The Stramski Report : Morgan Edition

One Year Development Report.

STRAMSKI DEVELOPMENT CENTER
High Risk Infant Follow-up Team Report
DATE OF ASSESSMENT: April 4, 2008

This is the first team visit to the Stramski Center for Morgan Haas a former preterm infant, who is now 11 months, 20 days old with an adjusted age of 8 months, 5 days. Morgan was referred on discharge from the NICU at Miller Children’s Hospital. He is being followed by his pediatrician, Dr. Moser and will be seen later this month for his 9 month well child check. He was brought in by his parents, Deborah and Donald. History was taken from parents and a chart review.

Haas, Morgan DOB: 04/24/07
DEVELOPMENTAL HISTORY: Morgan was initially referred to Harbor Regional Center for developmental follow-up. However, due to transitions with service coordinators, there has not been a developmental evaluation completed or any monitoring. Parents do not have any specific concerns and feel Morgan is doing well for his corrected developmental age.

SLEEP HISTORY: Morgan sleeps from between 7 and 8 p.m. to 6 a.m. He takes 2 naps during the day for 1-2 hours each. He sleeps in a crib in his own room. He has an occasional light snore.

NUTRITION HISTORY: Morgan is taking 8 ounces of Enfamil lipil 4 times a day with added rice cereal for reflux symptoms. He is also taking some pureed fruits and vegetables. He tolerates his food well and has a good appetite. He uses a spoon with assistance.

REVIEW OF SYSTEMS: Denies allergies. Immunizations up-to-date. Elimination within normal limits with some increasing firmness due to rice cereal. Denies pain. He received synagis this season.

Remaining review of systems at baseline.

PHYSICAL EXAMINATION:
VITAL STATISTICS: Weight was 8.84 kilograms, 30th percentile. Height was 74 centimeters, 90`h percentile. Head circumference was 46 centimeters, 75th percentile. Percentiles adjusted for prematurity.

GENERAL: Morgan was in no acute distress and was alert and interactive with this examiner.

HEAD: Normocephalic Normal hair distribution. No lumps or bumps. Fontanels soft and flat. No overriding sutures.

ENT: Tympanic membranes clear. Ears were symmetrical and set at normal level. Nares were patent bilaterally. He had 4 teeth that appeared well-positioned.

OPHTHAMOLOGY: PERRLA. Positive red reflex. Visual pursuit was age appropriate.

RESPIRATORY: Clear to auscultation bilaterally. Equal lung expansion bilaterally.

CARDIOVASCULAR: Cap refill less than 3 seconds. Normal sinus rhythm. No rubs or gallop. No murmur.

ABDOMEN: Bowel sounds positive. Abdomen soft and without distention. No hepatosplenomegaly.

NEURODEVELOPMENT/MUSCULOSKELETAL: On exam, cranial nerves II-XII grossly intact. Slight resistance on PROM of major joints. He had down-going toes in axillary suspension with negative slip-through. DTR’s were normoactive and symmetrical. No fisting. Negative clonus. Visual pursuit was age-appropriate. Postural reflexes were present appropriately. No head lag on pull-to-sit. He was babbling and making appropriate social interactions.
The Bayley Scales of Infant and Toddler Development III were administered today by Liz Juarez, MPT.

He received the following age-equivalent scores: ‘¢ Cognition: 8 months
‘¢ Receptive Language: 7 months
‘¢ Expressive Language: 9 months
‘¢ Fine Motor: 7 months
‘¢ Gross Motor: 8 months

IMPRESSIONS: Morgan is an 8 month adjusted age ex-27 week premature infant. He is a very happy and pleasant baby who was easy to work with and showed good interaction with others. He is showing very mild delays in fine motor skills and receptive language skills (parental report). He has some increased muscle tone that is expected for a baby his gestational age. There were no major concerns. Exercises were given by PT to work on breaking up some of the high tone and toeing. Parents were receptive and open to education and practiced the exercises with PT.

PLAN:
1. Return to Stramski Developmental Center in 6 months for team visit.
2. Read developmental handouts and language worksheets.
3. Continue to encourage more floor time and tummy time.
4. No infant walkers or Johnny jumpers.
5. Call with any questions or concerns.

Melissa Frey; CPNP Pediatric Nurse Practitioner
Total time of consultation: 60 minutes