Amarma Case Studies

Part A:

From the handover received from neonatal registrar, it can be assumed that baby Amira is in respiratory distress. Amira is currently receiving 30% flow-by oxygen at 10 minutes old to maintain oxygen saturation (Sa02) levels of 92%. Although the target Sa02 level at 10 minutes old is between 85-90% (Department of Health and Human Services, 2014) the fact that Amira is still displaying signs of nasal flaring and moderate work of breathing despite receiving flow-by oxygen is concerning. After conducting a brief initial top to toe assessment, weight and length, Amira should be transferred to an incubator for further vital signs, monitoring and observation of her breathing. Amira’s temperature of 35.9°C is also classified as moderately
It is recommended that midwives test Amira’s BSL using a blood gas machine or ISTAT device for immediate results so action to be taken accordingly (SAMNCN 2013). It is expected that her BSL will be low as her temperature is low; she would likely be using non-shivering thermogenesis to keep warm. Non-shivering thermogenesis requires energy (glucose) to metabolise brown fat for heat production, thus lowering her BSL (John Hunter Children’s Hospital, 2015). If Amira’s BSL is below 2.0mmol the 2013 South Australia Perinatal Practice Guidelines algorithm for hypoglycaemia suggests starting a 10% glucose infusion at 60mL/kg/day if in respiratory distress (SAMNCN 2013). This would be the appropriate treatment if Amira’s BSL was low until her work of breathing and oxygen saturations stabilised enough to attempt a breastfeed or artificial feeding, whichever the parents decide.

The importance of documentation should not be overlooked during the care given to baby Amira. It is the responsibility of midwife admitting Amira to SCBU to write an admission note and complete the required admission paperwork. The admission note should follow the ISBAR mnemonic and include a plan or recommendation for the care of
It is therefore important to provide reassurance and communication with the family members around and assure them you will explain everything as soon as the baby is stable (Women’s and Children’s Health Network 2015). In Amira’s situation her father, Hassan, has accompanied her during the transfer to SCBU so it is important to involve him in the care as much as practical and maintain continuous communication (Women’s and Children’s Health Network 2015). When time permits, it can be useful to use supplemental verbal and visual materials to aid in successful communication, visual aids can be especially helpful when there is a language barrier (Meeks, M, et al., 2013). Hassan should be encouraged to ask questions by the midwives caring for Amira if he is unsure about anything such as procedures or the plan for Amira’s care (Women’s and Children’s Health Network