He continues on intravenous fluids and is still ventilated. During your shift he has a low blood pressure, but this improves with two small fluid boluses of 10 ml/kg of 0.9% NaCl. His nurses check his blood glucose and find that it is 3.2 mmol/L.

Ventilation is increased overnight because his blood CO₂ is above normal, and he continues to need 30-40% oxygen.

He is reexamined at 6 hours of age:

Respiratory: RR 30/min, no recession, some spontaneous respiration. SaO₂ 95% in 40% oxygen.
Cardiovascular: HR 145/min, warm and well perfused BP 85/35 mmHg, Heart sounds normal, no added sounds.

Neurological: He is settled and comfortable on the ventilator.

Initial blood results are now back:

Hb       193 g/L

Wcc    21 x 10⁹/L

Plats    120 x 10⁹/L

Urea    3.2 mmol/L

Na       134 mmol/L

K          4.2 mmol/L

Creat   57  micromol/L

You are thanked at the end of your shift and leave the unit.

You return the following night and are pleased to see Baby Barton is doing well.

He is still on his antibiotics, and is still ventilated, but with reduced pressures and oxygen requirements. The team are hoping to take him off the ventilator in the morning to allow him to breathe independently.

The team have started feeds for him and these are tolerated well.

The blood cultures have not shown any bacterial growth.

After a few days you return to the NICU and find that baby Barton is now called Dominic (Dom for short). He is now 10 days old and has made excellent progress.

He is now off the ventilator and supplemental oxygen altogether. He is being fed by nasogastric tube and beginning to put on weight. He has been taken out of the incubator for cuddles with his parents. His antibiotics have been stopped after seven days.

You are asked to see him as he has been having some episodes of desaturation.

He is examined:

Respiratory: RR 50/min, mild recession, equal chest movement. Some fine inspiratory crackles in all areas. No grunting. SaO₂ 92% in 35% oxygen.
Cardiovascular: HR 165/min, good capillary refill time. Bounding pulses and easy to feel femoral arteries. BP 85/30, Heart sounds normal, with a systolic murmur heard under the left clavicle.

Abdominal: Full, but soft on palpation, liver edge palpable at 4cm below costal margin, no other organs felt.

Neurological: Active and alert, moving all limbs. Anterior fontanelle soft.

You request a chest radiograph and some blood tests.

 CXR 2

Hb       135 g/L

Wcc    9.1 x 10⁹/L

Plats    410 x 10⁹/L

Urea    1.9 mmol/L

Na       137 mmol/L

K          4.7 mmol/L

Creat   39  micromol/L