BP with headache and spots in vision. Admission Reason: Hypertension Admission Findings Membranes Intact Vaginal Exam 1/50/-2 Contractions – none Fetal heart rate – 140’s Labs ordered on admission ABO – AB+ negative antibody screen SGOT – 28 WBC 8.1 Hgb 10.4 Hct 30.7 Platelets 256 Group B strep negative 24 hour urine – protein 360 creatinine cl 138 Urine C & S lactobacillus Notes Patient admitted from MD office for increase blood pressure. Daily NST and monitoring of BP continued for 6 days. Pt to be induced at 36 weeks. Cervidil placed at 1700 on 4/3/11. Magnesium started at 1720 at 2 gm/hour. In the am on 4/4 Ve 3/80/0. Amniotomy performed with clear fluid. Pitocin augmentation started and labor lasted 6 hours.

Delivery Gestation 36 weeks Delivery method – spontaneous vaginal Person delivering baby – OB Support person with mother in L & D – father of baby Notes: patient pushed for about 20 minutes. Infant delivered OP over 2 degree MLE. Placenta expressed intact. Epidural anesthesia. 3 vessel cord. Patient remained on magnesium sulfate

Placenta Pathology No info

Postpartum Care Patient remained on Mgso4 and was discontinued 4 hours after delivery. BP remained elevated and patient was placed on Procardia XL 60 mg daily and was discharged on medication. Duration of PP stay – 3 days Family Planning – Depo Provera Postpartum teaching Family planning/birth spacing Fluid intake Medications PP self care Return to work Vaginal rest warning signs of when to call doctor

Ambulatory Postpartum care Postpartum Appointment 6 weeks kept Weight 188 Blood pressure 122/72 Depo provera injection given UA negative Hct 30

Newborn Assessment Birth Weight 6 pounds 10 ounces 3005 grams APGAR 8 at 1 min 9 at 5 minutes Description of Baby at delivery: Alert, pink spontaneous respirations Crown-Heel Length: 47 cm Head circumference : 33 cm Stimulation at birth no issues blue bulb suction Temp 97.2 Heart rate 148 Respiratory rate 48 BP 65/42

Notes: Infant discharged at 48 hours. Infant breastfeeding well. Discharge weight 6-12. NBS normal. Hearing Screen passed.

Discharge teaching Back to sleep Bathing Breastfeeding education support Care of circumcision Care seat safety Cord care Infant care Infant safety Medical follow-up Recognizing illness/complication Safe sleeping Signs/symptoms requiring immediate attention Voiding/stooling Weight gain Well-baby care

Ambulatory Pediatric Care Provider Type – Pediatrician Number of well baby visits – 1 Infant seen in pediatrician office at 2 weeks. Weight 7 -10 temp 97.6 HR 124 Resp 32 Head circ 34.5 Length 48 cm. Mild hip click felt U/S obtained normal

ER hospitalizations Reason for Visit Full arrest unresponsive. Father found baby unresponsive. Father had laid down to rest two hours prior. No evidence of trauma. No spontaneous respirations. No pulse. Abdomen distended. Pupils fixed and dilated.

Death in hospital Father laid down to rest approximately 2 hours later woke up and found the baby unresponsive. Father called 911. Infant was in full arrest and unresponsive. No evidence of trauma. No spontaneous respirations and no pulse. Pupils fixed and dilated. Abdomen distend. Entubated with 2.5 ETT. IV started in R arm. NG tube placed with significant aspirate noted. CXR confirmed NG tube placement. X ray report shows increase opacity in right upper lung field. Epinephrine given at 1715, 1730 and 1745. NS boluses given. Infant was then pronounced. No documentation of sleep position noted in ER record on EMS record.

No scene investigation or autopsy performed.