Case in Progress
Amandalyn - 1
Amandalyn is an interesting story. When she arrived on February 5, she was four weeks early, and received a diagnosis of mild prematurity and transient fetal distress with respiratory distress. Upon discharge from the hospital she was referred to her local regional center.
At conception, Mother's overall health was generally good. This was Mother's first pregnancy. Prenatal care started at the end of the first month. Mother took prenatal vitamins and iron supplements. She had several urinary tract infections and was treated with antibiotics. Mother underwent an ultrasound and maternal serum AFP studies with normal findings. Mother began to undergo some premature labor, and a few days before the birth, mom had further ultrasounds and amniocentesis to determine that the patient had mature lungs.
When labor started there was a medical rupture of the membranes (the doctor broke the bag of waters) but it was determined that the baby had developed a prolapsed cord. Efforts were made to deliver the baby by vacuum extraction, but it was unsuccessful. The baby was delivered by emergency Caesarian section with the mother under general anesthesia. Her Apgar score was 3 at 1 minute and 5 at 5 minutes. Amandalyn weighed slightly over five pounds at birth, and she appeared to be the average gestational size for a 36 week gestation.
Initially there were concerns about Amandalyn's lack of spontaneous respirations. She was given stimulation and oxygen and had an endotracheal tube in place until February 8. A cerebral ultrasound on February 6 showed normal findings. She had one possible seizure so an EEG was performed, which showed some left central sharp waves. She was given phenobarbital for four days, and there were no further seizures. Amandalyn had spent over 2 weeks in the neonatal intensive care unit.
We began to provided services to Amandalyn and her mother on March 1. At that time she was assessed to have all of the pertinent newborn skills - her hands were loosely fisted, she was aware of her mother, she cried to get attention and when she was hungry and she would stick her own hands in her mouth to comfort herself. Amandalyn initially had some trouble nursing, and mom was working with a lactation consultant while supplementing feedings with formula.
One of the very first things we noticed about Amandalyn was her love of attention and social skills. She didn't want to miss a thing, and her mother had to be careful to provide a quiet environment so she would nap. Amandalyn quickly proceeded to have awake alert times but she was a good sleeper.
As we worked with Amandalyn and her mother on acquisition of skills and her growth and development, we noticed that Amandalyn was learning skills at both her corrected age and her chronological age. She began to move and communicate and explore her environment all right on time. It was becoming apparent that even with her rough start, Amandalyn was determined to catch up.
In the meantime we were able to work closely with her mother, who has some physical difficulties, on making Amandalyn's environment safe and healthy.
When Amandalyn turned six months old, we assessed her and discovered that she was age appropriate in all areas. We have every confidence that she would continue to develop right on time without additional services. We monitored her development for another six months, and she is doing just what she should be.
Amandalyn is a great example of an Early Start program being called to provide services for a child who was "at risk". It is our privilege to help Amandalyn get a little help in the beginning to making sure she had a good start to a happy life.
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