Jeremy Brandon Jones

   Jeremy is one of a twin born at 27 weeks gestation.  He was born on July 12, 1997, "twin A", and was delivered by spontaneous vaginal delivery.  His birth weight was 1.145 kg. (2 pounds 8 1/2 ounces).  He was bagged for 15 minutes and was intubated.  Apgars were 5 at 1 minute, 5 at 5 minutes and 10 at 10 minutes.  Survanta was given and cultures were taken.  He was started on Ampicillian and Gentamicin.  UV and UA lines were inserted.  He was then transferred from the Grace General Hospital to the Janeway Children's Hospital.  The transfer was somewhat unstable because the batter had failed and he had to be bagged the entire route.

    Jeremy has a grade 3 intraventricular hemorrhage with blood into the ventricles and quite marked ventricular dilation.  He was on Acetazolamide for this.  There was also prominence of the 4th ventricle, cysterna magna subarachnoid space indication the hydrocephalus was presently communicating.  He is being followed by Neurosurgery.  Neurology and Child Development.  He has brisk reflexes and clonus suggesting early stages of cerebral palsy.  His tone is normal but is jittery when handled.  He is placed in Rehabitation for intense physio and he does see Occupational therapy for his fine motor skills.  He is also on the waiting list to see a speech therapist.

    Jeremy had respiratory distress syndrome at birth and received Surfacant.  He was intubated and ventilated for 10 days.  He did have chronic lung changes on chest X ray suggestive of bronchopulmonary dysphasia and has been on Hydrochlorothiazide and Spironolactone.  He was also on Fluticasone which has been discontinued.  At discharge he was doing well in room air.  The plan was to let him outgrow his diuretics and to not increase the dose.

    Jeremy had a Patent Ductus Arterious ligated at day 6 of life after a trial of Indomethacin failed.  His post-op course has been well and has been doing well ever since.  Otherwise the cardiac anatomy was normal.

    Jeremy has had his eyes checked and he has no signs of ROP.  He has had his ABRs done just prior to discharge and has passed these.  Initially Jeremy had a very poor cry after his extubation.  He has been followed by Dr. Burrage with ENT and it was thought to possibly be secondary to vocal cord damage.  However prior to his discharge Jeremy seemed to be crying well, so this problem has taken care of itself.  His immunizations are all up to date.

    Jeremy had a urinary tract infection found in hospital.  He has a voiding cystogram which showed bilateral vesical ureteric reflux.  He was placed on Septra once a day and tolerated it well.  He has a repeat urine done since and his urine has been clear and the reflux has since cleared itself.

    In summary, Jeremy is a 2 year old child who does have some motor and speech delay who is exhibiting some signs of consistent with cerebral palsy.  He will continue with his physio and occupational therapy through the Rehab Program.  With respect to his constipation he is given Lactulose once a day until the problem solves itself.  Follow up appointments are made with Dr. Price.  With respect to the question of a hearing loss, an ABR is scheduled to be done late August, 1999 and will be followed by Audiology.

    Update November, 2000

    Jeremy was found thru a sedated ABR to have a 40% hearing loss in both ears...he was fitted at that time for hearing aids.  He also was seen at the NSD (Newfoundland School for the Deaf) on June 13 and 22, 2000, for an audiological evalution.  Previous testing in the sound field indicated minimal responses in the Electroacoustic analysis and listening check indicated both aids are working within manufacturers specifications.   Jeremy seems to respond better when he is wearing his amplication, but indicated he will not wear them consistently.  He also had bilateral ventilation tube surgery on June 5, 2000.  (first one done April 10, 2000)  Results of testing using inserts and visual reinforcement audiometry indicated responses in the low normal range from 5000-4000Hz in the left ear and from 1000- 2000 Hz in the right ear, with speech audiometry in agreement with tonal findings bilaterally.  These results are considered of fair reliability.  Impedance testing indicated large physical ear canal volumes with flat tympanic tracings bilaterally, consistent with patent ventilation tubes bilaterally.  Jeremy will continue to wear his amplification and is encouraged to have him wear them more consistently.  He will be followed at NSD audiology again in the fall in conjuction with his Home Parent Program visits with Ellen Penny, who is teaching him some sign language.

    Jeremy also seen Dr. Devan (optician) and was noted to have a change in his eye sight since his last visit.  He has scheduled a recheck for 6 months and is considered a borderline patient for glasses.

    Jeremy is followed thru the Rehab seeing Physio, Occupational Thearpy, Speech Thearpist, on a regular weekly basis.  Progress is visible.   Community health and services home program makes regular weekly visits to work on some of his OT skills and speech as well.  He presently attends DayCare for 2 days a week with a one on one worker, to interact with other kids and learn how to maintain daily skills in a different atmosphere. 

    As of November 8, 2000, Jeremy weights 13 Kg (28.6 lbs), height - 87 cms, head circumference - 51 cms, all normal for a child his age.  He's discharged from the Perinatal Program as a 3 year old boy, with noticable disabilities, behind in some catagories for his age group.  Mostly related to his hearing loss.

    Update Jan - 2001

    On Jan 17 - 2001, Jeremy received his first Botex injections, which required surgery.  He received 8 injections, 4 into each muscle of both legs.  Dr. Buckley waited 10 days for the full affect and serial casted his right leg only in a prolonged stretch for 2 weeks.  After the 3rd to 4th day I noticed a difference in doing his stretches.  On Jan 22 - 2001, he received his 3rd set of bilateral ventilation tube surgery.  Other than that, he still goes to the School for the Deaf once a week and see OT on a weekly basis.

    Update September - 2001

    Jeremy has finished up seeing Rehab on a weekly basis and is attending the School for the Deaf on a full time basis starting Sept 4, 2001.  He was found thru another hearing test that his hearing has gotten worse.   He was fitted for new hearing aids and is doing well with these.

     Update March - 2002

   Jeremy was seen at the Shiner's Children hospital in Montreal March 1st, 2002 by Dr. Benaroch.  The first appointment was only suppose to be for an assessment for a possible Selective Dorsal Rhizotomy patient.  After seeing Jeremy, Dr Benaroch decided to wait on the Rhizotomy surgery and went ahead and did the BOTOX injections with triple the amount he was given in Newfoundland.  Second appointment was made in Montreal for the weekend after, March 8th, 2002 for Jeremy to be stretched and casted for 3 weeks.  Third appointment was made for March 25th, 2002 to have the cast removed.  Update to come later.

Update Oct - 2002

    Jeremy was seen in Montreal Oct 15, 2002 for the Selective Dorsal Rhizotomy clinic and it was decided at clinic to go ahead with the surgery.  Surgery is booked for June 2003.  Will update when know more information. 

July 18, 1997 - Patent Ductus Arteriosus (PDA) closure

Feb 3, 1998 - RSV

Mar 2, 1998 - Urinary tract infection

April 1, 1998 - Reflux of bladder

May 19, 1998 - RSV

Nov 2000 - ABR (discovered hearing loss)

April 10, 2000 - bilateral ventilation (tube surgery)

June 5, 2000 - bilateral ventilation (tube surgery)

Sept 2000 - serial casting

Jan 17, 2001 - botox injections

Jan 22, 2001 - bilateral ventilation (tube surgery)

Jan 26, 2001 - serial casting (right leg - 2 weeks)

Aug 1, 2001 - chicken pox

March 1, 2002 - botox injections (triple amount from nfld, done in Montreal)

March 8, 2002 - serial casting (both legs in Montreal)

March 25, 2002 - casts removed (Montreal)

Sept 10 - 2002 - bilateral ventilation (tube surgery)