Cara is a 9-month old infant delivered by C-section at 28 weeks gestation second

Question

Cara is a 9-month old infant delivered by C-section at 28 weeks gestation secondary to premature rupture of the amnioticmembranes. She weighed 1.1 kg at birth and required mechanical ventilation at birth until she was 5 months of age. Currently she still requires 38% oxygen by tracheostomy collar to maintain her O2 saturations greater than 92%. Currently she weighs 4.9 kg and receives gastrostomy feedings of 80 mL every 4 hours (given over 2 hours via infusion pump) as a result of severe GER. Prior to her daytime feedings she receives metoclopramide 0.5 mg per gastric tube. She requires trach suctioning approximately every two hours for thick yellow secretions. She is given an Albuterol inhaler every 4 hours and ipratropium inhaler every 8 hours. She also receives an iron supplement. Before being discharged from the hospital at 7 months old she was diagnosed with bronchopulmonarydysplasia (BPD) into the care of her parents, Carolyn and Josh. She also has a 4 yobrother, Alex, at home.

Cara was brought to the hospital yesterday following a call from her mother stating that she had been experiencing respiratory distress at home. Her mother is reported by the nurse to be very involved with the care insisting on doing all the care including g-tube feedings and trach care/ suctioning. The staff reports that the care is appropriate but that mother Carolyn appears very tired. She leaves only long enough to get a cup of coffee and a snack twice a day. Questions are appropriate and she spends all day holding and caring for Cara.

Explanation / Answer

Q1) What is the purpose of the prescribed metoclopramide? Is the current dose safe? What is the purpose of each of the inhalers? What further, if any medications and /or treatments would you want to see prescribed?

The metoclopramide is a dopamine antagonist and acts on the chemoreceptor trigger zone result in prevention of nausea and gastrointestinal reflux in infants. The safe dose for above infant (Cara) is according to her weight i.e. 0.1-0.2 mg/kg PO/IM/IV as she has Gastro esophageal reflux disorder (GERD) or acid indigestion is a physiological abnormality in which the acidic contents of stomach reflex into esophagus. The causes of GERD include weakened lower esophageal sphincter, impaired acid clearance in the stomach due to unhealthy food habits and pregnancy. Heart burn and acid indigestion are the common symptoms of GERD. Proton pump inhibitors (PPIs) are the antacids used in the treatment of GERD

Q2) What further assessments are needed of Cara’s current condition?

Renal and hepatic functions should be monitored & assessed. Currently she weighs 4.9 kg and receives gastrostomy feedings of 80 mL every 4 hours (given over 2 hours via infusion pump) as a result of severe GER. Prior to her daytime feedings she receives metoclopramide 0.5 mg per gastric tube

Q3) What is the pathophysiology of BPD? Include treatments and potential complications

Bronchopulmonary dysplasia is most common in infants with low-birth weight result in respiratory distress due to improper lung function. The oxygen ventilation is essential with bronchodilators (albuterol). Sometimes steroidal therapy is also essential

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