CHIEF COMPLAINT: 

PRESENT ILLNESS: Baby [**Known firstname **] [**Known lastname **] was admitted on [**5-16**] at 35 days of age. He was transferred from [**Hospital1 **] NICU
for further management. He was born at 27 weeks to a 33-year-
old, G4, P2 mother with [**Name2 (NI) **] type O+, antibody negative,
hepatitis B surface antigen negative, RPR nonreactive, HIV
negative, GC negative, chlamydia negative. She had
spontaneous vaginal delivery at [**Hospital6 **] after
preterm labor.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other respiratory problems after birth,Neonatal jaundice associated with preterm delivery,Other specified cardiac dysrhythmias,Other specified disorders of biliary tract,Umbilical hernia without mention of obstruction or gangrene,Edema of male genital organs,Unspecified anomaly of gallbladder, bile ducts, and liver,Congenital hydrocele
Resp prob after brth NEC,Neonat jaund preterm del,Cardiac dysrhythmias NEC,Dis of biliary tract NEC,Umbilical hernia,Edema, male genital orgn,Biliary & liver anom NOS,Congenital hydrocele
Admission Date: [**2194-5-16**]        Discharge Date: [**2194-6-13**]

Date of Birth:  [**2194-4-11**]        Sex:  M

Service:  NB


HISTORY OF PRESENT ILLNESS:  Baby [**Known firstname **] [**Known lastname **] was admitted on [**5-16**] at 35 days of age. He was transferred from [**Hospital1 **] NICU
for further management. He was born at 27 weeks to a 33-year-
old, G4, P2 mother with [**Name2 (NI) **] type O+, antibody negative,
hepatitis B surface antigen negative, RPR nonreactive, HIV
negative, GC negative, chlamydia negative. She had
spontaneous vaginal delivery at [**Hospital6 **] after
preterm labor.

HOSPITAL COURSE AT [**Hospital6 **] WAS REMARKABLE FOR:
RESPIRATORY: Intubation and receipt of 2 doses of surfactant.
He was extubated to CPAP on the first day, then to nasal
cannula by day 2. CPAP was then changed to BIPAP, then SIMV
was started for apnea, as well as respiratory acidosis. He
was transferred to [**Hospital1 **] NICU on day 11 on pressure
support for further management of SVT.

CV: SVT developed on day 2. He was treated with adenosine and
later loaded with digoxin, which was subsequently discontinued.
He was started on esmolol on day 9. The echo showed no structural
defect and a tiny PDA.

FEN: He was made n.p.o. with [**Last Name (un) 37079**] drainage for dilated
loops. Creatinine was 1.1 on day 11.

ID: He was initially treated with amp and gent, and later
started on vancomycin, clindamycin, gentamicin because of
concerns for NEC. [**Last Name (un) **] culture grew gram-negative rods on day of
transfer to [**Hospital1 **].

NEURO: Head ultrasound was normal on day 11.

HOSPITAL COURSE AT [**Hospital1 **] NICU WAS NOTABLE FOR:
RESPIRATORY: He was extubated on [**5-2**] after caffeine load.
He was initially on CPAP and then transitioned to nasal
cannula. He was on low flow at 30 cc/min on the day of
transfer to [**Hospital3 **] NICU. The baseline for him was
intermittent desaturation episodes.

CV: He was briefly on a dopamine infusion. The echo at
[**Hospital1 **] showed a PFO. Esmolol was discontinued. The SVT
recurred on [**4-30**]. He responded to vagal maneuvers and
adenosine. He was then started on propranolol at 1.5 mg/kg/D
which was adjusted for weight. No further episodes of SVT
recurred. He was followed by the [**Hospital1 **] EP service.

ACCESS: The PICC line was removed on transfer to [**Hospital1 **].
His Broviac was placed on [**5-1**] and then discontinued on [**5-13**].

FEN: Bowel rest was instituted for 1 week. He was slowly
advanced on enteral feeds, and on transfer to [**Hospital3 **], he was
on breast milk 28 Calories with Neosure and MCT at 140
mL/kg/D. No p.o. feeding had been started prior to transfer
to [**Hospital3 **].

GI: GI issues were attributed to septic ileus. He had a normal
upper GI on [**4-24**]. A scrotal ultrasound was done on [**4-22**]
because of a left-sided mass which showed a left hydrocele. The
hydrocele was aspirated while at [**Hospital1 **] NICU. He also had
direct hyperbilirubinemia, which was thought to be secondary to
sepsis and PN cholestasis. His most recent bilirubin results
prior to transfer to [**Hospital3 **] on [**5-13**] was 4.2/3.2.

HEME: Multiple transfusions were given at [**Hospital1 2177**] and [**Hospital1 **].
The most recent hematocrit prior to transfer was 25. He was on
iron prior to transfer.

ID: [**Hospital1 **] cultures grew both Staph epi and E. coli. He was
treated with meropenem and vancomycin. He was treated for 14
days from the first negative [**Hospital1 **] culture on [**4-25**], and
LP on [**4-22**] was negative.

NEURO: Head ultrasound on [**5-1**] and [**5-13**] were normal.

SENSORY: Due for ROP exam at 6 weeks. No hearing screen yet.

HEALTHCARE MAINTENANCE: He received the hepatitis B vaccine
on [**5-10**] prior to transfer.

PHYSICAL EXAM ON ADMISSION TO [**Hospital3 **] NICU:  Well-
appearing preterm infant with temp 98.6, pulse 152,
respiratory rate 50, [**Hospital3 **] pressure 79/52. Pink infant. Soft
anterior fontanel. Intact palate. Normal facies. No grunting,
flaring or retractions. Clear breath sounds. No murmur.
Femoral pulses present. Flat, soft, nontender abdomen without
hepatosplenomegaly. Normal phallus, testes and scrotum. Left
testis larger than right, nontender. Stable hips. Normal tone
and activity. Normal perfusion. A 3-mm nodule with overlying
nonerythematous crust in right antecubital area.

SUMMARY OF HOSPITAL COURSE BY SYSTEMS:
RESPIRATORY: He remained on low-flow nasal cannula until [**5-25**],
at which time he was transitioned to room air. He has had
occasional drifts in his O2 saturations, but associated with
eating and choking, last occurring on the morning of [**6-10**].
Otherwise, he has been stable.

CARDIOVASCULAR: He remained on propranolol throughout the
hospitalization at [**Hospital3 **]. He has had no recurrent
episodes of SVT.

FLUIDS, ELECTROLYTES AND NUTRITION: On transfer to [**Hospital3 **], he was on 28 Calorie breast milk. With advancing age,
he has been transitioned to breast milk 24 Calories, and
continues to gain weight on that. He has been taking full
p.o. feeds since [**6-9**]. Weight on [**6-13**] is 2530 grams.

GI: He is on Actigall for direct hyperbilirubinemia. He was noted
to be jaundiced on [**5-25**] and found to have a bilirubin of
13.6/11.5. Electrolytes at that time: 138/4.8/106/25,
alkaline phosphatase 876, SGOT 170, SGPT 94. An abdominal
ultrasound was done on [**5-27**] which showed incidental
calcifications in the left lobe of the liver. No biliary
atresia or other abnormalities noted. A GI consult was
obtained. They recommended a TORCH work-up and the CT of the
abdomen. The abdominal CT was done on [**6-3**] which showed the
same calcifications in the left lobe with no other abnormalities.
The TORCH work-up has been negative. He was also started on some
calcium carbonate and sodium phosphate on [**6-9**] for increasing
alkaline phosphatase to 1468 and concern for metabolic bone
disease. His bilirubin has improved to 9.7/7.4 on [**6-2**].

HEMATOLOGY: His last hematocrit on [**6-7**] was 26.8 with a
retic of 8.8. He is on iron as well as multivitamins. He did
not receive any transfusions while at [**Hospital3 **].

INFECTIOUS DISEASE: He was noted to have some scrotal edema
and erythema on [**5-23**]. A scrotal ultrasound was done which
showed no torsion with the testes in the canals. He was
started on vancomycin, gent for concern of infection. CBC:
White count 9.4 with 3 bands, 63 neutrophils, hematocrit
35.9, platelets 203. The swelling and edema improved, and he
was treated with antibiotics for a full 7 days (four days IV and
3 days of Keflex). The [**Month (only) **] culture was negative. During the
course of hospitalization, he was also found to have some brief
temperature instability, which has resolved. Thyroid function
testing was reassuring.

NEUROLOGY: No further head ultrasounds have been done here.

SENSORY:
1. AUDIOLOGY: Hearing screen passed.
2. OPHTHALMOLOGY: Eye exam on [**5-26**] showed immature zone II
with follow-up recommended in 2 weeks. [**6-9**] exam showed
immature zone III with follow-up recommended in 3 weeks. He has
an ophthalmology outpatient appointment scheduled.

Upon discharge home, he has been gaining weight on full p.o.
feeds, clinically stable.

The primary pediatrician will be Dr. [**Last Name (STitle) 67310**], phone number [**Telephone/Fax (1) 67311**], fax number [**Telephone/Fax (1) 67312**] (attention: [**Doctor First Name **]).

CARE/RECOMMENDATIONS:
1.  He will be discharged home on Breast milk made 24 cal/oz
    with NeoSure which is recommended until 6-9 months corrected
    age.
2.  Medications on discharge:
    iron (4 mg/kg/day) 0.4 ml daily (of 25 mg/ml)
    multivitamins 1 ml daily
    Actigall 24 mg po Q 12
    Neutra-Phos 4 mmol po daily
    calcium carbonate 70 mg of elemental Ca po tid
    propranolol 1 mg po Q 8 hour
3.  Car seat testing was passed.
4.  State newborn screen on [**4-22**] showed low thyroxine,
    [**5-14**] was normal, and the one on [**6-6**] is still pending.
5.  He received his first hepatitis B vaccine on [**5-10**]. His
    2 month vaccinations were given [**6-11**] which included
    Pediarix, HIB and Prevnar.
6.  Immunizations recommended: Synagis RSV prophylaxis should
    be considered from [**Month (only) **] through [**Month (only) 958**] for infants who
    meet any of the following 3 criteria: 1) Born at less
    than 32 weeks; 2) Born between 32 and 35 weeks with 2 of
    the following: Daycare during RSV season, a smoker in the
    household, neuromuscular disease, airway abnormalities,
    or school-aged siblings; or 3) with chronic lung disease.
    Influenza immunization is recommended annually in the
    fall for all infants once they reach 6 months of age.
    Before this age and for the first 24 months of the
    child's life, immunization against influenza is
    recommended for household contacts and out-of-home
    caregivers.
7.  [**Name2 (NI) 269**] scheduled for [**2194-6-14**].
8.  Early intervention recommended.
9.  GI recommends repeating bilirubin in the first week of [**7-7**]. Follow-up appointments:
    - pediatrician on [**6-17**] at 3:00 p.m
    - GI at [**Hospital1 **] on [**8-5**]
    - Cardiology at [**Hospital1 **] on [**7-10**]
    - Ophthalmology with Dr. [**Last Name (STitle) **] in [**Location (un) 3307**] on [**7-8**]
    - Infant Follow-up Program at [**Hospital1 **]

DISCHARGE DIAGNOSES:
1.  Respiratory distress syndrome.
2.  Escherichia coli sepsis.
3.  Supraventricular tachycardia.
4.  Left hydrocele status post aspiration.
5.  Prematurity at 27 weeks.
6.  Suspected necrotizing enterocolitis versus septic ileus.
7.  Hyperbilirubinemia.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 48738**], MD [**MD Number(2) 55708**]

Dictated By:[**Name8 (MD) 67313**]
MEDQUIST36
D:  [**2194-6-12**] 16:46:31
T:  [**2194-6-12**] 18:01:24
Job#:  [**Job Number 67314**]
{'Other respiratory problems after birth,Neonatal jaundice associated with preterm delivery,Other specified cardiac dysrhythmias,Other specified disorders of biliary tract,Umbilical hernia without mention of obstruction or gangrene,Edema of male genital organs,Unspecified anomaly of gallbladder, bile ducts, and liver,Congenital hydrocele'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: 

PRESENT ILLNESS: Baby [**Known firstname **] [**Known lastname **] was admitted on [**5-16**] at 35 days of age. He was transferred from [**Hospital1 **] NICU
for further management. He was born at 27 weeks to a 33-year-
old, G4, P2 mother with [**Name2 (NI) **] type O+, antibody negative,
hepatitis B surface antigen negative, RPR nonreactive, HIV
negative, GC negative, chlamydia negative. She had
spontaneous vaginal delivery at [**Hospital6 **] after
preterm labor.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other respiratory problems after birth,Neonatal jaundice associated with preterm delivery,Other specified cardiac dysrhythmias,Other specified disorders of biliary tract,Umbilical hernia without mention of obstruction or gangrene,Edema of male genital organs,Unspecified anomaly of gallbladder, bile ducts, and liver,Congenital hydrocele'}
