history of present illness: baby girl is the former 2.310 kg product of a 34 and week gestation pregnancy born to a 36 year-old, g2, p0 now 1 woman. prenatal screens: blood type a negative, antibody negative, rubella immune, rpr nonreactive. hepatitis b surface antigen negative. group beta strep status unknown. the pregnancy was uncomplicated. the mother has prior surgical history of breast reduction. she presented in labor with rupture of membranes and was found to be 5 cm dilated. she progressed to a spontaneou8s vaginal delivery. infant emerged vigorous with good cry. apgars were 9 at 1 minute and 9 at 5 minutes. she was admitted to the nicu for treatment of prematurity. there was antepartum, antibiotic treatment for 1 hour prior to delivery. mother was afebrile and there were no other symptoms of chorioamnionitis. anthropometric measurements upon admission to the neonatal intensive care unit: weight was 2.310 kg, 50th percentile. length 45 cm, head circumference 31.5 cm, both 25th to 50th percentile. physical examination: upon discharge, weight was 2.215 kg. general: non distressed infant, pink in room air. skin warm and dry. pink, well perfused, no rashes or lesions. heent: anterior fontanel open and level. sutures apposed. chest: breath sounds clear and equal, easy respirations. cardiovascular: regular rate and rhythm, no murmur. normal s1 and s2. femoral pulses +2. abdomen soft, nontender, nondistended, no masses, positive bowel sounds. cord on and drying. genitourinary: normal appearing female, external genitalia. musculoskeletal: spine straight, intact sacrum. hips stable, moving all well. neuro: awake and alert, moving all extremities. symmetric tone and reflexes. hospital course by systems: including pertinent laboratory data: system 1: respiratory: this infant has been in room air for her entire neonatal intensive care unit admission. she has not had any spontaneous episodes of apnea and bradycardia. system 2: cardiovascular: this infant has maintained normal heart rates and blood pressures. no murmurs have been noted. baseline heart rate is 120 to 140 beats per minute with a recent blood pressure of 69/44 mmhg. mean arterial pressure of 51 mmhg. system 3: fluids, electrolytes and nutrition: this infant has been ad lib p.o. feeding and breast feeding since admission. her mother is status post breast reduction surgery and is planning to supplement as needed. the infant has been taking 100 to 130 ml/kg per day, breast milk or enfamil 20 formula. weight on the day of discharge is 2.215 kg. system 4: infectious disease: due to the unknown etiology of the preterm labor and the unknown group beta strep status of her mother, this infant was evaluated for sepsis upon admission to the neonatal intensive care unit. a white blood cell count and differential were within normal limits. a blood culture was obtained prior to starting iv ampicillin and gentamycin. blood culture was no growth at 48 hours and the antibiotics were discontinued. system 5: hematologic. this infant is blood type a positive and is direct antibody test negative. hematocrit at birth was 46.8%. system 6: gastrointestinal. peak serum bilirubin occurred on day of life #4, total of 8.6 mg/dl. this bilirubin was repeated on day of life 5 and was 8.5 mg/dl. system 7: neurology. this infant has maintained a normal neurologic examination during admission. there were no neurologic concerns at the time of discharge. system 8: sensory. audiology: hearing screening was performed with automated auditory brain stem responses. this infant passed in both ears on . condition on discharge: good. discharge disposition: home with the parents. primary pediatrician: dr. pediatrics incorporated, , , ma, telephone number . care and recommendations: 1. ad lib feeding, breast feeding or expressed breast milk or enfamil 20 calories per ounce formula ad lib. 2. no medications. 3. iron and vitamin d supplementation: iron supplementation is recommended for preterm and low birth weight infants until 12 months corrected age. all infants fed predominantly breast milk should receive vitamin d supplementation at 200 i.u. (may be provided as a multi-vitamin preparation) daily until 12 months corrected age. 4. car seat position screening was performed: this infant was observed in her car seat for 90 minutes without any episodes of bradycardia or oxygen desaturation. 5. state newborn screen was sent on . there has been no notification of abnormal results to date. 6. immunizations: hepatitis b vaccination was administered on . 1. immunizations recommended: synagis rsv prophylaxis should be considered from through for infants who meet any of the following four criteria: (1) born at less than 32 weeks; (2) born between 32 weeks and 35 weeks with two of the following: day care during rsv season, a smoker in the household, neuromuscular disease, airway abnormalities or school age siblings; (3) chronic lung disease or (4) hemodynamically significant congenital heart disease. influenza immunization is recommended annually in the fall for all infants once they reach 6 months of age. before this age, and for the first 24 months of the child's life, immunization against influenza is recommended for household contacts and out-of-home caregivers. this infant has not received rota virus vaccine. the american academy of pediatrics recommends initial vaccination of preterm infants at or following discharge from the hospital if they are clinically stable or at least 6 weeks but fewer than 12 weeks of age. followup: appointment with dr. within 3 days of discharge. discharge diagnoses: 1. prematurity at 34 and 6/7 weeks gestation. 2. suspicion for sepsis ruled out. , m.d. Procedure: Prophylactic administration of vaccine against other diseases Diagnoses: Need for prophylactic vaccination and inoculation against viral hepatitis Single liveborn, born in hospital, delivered without mention of cesarean section Other preterm infants, 2,000-2,499 grams 33-34 completed weeks of gestation