CHIEF COMPLAINT: 

PRESENT ILLNESS: In brief, this is a 26
and [**3-11**]-week baby born here at [**Hospital1 **], #1 of twins, to a 36-year-
old G3, P1 mother.  Prenatal screens are unremarkable.
Maternal [**Hospital1 **] type is B+.  Vaginal delivery of twins.
Unstoppable preterm labor.  [**Known lastname **] developed a spontaneous
ileal perforation with a volvulus, which was repaired at
[**Hospital3 1810**] on day of life #5.  He did well
postoperatively.  Returned to the [**Hospital3 **] on [**1-21**]
where he continued his management of prematurity.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Primary apnea of newborn,Septicemia [sepsis] of newborn,Other transitory neonatal electrolyte disturbances,Other colostomy and enterostomy complication,Other specified perinatal disorders of digestive system,Retrolental fibroplasia,Anemia of prematurity,Other specified conditions originating in the perinatal period,Hypospadias,Need for prophylactic vaccination and inoculation against viral hepatitis,Unspecified disorder of kidney and ureter
Primary apnea of newborn,NB septicemia [sepsis],Neonatal dehydration,Colstmy/enteros comp NEC,Perinat GI sys dis NEC,Retrolental fibroplasia,Anemia of prematurity,Perinatal condition NEC,Hypospadias,Need prphyl vc vrl hepat,Renal & ureteral dis NOS
Admission Date: [**2122-1-21**]        Discharge Date: [**2122-3-2**]

Date of Birth:  [**2121-12-31**]        Sex:  M

Service:  NBB


INDICATION/REASON FOR ADMISSION:  This is an interim summary.
There is a previous summary that goes from [**12-31**] to
[**1-6**]; at which time the baby was transferred to
[**Hospital3 1810**].  Today, the baby is returned to
[**Hospital3 1810**] for continued management of prematurity
and complications of ileostomy.

INTERIM HISTORY OF PRESENT ILLNESS:  In brief, this is a 26
and [**3-11**]-week baby born here at [**Hospital1 **], #1 of twins, to a 36-year-
old G3, P1 mother.  Prenatal screens are unremarkable.
Maternal [**Hospital1 **] type is B+.  Vaginal delivery of twins.
Unstoppable preterm labor.  [**Known lastname **] developed a spontaneous
ileal perforation with a volvulus, which was repaired at
[**Hospital3 1810**] on day of life #5.  He did well
postoperatively.  Returned to the [**Hospital3 **] on [**1-21**]
where he continued his management of prematurity.

[**Hospital **] HOSPITAL COURSE:
1.  RESPIRATORY:  [**Known lastname **] arrived on nasal prong CPAP of 5 cm
    in room air.  This was increased to 6 cm a day later due
    to increase in spells.  He was maintained on caffeine
    citrate during this time and did well.  He transitioned
    to nasal cannula oxygen at 200 cc on day of life #44 for
    5 days.  He returned to nasal prong CPAP because of
    increased periodic breathing on day of life #49.  On
    [**2-28**], he was reintubated because of increased apnea
    and desaturations during a decompensation.  He was
    started on SIMV at settings of 18/5, and a rate of 20,
    and 25-30%; and was increased to settings today at time
    of transfer to 26/7, and a rate of 35, and anywhere from
    40-100% oxygen.  His last [**Month (only) **] gas prior to leaving was
    7.26, 72; requiring increasing rate.  His chest x-ray was
    notable for a right upper lobe collapse and intermittent
    right lower lobe collapse as well.  The endotracheal tube
    was midway between the carinae and the thoracic inlet.
    He has had moderate secretions.  His caffeine was
    discontinued on [**2-28**].
2.  CARDIOVASCULAR:  [**Known lastname **] has been stable with mean [**Known lastname **]
    pressures in the 40s to 50s.  He has a CVL in place,
    which has been functioning well, that was placed for his
    initial surgery on [**1-5**].  On [**2-28**], he had a
    transient decrease in his mean arterial pressure to 26,
    responding to a bolus of normal saline.  He has not
    required pressors at this time.  He had a peripheral
    arterial line placed in his left dorsalis pedis artery to
    monitor his mean [**Month (only) **] pressures.  His AP has been 120s
    to 140s.  He had 1 episode of a mean [**Month (only) **] pressure in
    the 60s earlier today, responding to a dose of fentanyl
    for presumed discomfort.
3.  FLUIDS, ELECTROLYTES AND NUTRITION:  On [**1-21**] when
    [**Known lastname **] returned from the [**Hospital3 1810**], he was on
    total fluids of 140/kg of breast milk 20 calorie by
    continuous feeds.  Over the next 4 days he increased in
    calories to 24 per ounce.  On [**1-25**], secondary to
    lethargy and a decreased urine output, a workup revealed
    a serum sodium of 118, a serum potassium of 8.9;
    necessitating a normal saline bolus and a sodium
    replacement infusion.  He also received calcium gluconate
    x 1 dose and an insulin infusion with concurrent high
    glucose infusion to decrease his serum potassium.  His
    EKG at this time remained normal.  Thereafter, his [**Known lastname 9341**]
    output was replaced cc-for-cc with half volume normal
    saline.  It was reduced to half cc-for-cc replacement
    over time.  A renal consult was obtained.  Serum and
    urine osmolarity were monitored, all of which were
    normal.  A BUN/creatinine at that time was noted to be
    elevated with a BUN of 31 and a creatinine of 1.3, which
    corrected over the next 48 hours to 12 and 0.6.  He was
    presumed to have renal insufficiency secondary to
    dehydration.  The serum electrolytes continued to improve
    on this half-volume replacement with half normal saline,
    and he was transitioned off of his replacement on [**2-8**]; at which time oral sodium chloride and potassium
    chloride supplements were started.  These have been
    weaned as well for serum sodium's of 140 and potassium's
    of greater than 5.  On [**2-26**], his electrolytes were
    135, 5.2, 106 and 19.  Also in relation to his fluids and
    electrolytes, [**Known lastname **] was restarted on feeds on [**1-28**] after the electrolyte aberration and quickly advanced
    to full volume.  Increasing calories on [**2-6**], was
    tolerating continuous feeds of breast milk 30 with
    Beneprotein.  This was made with 4 calories of human milk
    fortifier, 4 calories of MCT, 2 calories of Polycose and
    Beneprotein as well.  He transitioned to bolus slowly,
    going from continuous to being fed over 3-1/2 hours; and
    most recently tolerating bolus feeds over 2-1/2 hours.
    Calories were reduced to 28 calories by eliminating the
    Polycose due to increased [**Known lastname 9341**] output.  Total volume
    was increased to 150 mL/kg, which also increased [**Known lastname 9341**]
    output; so, the total fluids were trimmed to 140/kg of
    breast milk 28 with Beneprotein over 2-1/2 hours.  These
    were well tolerated.  In addition, on [**2-13**], Imodium
    was added to [**Known lastname 9231**] regimen to help decrease his [**Known lastname 9341**]
    output; and that was also well tolerated by [**Known lastname **]. On
    [**2-28**], [**Known lastname **] was made n.p.o. once again for frank
    [**Known lastname **] in his stool from his [**Known lastname 9341**].  He was restarted on
    parenteral nutrition through his central Broviac, which
    has remained in place.  On day of transfer, he was
    receiving D-7.5 with 2.5 mg/kg of protein, 2 mg/kg of
    lipids, 3 mEq/kg of sodium, and 3 mEq of potassium - half
    chloride, half acetate.  His glucose was noted to be
    elevated during the initial presentation with the frank
    bloody stools, peaking at 343.  He responded to a single
    dose of subcutaneous insulin and has been euglycemic on a
    decreased GIR as above.  Total fluids are at 130.  He
    also has normal saline at mL/hour via peripheral arterial
    line.  Most recent set of electrolytes were at 11:00 a.m.
    on [**3-2**]:  Sodium 134, potassium 3.6, chloride 101,
    and CO2 of 29, glucose was 88.  A copy of PN sheet was
    faxed over for your information on specific details
    related to the current parenteral nutrition.
4.  GI:  [**Known lastname **] had [**Known lastname 9341**] drainage that averaged 1.2 to 2
    mL/kg/hour of yellow, seedy, liquid stool.  There were
    multiple changes in his bag over time secondary to skin
    breakdown.  The [**Known lastname 9341**] nurse was involved with his care.
    He had breakdown from 9 o'clock until 3 o'clock,
    graphically speaking, around his stoma which is being
    treated.  He, as I said, responded to fine-tuning of his
    fluid intake and Imodium added to his dietary regimen.
    On [**2-28**], when [**Known lastname **] was noted to have frank [**Known lastname **]
    in his [**Known lastname 9341**], a KUB was obtained which showed dilated
    loops of the small bowel proximal to the stoma.  Serial
    KUBs revealed nonspecific distention of several loops of
    bowel.  On [**2-28**] at 18:00 hours, he continued to
    have moderate distention of loops of bowel, mid abdomen,
    with a string-of-pearl appearance of bubbles seen in a
    concentric pattern in the left lower quadrant; suspicious
    of pneumatosis intestinalis.  There was no free air
    identified in any of the serial films.  His [**Last Name (un) 37079**]
    drains with scant amounts of bilious drainage.  He was
    noted to have overlying erythema medial to the stoma of
    the skin.  Surgery continued to see the patient at the
    [**Hospital3 **] NICU, and at this time inserted a catheter
    into the stoma with return of frank [**Hospital3 **].  Currently,
    there is minimal drainage from the stoma.  LFTs were
    obtained on [**3-2**] with an ALT of 65, an AST of 86.
    [**Known lastname **] is being transferred to the surgery service for
    continued management of his abdominal process at this
    time.
5.  INFECTIOUS DISEASE:  On [**1-26**], during the
    decompensation secondary to electrolyte imbalance, [**Known lastname **]
    had a sepsis evaluation - including [**Known lastname **], stool and
    urine cultures - all of which remained negative.  He
    received 7 days of ampicillin and cefotaxime.  On [**2-4**], he had a repeat sepsis eval secondary to his CVL
    dressing becoming contaminated.  His cultures remained
    negative.  His CBC was benign, and he completed 48 hours
    of vancomycin and cefotaxime.  On [**2-28**], at the time
    of this abdominal process, [**Known lastname **] again underwent a
    sepsis evaluation.  He had [**Known lastname **], urine and stool
    cultures sent again on [**2-28**] and [**3-1**].  Those
    [**Month (only) **] cultures have remained negative.  He was started on
    ampicillin, and gentamicin and clindamycin.  Due to the
    concern for cellulitis in the abdomen, vancomycin was
    also added.  The ampicillin was discontinued on [**3-2**].  His gentamicin levels on [**3-2**] were 0.3 and
    5.3.  Vancomycin on [**3-2**], levels were 13.6 and
    31.1.
6.  HEMATOLOGIC:  [**Known lastname **] is status post packed red [**Known lastname **] cell
    transfusions.  The [**Known lastname **] has been made available through
    direct donor at [**Hospital3 1810**] from [**Known lastname 9231**] dad.
    [**Name (NI) **] received transfusions on [**1-27**], on [**2-5**], on
    [**2-28**].  He received two 15 cc/kg PRBC's transfusions.
    On [**3-1**], twenty per kilo of packed red [**Month (only) **] cells.
    His hematocrit on [**3-2**] is 42.5.  The initial CBC on
    [**2-28**] showed a white count of 10; a hematocrit of
    35; platelets of 700,000; and nonshifted differential.
    On [**3-1**], his white count was noted to be 7.6; and
    at this time the differential was markedly shifted with
    15 polys, 39 bands, 36 lymphs, and 8 myelos.  He
    continued on antibiotics, and a repeat [**Month (only) **] culture was
    sent at that time as well.  On [**3-2**], his CBC was
    notable for a white count of 6.3, with 12 poly's, 8
    bands, 43 lymphs, 18 monos, and 7 metamyelocytes.  [**Known lastname **]
    had coagulation studies performed on [**2-28**] with a PT
    of 16.6, a PTT of 68.8, and INR of 1.5.  On [**3-2**], a
    PT of 20, a PTT of greater than 150, a fibrinogen of 443
    were reported; with a question of whether this was a half-
    absorbed specimen or not.  There has been no further
    clinical evidence of active bleeding.  [**Known lastname **] has
    additional direct donor [**Known lastname **] available that will be
    transferred with him to [**Hospital3 1810**].
7.  NEUROLOGIC:  Head ultrasound on [**2-19**] was normal for
    age.  Initial head ultrasound done at [**Hospital3 1810**]
    was notable for some echogenicities in the subependymal
    region of the frontal horns, and recommendation for MRI
    at term was recommended by the radiologist at that time.
    Subsequent head ultrasounds performed at the [**Hospital3 **]
    on [**1-29**] and [**2-19**] were considered to be
    normal for his age.  His exam has been appropriate for
    his postmenstrual age.  On [**2-28**], because of the
    acute abdominal process, [**Known lastname **] was started on bolus
    doses of fentanyl at 2 mcg/kilo every 2 to 4 hours.  On
    [**3-1**], was started on a 2 mcg/kilo per hour drip
    with good affect, requiring occasional boluses for
    procedural discomfort.
8.  OPHTHALMOLOGY:  An ROP screen performed on [**2-9**]
    showed immature retinae to zone 2.  On [**2-23**], a
    repeat examination showed stage I zone 2 in the right and
    immature zone 2 in the left.  Followup is scheduled for
    this week.  Has not been performed at this time.
9.  IMMUNIZATIONS RECEIVED:  Hepatitis B vaccine on [**1-30**], and a single dose of Synagis on [**2-20**].  Newborn
    screens were sent on [**1-12**], [**2-4**], and [**2-24**].
10. SOCIAL:  Parents are involved and concerned about the
    changing condition of [**Known lastname **] at this time and have
    accompanied him to [**Hospital3 1810**].  His twin, [**Known lastname **],
    remains well.  Is growing and learning to feed at the
    NICU at the [**Hospital1 **].

DISCHARGE DIAGNOSES:  Respiratory distress, sepsis suspect,
necrotizing enterocolitis, retinopathy of prematurity, anemia
of prematurity.

NAME OF PRIMARY PEDIATRICIAN:  Not yet identified.

FEEDINGS AT TIME OF TRANSFER:  N.p.o., PN as above.

MEDICATIONS:  Include vancomycin, gentamicin, clindamycin,
fentanyl.



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

Dictated By:[**Last Name (NamePattern1) 54678**]
MEDQUIST36
D:  [**2122-3-2**] 16:34:26
T:  [**2122-3-2**] 17:59:06
Job#:  [**Job Number 69918**]
{'Primary apnea of newborn,Septicemia [sepsis] of newborn,Other transitory neonatal electrolyte disturbances,Other colostomy and enterostomy complication,Other specified perinatal disorders of digestive system,Retrolental fibroplasia,Anemia of prematurity,Other specified conditions originating in the perinatal period,Hypospadias,Need for prophylactic vaccination and inoculation against viral hepatitis,Unspecified disorder of kidney and ureter'}


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: In brief, this is a 26
and [**3-11**]-week baby born here at [**Hospital1 **], #1 of twins, to a 36-year-
old G3, P1 mother.  Prenatal screens are unremarkable.
Maternal [**Hospital1 **] type is B+.  Vaginal delivery of twins.
Unstoppable preterm labor.  [**Known lastname **] developed a spontaneous
ileal perforation with a volvulus, which was repaired at
[**Hospital3 1810**] on day of life #5.  He did well
postoperatively.  Returned to the [**Hospital3 **] on [**1-21**]
where he continued his management of prematurity.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Primary apnea of newborn,Septicemia [sepsis] of newborn,Other transitory neonatal electrolyte disturbances,Other colostomy and enterostomy complication,Other specified perinatal disorders of digestive system,Retrolental fibroplasia,Anemia of prematurity,Other specified conditions originating in the perinatal period,Hypospadias,Need for prophylactic vaccination and inoculation against viral hepatitis,Unspecified disorder of kidney and ureter'}
