Site Evaluator: Gary Maida, PA-C
During my site evaluations, I presented two cases, ten drug cards, and one article relevant to one of my cases. First, I presented a 10-year-old girl who came in complaining of constipation and UTI symptoms. After taking a thorough history and investigating imaging, the emergency department attending decided it would be best to transfer this patient to another NYC HHC facility for an ultrasound to rule out appendicitis. This case was interesting as it did not present with the typical “exam” presentation that one would expect. Professor Maida was impressed that this child has never had an extensive workup before, after I had mentioned that this child has presented to the emergency department twice in the past for the exact same symptoms. Our discussion emphasized not letting a previous diagnosis give you tunnel vision with your current patient, no matter how simple the diagnosis may seem.
Because the fourth week of the rotation was spent in the neonatal ICU, I presented my second case on a 27-week-old born to a 43-year-old mother with a history of two miscarriages, T2DM, and hypertension throughout her pregnancy. The baby was taken to the NICU where we inserted an umbilical venous catheter and briefly intubated them for surfactant administration. The baby was also seen to have transient episodes of apnea, so we gave a caffeine dose to reduce the incidence of bronchopulmonary dysplasia.
Because I had never heard of this caffeine treatment, my article was an 11-year follow-up study to the Caffeine for Apnea of Prematurity trial published in 2006. The original RCT found that caffeine citrate therapy for apnea of prematurity reduces the rates of bronchopulmonary dysplasia, severe retinopathy, and neurodevelopmental disability at 18 months and may improve motor function at 5 years. This follow-up study was conducted to evaluate whether enrollment in that original therapy is associated with improved functional outcomes 11 years later.