■ 1:00 PM
One of the nurses pages me that another one of my patients, a 10-day-old, 24-week preemie, has worsening blood gas results compared to her previous numbers. This baby was transferred to CHOP a couple of days ago for an intestinal perforation after receiving indomethacin to treat her patent ductus arteriosus (PDA). The PDA needs to be treated if it is causing an overcirculation of blood to the lungs. I go to the patient's bedside, increase her ventilator settings, and order a STAT chest radiography. The radiograph shows that her endotracheal tube is a little high, so it is adjusted and retaped. A follow-up blood gas with the adjusted endotracheal tube and increased ventilator settings shows improvement.
■ 2:00 PM
Baby M's nurse lets me know that my patient is back from her upper GI study. Thankfully, Baby M's G-tube is in the correct position and there is no leak. The surgical team is notified. Baby M will stay on antibiotics for a 48-hour septic rule-out.
■ 2:30 PM
I order the rapid-sequence medications that will be given to Baby C prior to intubating her for eye surgery. We try to intubate a baby a couple of hours before surgery to allow time to make any necessary adjustments to the endotracheal tube and ventilator settings. When the nurse and respiratory therapist are ready, I go to Baby C's bedside to intubate her. There are no complications; a chest radiograph will be done to confirm the placement of the endotracheal tube. Baby C is placed on the ventilator and will have a blood gas drawn to make sure she is stable on the current settings. Her surgery will start early this evening at her bedside. The frontline clinician on call for our team will be there during the surgery and will sedate Baby C. The surgery can take 1 to 2 hours when both eyes need to be done, as is the case for this baby.
■ 3:15 PM
When I call to let Baby C's nurse know that the endotracheal tube is in good position, she reads me the blood gas results. They are good—no ventilator adjustments are necessary. I update the summaries for two of my patients who will likely be discharged home in the next couple of days.
■ 4:00 PM
The overnight frontline clinician comes in, and I give her sign-out on each of my patients, including any labs for tonight and the following morning.
■ 4:30 PM
Baby S's nurse pages me. The patient's parents have arrived and would like an update. I talk to the parents about the barium swallow requested by the speech therapist. I will call them tomorrow when I know the scheduled time for the study.
■ 5:00 PM
I leave the hospital and turn off my pager. Days like these seem to go by quickly and can be draining at times. As with any other area of medicine, there is a constant learning curve. Even though the NICU can take an emotional toll on all involved, the best reward is seeing a baby get better and go home. JAAPA
Shana Perman works in the Division of Neonatology at the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania in Philadelphia. She has indicated no relationships to disclose relating to the content of this article.