Mother-Neonatal Intensive Care Unit - A New Model Of Family Participatory Care?

A male neonate was born at the gestational age of 30 weeks by emergency cesarean section due to maternal hypertensive disorders of pregnancy. The patient’s body weight and length were 1361 g (–0.80 SD) and 40.0 cm (–0.03 SD), respectively. His Apgar scores were 3, 5, and 8 at 1, 5, and 10 minutes after birth, respectively. After resuscitation, including intubation, he was admitted to the neonatal intensive care unit (NICU). Echocardiography revealed no structural abnormality. After administration of indomethacin for eight times from the 1st to 23rd days, the ductus arteriosus became narrower and asymptomatic. On day 13, the first extubation was performed. Soon after extubation, a recurrent attack of bradycardia with a heart rate of 50 to 80/min was observed, which required re-intubation and mechanical ventilation. Holter electrocardiography (ECG) performed on day 17 showed that an escaped rhythm occurred for 0.7% of the total 24 recorded hours, leading to the diagnosis of SSS. Enteral administration of procaterol via gastric tube with a dose of 0.65 μg/kg for three times/day was initiated on day 21. The frequency of bradycardia reduced, and the minimum heart rate increased above 90 beats/min, whereas his heart rate at rest was elevated to 180–190 beats/min soon after initiating procaterol. Therefore, procaterol was adjusted to 0.65 μg/kg/dose for two times/day on the 22nd day. From the 34th day, procaterol was increased to 1 μg/kg/ dose for two times/day for prevention of bradycardia after re-extubation. Holter ECG performed on day 34 showed disappearance of the escape rhythm, and the patient was successfully extubated on day 38. He is now 6 months of age, and the procaterol therapy has been continued after the discharge. SSS is well controlled and pacemaker implantation was not required.