In the setting of a neonatal intensive care unit, we are often presented with infants who have experienced a difficulty in utero and/or transition to extrauterine life. These vulnerable infants are more susceptible to health challenges as they develop and require specialized care and support to promote optimal health. In this paper, we will examine a case study of a child Billy, born at 32 weeks, and look deeper into the influences of his early life evaluating what challenges he may encounter.

Billy
In Billy’s case, we come to know that he is the fourth child to mother Michelle, who states that she smoked and drank heavily prior to knowing she was pregnant. She received prenatal care for the last two months of her pregnancy and was found to have a positive diabetes screen and her GBS was negative. Michelle is known to have inadequate living conditions with a history of violence in the home and her three other children are in the care of the ministry. At 32weeks +4 days of her pregnancy, Michelle’s membranes rupture at home. Upon arrival to the hospital, the fetal heart tracing is seen to have low variability and decelerations so Billy is delivered via emergency cesarean section. Weighing only 2260g, but classified as large for gestational age (LGA) Billy is born with APGARS of 6 at one minute and nine at five minutes. There was an initial low blood pressure 43/26 and oxygen saturation of 70%. Five minutes after birth, Billy began to show signs of respiratory distress and thus required some intermittent positive pressure ventilation (IPPV). He was then transitioned to CPAP with 30% oxygen. Billy was transported to a higher level of care facility where he received an IV of D10W for an initial blood sugar reading of 1.7, as well as a bolus of Normal Saline for his low BP and antibiotics. His mum joined him there the following day, and the decision was made not to breastfeed.

Fetal Growth and Development
The prenatal environment p...