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| October 19, 2000 Dr. Elaine Barrios, M.D. RE: Wilson, Kaylee Dear Dr. Barrios: Kaylee presented for her third and final High Risk Infant Clinic follow-up visit accompanied by both parents and her grandmother. Kaylee is now 22 1/2 months chronologic age and almost 20 months corrected age. As you know, she is a former 29-week gestational age, appropriate for gestational age, preterm infant who had a relatively benign prenatal course. Previous testing in this clinic has revealed normal development. At 19 weeks adjusted age, her Adjusted Mental Development Index was 109 and her Adjusted Performance Developmental Index 104. At 13 months corrected age, her Adjusted Mental Developmental Index 118 and her Adjusted Performance Developmental Index 122. At the time of her last visit at 13 months corrected age, she was noted to be below the growth curve for height and weight. Since her last visit, Kaylee has been well with two episodes of reactive airways accompanying upper respiratory infections. She takes p.r.n. nebulizers and was recently in the Emergency Room for wheezing which is just resolving now. She is on no chronic medications and her immunizations are up-to-date. Kaylee attends daycare and takes music classes well. She is receiving no early intervention services. The Mullen Scales of Early Learning were administered. Kaylee was very well regulated during this testing and transitioned easily between items and would socially reference her parents and the examiner frequently. She was a good communicator. She used 21 different single words but was not noted to be combining words. The Mullen is divided into five subscales. Each subscale is scored with a T score of 50 being average. The four cognitive subscales are summed to calculate an early learning composite standard score, 100 is an average standard score. Kaylee's gross motor skills were at a 20 month age equivalent. Her visual receptive age equivalent was 25 with a T score of 63. Her fine motor age equivalent was 21 with a T score of 52. Her receptive language age equivalent was 28 months with a T score of 70. Her expressive language age equivalent 18 months with a T score of 46. On physical exam, Kaylee continues a petite girl who is well developed and has big blue eyes. She is quite alert, oriented, and in no distress. Her weight is 7.95 kilos which is less than the 5th percentile for corrected age and the 50th percentile for a 7 month old. She has increased 0.75 kilograms in weight over the past six months. Her length is 77.7 cm which is less than the previously established growth curve and is following along her 45 cm which is less than the 5th percentile for age but is also following her previously established growth curve. Her skin is free of neurocutaneous lesions. her head is somewhat narrow. Anterior fontanelle is closed. Her face is notable for large eyes. Her eyes are conjugate, negative cover/uncover test. Pupils are equal, round, and reactive to light. Positive Dennie's lines. Her pinna continue protuberant. Her tympanic membranes are clear bilaterally. Nose and throat were clear. Neck was supple. She had no clear respiratory distress and no retractions but she did have expiratory wheezes on the left posteriorly. Her heart had a regular rate and rhythm without murmur. Abdomen was soft without organomegaly. Genitalia was normal female, no rashes present. Lumbar sacral spine was clear. Her extremities had full range of motion without clubbing, cyanosis, or edema. On neurologic exam, her strength, tone, and muscle mass were normal. Deep tendon reflexes were 2+ and equal. No clonus was noted. She is toddling well and has a stiff running gait. She was able to walk up stairs holding on, nonalternating. She gets up from a supine position by rolling to her hands and knees and standing up. She can squat and re-erect. Her cranial nerves II-XII are functionally intact. Impressions: Kaylee is a 19 3/4 month old girl, former 29 week AGA preemie who continues to develop well within the normal range. We have no concerns about her development. However, Kaylee's growth is falling off her previously established curve. Her height and head circumference curves, while less than the 5th percentile, are following previously established curves. It is unclear why she is not gaining weight nor why she is so small, particularly since she was appropriate for gestational age at birth. Recommendation: Kaylee is no longer eligible to be followed in the High Risk Infant Clinic because of her age. However, should concerns regarding her development arise in the future, we would be happy to see her again in our Child Development Clinic. Kaylee does have poor weight gain and we recommend that you consider a workup for her poor weight gain including nutrition consult and initial laboratory workup. Thank you very much, Dr. Barrios, for the opportunity to participate in Kaylee's care. Please contact us in the future should developmental concerns arise. Sincerely,
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