CHIEF COMPLAINT: 

PRESENT ILLNESS: [**Known firstname 37958**] girl [**Known lastname 429**] was born at
approximately 25 weeks' gestation to a 31-year-old G4, P0,
now 1 mother. This patient's birth weight was 640 g which was
equivalent to the approximate 10th percentile. The birth
length of this patient was 30.5 cm, which is equivalent to
less than the 10th percentile. The birth head circumference
was 21.5 cm which is equivalent to the less than 10th
percentile. This mother's prenatal labs were consistent with
the following: Blood type 0 positive, antibody negative, RPR
nonreactive, hepatitis B surface antigen negative, rubella
immune, and HIV unknown. This patient's mother was also a
hepatitis B carrier. The pregnancy was complicated by a
maternal history of bipolar disease. Mom was on Haldol,
Risperdal, and benzodiazepines. Mom had a history of a
suicide attempt on [**2184-8-4**], and was admitted to [**Hospital 14852**] at that time. Mom also had a history
of cocaine, marijuana, alcohol and smoking use during
pregnancy. Mom reportedly smoked up to 1 pack of cigarettes
per day.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: The discharge weight on [**2185-4-18**], at 169 days of life, which is equivalent to 48-6/7
weeks was 4.815 kg, which is equivalent to the 50th
percentile for corrected gestational age. The length on
discharge was 58 cm which is equivalent to the 25th
percentile. The head circumference at discharge was 39.5 cm,
which was equivalent to the 50th percentile for corrected
gestational age.

FAMILY HISTORY: 

SOCIAL HISTORY: 
Single liveborn, born before admission to hospital,Extreme immaturity, 500-749 grams,Chronic respiratory disease arising in the perinatal period,Patent ductus arteriosus,Septicemia [sepsis] of newborn,Anemia of prematurity,Infundibular pulmonic stenosis,Respiratory distress syndrome in newborn,Neonatal jaundice associated with preterm delivery,Retrolental fibroplasia,Other transitory neonatal electrolyte disturbances,Need for prophylactic vaccination and inoculation against viral hepatitis,Esophageal reflux,Hypotension, unspecified,Cocaine affecting fetus or newborn via placenta or breast milk,Constipation, unspecified
Singl livebrn-before adm,Extreme immatur 500-749g,Perinatal chr resp dis,Patent ductus arteriosus,NB septicemia [sepsis],Anemia of prematurity,Infundib pulmon stenosis,Respiratory distress syn,Neonat jaund preterm del,Retrolental fibroplasia,Neonatal dehydration,Need prphyl vc vrl hepat,Esophageal reflux,Hypotension NOS,Mat cocaine aff NB/fet,Constipation NOS
Unit No:  [**Numeric Identifier 75897**]
Admission Date: [**2184-10-31**]
Discharge Date: [**2185-4-18**]
Date of Birth:  [**2184-10-31**]
Sex:  F
Service:  NBB


HISTORY OF PRESENT ILLNESS:  [**Known firstname 37958**] girl [**Known lastname 429**] was born at
approximately 25 weeks' gestation to a 31-year-old G4, P0,
now 1 mother. This patient's birth weight was 640 g which was
equivalent to the approximate 10th percentile. The birth
length of this patient was 30.5 cm, which is equivalent to
less than the 10th percentile. The birth head circumference
was 21.5 cm which is equivalent to the less than 10th
percentile. This mother's prenatal labs were consistent with
the following: Blood type 0 positive, antibody negative, RPR
nonreactive, hepatitis B surface antigen negative, rubella
immune, and HIV unknown. This patient's mother was also a
hepatitis B carrier. The pregnancy was complicated by a
maternal history of bipolar disease. Mom was on Haldol,
Risperdal, and benzodiazepines. Mom had a history of a
suicide attempt on [**2184-8-4**], and was admitted to [**Hospital 14852**] at that time. Mom also had a history
of cocaine, marijuana, alcohol and smoking use during
pregnancy. Mom reportedly smoked up to 1 pack of cigarettes
per day.

Mom presented to [**Hospital 8**] Hospital with vaginal bleeding.
Mom had an emergent cesarean section for abrupt placental
bleeding. The infant emerged with a heart rate less than 60
and chest compressions were given. The infant also received 2
doses of epinephrine via an endotracheal tube. After this
intervention, the heart rate and color improved. The Apgar
scores were 2 at one minutes, 2 at five minutes, 4 at 10
minutes, 4 at 15 minutes, 4 at 20 minutes, and 6 at 25
minutes. The patient received surfactant, normal saline
boluses, ampicillin and gentamicin and was transferred from
[**Hospital 8**] Hospital to the [**Hospital6 2018**] Neonatology Intensive Care Unit.

DISCHARGE PHYSICAL EXAM:  The discharge weight on [**2185-4-18**], at 169 days of life, which is equivalent to 48-6/7
weeks was 4.815 kg, which is equivalent to the 50th
percentile for corrected gestational age. The length on
discharge was 58 cm which is equivalent to the 25th
percentile. The head circumference at discharge was 39.5 cm,
which was equivalent to the 50th percentile for corrected
gestational age.

On physical examination this patient generally was alert and
active and smiling. HEENT exam was significant for
extraocular movements intact with a normal red reflex. Ears
were normal set and rotated. The palate was slightly high-
arched. This patient had no obvious dysmorphic faces. This
patient does have an approximately 3 cm x 1 cm pedunculated
hemangioma to the top of the head. The hemangioma has no pain
on palpation and appears bright red. There are no ulcerations
to the hemangioma.

Neck was supple. Respiratory exam was significant for clear
breath sounds bilaterally with good aeration. Cardiovascular
exam is significant for normal S1 and S2, regular rate and
rhythm, with no murmur appreciated. Femoral pulses aer equal.
Abdominal exam is consistent with nondistention, nontender
during exam, with normal active bowel sounds. This patient
does have a PEG tube located in the left lower quadrant of
the abdomen. There is no erythema or skin breakdown
circumferentially around the PEG tube.

GU exam is consistent with normal female genitalia. There is
a patent anus and no sacral tuft or dimple. Hips have no
clicks or clunks on exam. The extremities are warm and well
perfused. The neurologic exam is consistent with a 2-month-
old. The infant had minor head lag on ventral suspension. The
patient has a normal suck and normal tone.

HOSPITAL COURSE:

1. Respiratory: This patient was initially placed on high-
    frequency ventilation until day of life 10. The patient
    received surfactant x3. The patient then remained on
    conventional ventilation from day of life 10 until day
    of life 44. On day of life 44, the patient was
    transitioned to CPAP. The patient was then transitioned
    to nasal cannula on day of life 56. The patient was
    transitioned to room air on day of life 149. Day of life
    149 was equal to 46 weeks gestational age. This patient
    also received Lasix, as much as 3 times per week for
    chronic lung disease during this hospitalization. At
    discharge the patient was sent home with no chronic
    diuretic therapy and the chronic lung disease had
    improved.

    The patient also received caffeine for apnea of
    prematurity. The patient's caffeine was discontinued on
    day of life 62, which was equal to 33-4/7 weeks'
    corrected gestation age. The patient has not had any
    significant apnea or bradycardia events for several weeks
    prior to discharge.

2. Cardiovascular: This patient initially was placed on
    dopamine for hypotension. The dopamine was discontinued
    on day of life 8. This patient received Indomethacin for
    patent ductus arteriosis for 2 course of 3 doses each.
    The patient had a PDA ligation on [**2184-11-5**],
    which was equivalent to day of life [**5-10**]. Follow-up
    echocardiograms have revealed normal biventricular
    function and structure. The last echocardiogram was
    performed on [**2185-3-25**]. This revealed right-sided
    ventricular pressures less than one-half systemic. It
    was thought that the right-sided ventricular
    hypertension had improved during hospitalization. Again
    there were no structural defects found in the heart.
    This patient had no appreciable murmur at discharge.

3. Fluids, electrolytes and nutrition: This patient was
    placed on total parenteral nutrition at birth. Enteric
    feeds were started on day of life 10 and the patient
    reached full feeds by day of life 18. This patient
    reached caloric supplementation at a maximum of 30
    kcal/oz. At discharge the patient was sent home on 160
    cc/kg/day of Enfamil 20 kcal/oz.

4. GI: This patient was initially started on p.o. feedings
    at corrected 35 weeks. This patient showed poor
    coordination and was observed clinically for maturity.
    On [**3-3**], the feeding team was consulted to
    evaluate this patient's eating potential at
    approximately 42 weeks corrected gestational age. The
    feeding team noted immature sucking pattern and
    recommended continued observation. The patient also had
    constipation and was treated with prune juice. This
    patient continued to have trouble p.o. feeding and the
    GI team was consulted for G-tube placement. A PEG tube
    was placed on [**2185-4-12**], at corrected 48-0/7 weeks.
    At discharge the patient's feeding regimen included 160
    cc/kg/day of Enfamil 20 kcal/oz formula. This was based
    on a weight of 5 kg. This regimen consisted of
    continuous feeds at 50 cc/hr from 10 p.m. until 6 a.m.
    This regimen also included 130 ml of feed given p.o. or
    PG x3 during the day. At discharge, this patient was
    taking approximately a third to half of each of the
    feeding volumes during the day by mouth instead of per
    PEG tube. This patient was also discharged home on
    Prilosec and Reglan for clinical reflux. This patient will
    continue to follow- up with GI service and occupational
    therapy via early intervention as an outpatient.

5. Infectious disease: This patient was initially treated
    with ampicillin and gentamicin for presumed sepsis for
    14 days at birth. No positive blood cultures were ever
    documented. This patient also had an HIV test during
    this admission which was negative. The suspicion for HIV
    was based on mom's drug history including intravenous
    drugs.

6. Dermatologic: This patient was noted to have a scalp
    hemangioma which grew persistently during this
    hospitalization. The scalp hemangioma was noted to be
    pedunculated but not ulcerated. Dermatology was not
    consulted for the hemangioma during this
    hospitalization.

7. Hematology: This patient was anemic at birth and
    received several blood transfusions in the first week of
    life, as well as during the first month of
    hospitalization. This patient also had phototherapy for
    hyperbilirubinemia. This patient received iron for
    anemia of prematurity and will be discharged home with
    iron supplementation. Her lst hematocrit on [**2185-4-11**] was
    35.

8. Neurologic: This patient was initially placed on a
    fentanyl drip due to high-frequency ventilation. The
    fentanyl drip was gradually weaned down during the
    hospitalization.

    This patient had several head ultrasounds as well. The
    head ultrasounds performed showed a bilateral grade 2
    intraventricular hemorrhage.  The intraventricular
    hemorrhage was monitored by serial head ultrasound and
    had resolved by [**2184-12-14**].  Most recent head
    ultrasound prior to discharge was [**2185-4-15**], which
    was reportedly normal.

    This patient also had several eye exams to evaluate for
    retinopathy of prematurity. This patient had a maximum
    retinopathy of prematurity exam on [**2185-2-2**],
    which revealed ROP stage 2 zone 2 bilaterally. On
    [**2-23**], the patient had ROP stage 1 zone 3. On [**3-21**], [**2185**], the eyes were noted to be mature, and
    ophthalmology follow-up was recommended in 9 months. The
    patient also had a hearing screen which was normal prior
    to discharge.

9. Social: This patient initially had a urine toxicology
    screen performed due to history of mom's drug use during
    pregnancy at birth. This urine toxicology screen revealed
    no evidence of drugs tested on the screen. Social work
    was consulted due to history of mom's bipolar disease and
    drug use. DSS became involved and the patient was
    transferred to DSS custody on [**2184-12-31**]. The
    patient will be discharged home to a [**Doctor Last Name **] parent as
    recommended and appointed by the DSS. During this
    hospitalization, the case worker from DSS was [**First Name9 (NamePattern2) 75898**]
    [**Location (un) **].

CONDITION ON DISCHARGE:  Stable.

DISCHARGE DISPOSITION:  Home to [**Doctor Last Name **] care parents.

PRIMARY CARE PHYSICIAN:  [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7931**], MD, [**Hospital **] Clinic
Center, [**Location (un) 71831**], [**Hospital1 **], [**Telephone/Fax (1) 75899**].

CARE RECOMMENDATIONS:
1.  Feedings at discharge: The feedings at discharge are
    Enfamil 20 kcal/oz at 160 cc/kg/day based on a weight of
    5 kg. This is distributed as continuous feedings at 50
    cc/hr x8 hours/day specified from 10 p.m. until 6 a.m.  As
    well this patient takes 130 ml, first attempt at p.o., the
    remainder given via PEG tube 3 times/day. We recommend to
    the pediatrician that if the patient has trouble taking
    this quantity of feeds by mouth, to reduce the total of
    volume of feed and increase the caloric intake.  The
    patient will also be sent home on Prilosec and Reglan for
    presumed reflux. The patient will follow-up with the [**Hospital **]
    clinic in addition. This patient will continue to need
    occupational therapy to evaluate for oral aversion or a
    feeding intolerance.

2.  Discharge medications:
    a.  Ferrous Sulfate (concentration 25 mg/mL) at 0.5 ml
        p.o. or via PEG tube once daily -- which is
        equivalent to approximately 2 mg of elemental iron per
        kg/day.

    b.  Reglan 0.5 mg p.o. or PEG tube t.i.d. which is
        equivalent to approximately 0.1 mg/kg/dose.

    c.  Prilosec 5 mg p.o. or PEG tube daily which is
        equivalent to 1 mg/kg/dose.

3.  Car seat position screening: Performed prior to discharge.
    The patient passed car seat screening test.

4.  State newborn screening: Performed several times during
    this
    hospitalization: [**2184-11-14**], [**2184-11-24**], [**2184-12-4**],
    [**2184-12-13**],
    [**2185-1-10**].

    The patient initially had a low thyroxine level on
    newborn screen with a normal TSH level on [**2184-11-14**] and
    [**2184-11-24**].  This low thyroxine level spontaneously
    resolved and the infant had normal newborn screens for
    the last 3 assessments.  This is consistent for Transient
    Hypothyroxinemia of Prematurity (THOP).

5.  IMMUNIZATIONS RECEIVED:  Immunizations received during
    this hospitalization included the 2- and 4-month
    immunizations.  Pediarix, HIB, and pneumococcal
    seven-valent conjugant vaccine were given on [**2184-12-31**], and [**2185-3-3**]. This patient also received
    Synagis on [**2185-4-18**], prior to discharge.

IMMUNIZATIONS RECOMMENDED:  Synagis RSV prophylaxis should be
considered from [**Month (only) **] through [**Month (only) 958**] for infants who meet
any of the following 4 criteria.
1. Born at less than or equal to 32 weeks.
2. Born between 32 and 35-0/7 weeks with 2 of the
    following: Daycare during RSV season, a smoker in the
    household, neuromuscular disease, airway abnormalities,
    or school-age siblings.
3. Chronic lung disease.
4. Hemodynamically significant congenital heart 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.

This infant has not received Rotavirus vaccine. The American
Academy of Pediatrics recommend initial vaccination of
preterm infants at or following discharge from the hospital
if they are clinically stable and at least 6 weeks but fewer
than 12 weeks of age.

6.  FOLLOW-UP APPOINTMENTS:
    a.  [**Hospital **] clinic scheduled for [**2185-5-13**], at 11 a.m.
    b.  Primary care pediatrician with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7931**] on
        Thursday, [**2185-4-21**].
    c.  Referral has been made for the neonatal infant
        [**Hospital 702**] clinic and early intervention.  Early
        intervention should see this patient as soon as
        possible to get an occupational therapy to see [**Female First Name (un) 75900**]
        on a regularly scheduled visit to assess her feeding
        intolerance and oral aversion as previously
        mentioned.
    d.  This patient will also have a visiting nurse visit
        her in the home on Tuesday, [**2185-4-19**].
    e.  Ophthalmology follow-up in 9 months with Dr. [**Last Name (STitle) **],
        [**Hospital3 1810**].

DISCHARGE DIAGNOSIS:
1.  Premature birth at 25 weeks gestation.
2.  Substance abuse exposure.
3.  Respiratory distress syndrome, resolved.
4.  Chronic lung disease, resolved.
5.  Apnea of prematurity, resolved.
6.  Hypotension, resolved.
7.  Patent ductus arteriosis status post PDA ligation.
8.  Anemia of prematurity, resolved.
9.  Hyperbilirubinemia, resolved.
10. Presumed sepsis, resolved.
11. Retinopathy of prematurity, resolved.
12. Bilateral grade 2 germinal matrix hemorrhages,resolved.
13. Gastrostomy tube placement.
14. Gastroesophageal reflux.
15. Transient hypothyroxinemia of prematurity, resolved.
16. Scalp compound pedunculated hemangioma.




                        [**Name6 (MD) **] [**Last Name (NamePattern4) **], [**MD Number(1) 55472**]

Dictated By:[**Last Name (NamePattern4) 75901**]
MEDQUIST36
D:  [**2185-4-18**] 14:09:11
T:  [**2185-4-18**] 15:44:39
Job#:  [**Job Number 75902**]
{'Single liveborn, born before admission to hospital,Extreme immaturity, 500-749 grams,Chronic respiratory disease arising in the perinatal period,Patent ductus arteriosus,Septicemia [sepsis] of newborn,Anemia of prematurity,Infundibular pulmonic stenosis,Respiratory distress syndrome in newborn,Neonatal jaundice associated with preterm delivery,Retrolental fibroplasia,Other transitory neonatal electrolyte disturbances,Need for prophylactic vaccination and inoculation against viral hepatitis,Esophageal reflux,Hypotension, unspecified,Cocaine affecting fetus or newborn via placenta or breast milk,Constipation, unspecified'}


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: [**Known firstname 37958**] girl [**Known lastname 429**] was born at
approximately 25 weeks' gestation to a 31-year-old G4, P0,
now 1 mother. This patient's birth weight was 640 g which was
equivalent to the approximate 10th percentile. The birth
length of this patient was 30.5 cm, which is equivalent to
less than the 10th percentile. The birth head circumference
was 21.5 cm which is equivalent to the less than 10th
percentile. This mother's prenatal labs were consistent with
the following: Blood type 0 positive, antibody negative, RPR
nonreactive, hepatitis B surface antigen negative, rubella
immune, and HIV unknown. This patient's mother was also a
hepatitis B carrier. The pregnancy was complicated by a
maternal history of bipolar disease. Mom was on Haldol,
Risperdal, and benzodiazepines. Mom had a history of a
suicide attempt on [**2184-8-4**], and was admitted to [**Hospital 14852**] at that time. Mom also had a history
of cocaine, marijuana, alcohol and smoking use during
pregnancy. Mom reportedly smoked up to 1 pack of cigarettes
per day.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: The discharge weight on [**2185-4-18**], at 169 days of life, which is equivalent to 48-6/7
weeks was 4.815 kg, which is equivalent to the 50th
percentile for corrected gestational age. The length on
discharge was 58 cm which is equivalent to the 25th
percentile. The head circumference at discharge was 39.5 cm,
which was equivalent to the 50th percentile for corrected
gestational age.

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Single liveborn, born before admission to hospital,Extreme immaturity, 500-749 grams,Chronic respiratory disease arising in the perinatal period,Patent ductus arteriosus,Septicemia [sepsis] of newborn,Anemia of prematurity,Infundibular pulmonic stenosis,Respiratory distress syndrome in newborn,Neonatal jaundice associated with preterm delivery,Retrolental fibroplasia,Other transitory neonatal electrolyte disturbances,Need for prophylactic vaccination and inoculation against viral hepatitis,Esophageal reflux,Hypotension, unspecified,Cocaine affecting fetus or newborn via placenta or breast milk,Constipation, unspecified'}
