佛教大林慈濟醫院會議紀錄表

_PICU+NOR_出院準備服務個案討論記錄單

開會日期

　105年 03月 29 日

開會地點

　PICU討論室

開會時間

　1630-1730

記錄

吳怡青

報 告 者

吳怡青

指導者

　楊束玲/張守治

參與人員：

個案

基本資料

PICU-3

謝O如之男

105000**

入院日期

105年01月21日

住院天數

9天

主治醫師

張守治

主護護士

王思潔

診斷

Thrombocytopenia

個案類別：□14天再入院□住院超過30天者□超過合理住院天數■跨專業醫療人員討論■值得專業借鏡學習

其他

主要問題：■疾病因素□心理因素□經濟因素□家庭因素□環境因素□法律因素□機構因素□其他

現況說明：

This newborn was delivered to a G2P1 mother with GA:39+5 wks, BBW: 2980 gm, A/S:7-->9, via NSD. His mother received regular prenatal examination at our OBS-GYN. She had prenatal examination last 01/19 and pregnancy-induced hypertension was diagnosed. There was no complications during pregnancy.

At birth meconium stain 2+, bradycardia were noted. We was called for standy by. Vigorous crying and nasal flarring were noted. Then he was admitted to PICU for further evaluation and workup.

After admission, Nasal CPAP was temporarily used for tachypnea. Ampicillin + gentamicin were given. Initial laboratory data showed low platelet counts (35000-38000/ul on admission day), as well as low K+ value (2.5 meq/L, first data and checked on day 2 morning). Serial platelet and potassium levels were monitored. The K was normal later. The mother did not have SLE, ITP, thrombocytopenia, ecchymosis, or hypokalemia.

Due to persistent thrombocytopenia, IVIG (1 g/kg/day from day 2 and used for 2 days), steroid (prednisolone 2 mg/kg/day from day 2 to now) and platelet transfusion for 2 times (1/23 and 1/26) were administered. These provided transient improvement on platelet count. Brain echo revealed no IVH. She was regularly fed with infant formula. Feeding and activity were within normal limits. There was no obvious bleeding tendency symptoms. Follow up of CBC and platelet revealed persistent thrombocytopenia as well as decreasing Hb.

We suggested transfer to medical center and the parents decided to transfer to 彰基 for further care. Due to low platelet count and risk of bleeding, extreme care is advised to the parents during transfer to another hospital.

討論內容：

1.先天性血小板低下的原因為何?何者為高危險群?

2.先天性血小板低下在臨床上的治療與處置?後續追蹤?

3.先天性血小板低下在臨床上的照護重點?

4.住院中曾建議個案轉院,但家屬拒絕,直至1/29個案經治療後血小板仍未上升才同意轉彰基,假設家屬最後仍堅持拒絕轉院，我們可以強制轉院嗎?是否需簽署同意書?是否會有醫療爭議?

個案殘留問題: 無