Name: Custodio, John Luka Age/Sex: 2 months and 2 weeks Birthdate: 02/27/2026 AP: Dr. Dumalag (PC) Room: VS HR 156 bpm RR 33 cpm T 36 C O2 sat 95% at RA Weight: 1.75 kg Length: 43 cm Head circumference: 31 cm CC: Cyanosis HPI: Patient is apparently well until, 3 hours PTA, patient was actively breastfeeding when the mother noted generalized cyanosis last approximately 1-2 minutes, initially unresponsive. 1 hour PTA, mother re-initiated breastfeeding, with recurrence of generalized cyanosis for another 1-2 minutes, now with passage of stool. Due to unresponsiveness, brought to ER of another institution with stable VS as claimed. She was advised admission. Opted transfer to our institution. At the ER, patient noted with desaturation as low as 79% & bradycardia of 90s; hence, admission. Past Medical History: No childhood illnesses (BA, AR, Measles) (+) hospitalization: - preterm live baby boy, Ballard score, 28 wk AOG, cephalic, APGAR score 7,9 (BW = 930 grams) delivered via NSVD, respiratory distress syndrome; neonatal sepsis; retinopathy of prematurity; bronchopulmonary dysplasia, mild (for 57 days, Feb. 27 - Apr. 24, 2026) No surgical history No known food or drug allergies (+) antibiotics use for the past 3 months: - Ampicillin - Cefotaxime - Fluconazole - Gentamicin - Meropenem Family History: (+) DM - maternal side (+) HPN - maternal side (+) CKD - paternal side (-) Bronchial Asthma (-) CA Birth History: Born to a then 39 year old mother, G2P2 (1102), preterm, 28 weeks via NSVD at DDH Prenatal: Completed with OBGyn OB Hx: PROM x 2 hours, short cervix (1.9 cm) - S/P pessary insertion (Jan. 2026) Maternal Illnesses: None Maternal Drug Intake: None Smoking / Alcohol / Irradiation: None Neonatal History: Birthweight: 0.93 kg ENBS: unremarkable Hearing Test: unremarkable Blood type: mother O+, O+ child Feeding History: Currently on mixed feeding Started on formula milk April 28, 2026 (Enfamil, 1 scoop:30 ml) Growth and Developmental History: Gross Motor: predominantly in flexor tone, head from side to side Fine motor: (+) grasp reflex, hands fully fisted, (+) visual fixation to bright object Language: crying Personal Social: visual preference for mother & caregiver Immunization History: Done while admitted at NICU BCG (1 at birth), HEP B (1 at birth) Covid 19 vaccination: none Personal/Social History: Living with family, Household members (6 adults, 3 kids) Parents are the primary care givers Mother is a teacher Father is a construction worker (-) Family members with signs of infection (-) Travel history Environment History: Living in a bungalow (-) exposure to secondhand smoke Garbage: scheduled for pick up every week Water source: Purified (-) TB exposure ROS: (-) vomiting, (-) diarrhea, (-) decreased activity Physical Examination: Awake, comfortable, not in respiratory distress, Pinkish, no cyanosis, Flat fontanelles Anicteric sclerae, moist lips and oral mucosa, nonhyperemic, nonswollen tonsils, Good air entry, no retractions, clear breath sounds, no wheezing Regular rhythm, no murmurs Nondistended, normoactive bowel sounds, soft, nontender abdomen Warm extremities, full pulses, CRT <2sec