*Neuro/HEENT: * Head proportionate to body size but patient is small for age. Fontanels are soft and flat, Small mouth with micrognathia and macroglossia; palate intact. Face is symmetrical, eyes slightly almond shaped with epicanthal folds and mild crust on lashes. Pupils equal and bilaterally reactive to light. Nares patent but evidence of discharge around nostrils. Ears are low set and not in line with outer canthus; bilateral hearing loss. Neck is soft with limited ROM due to trachea tube.
Cardiovascular: skin cool to warm and dry, no cyanosis, CRT<3, no edema, peripheral pulses 2+, Mobitz Type 2 Heart Block, faint murmur but no JVD, patient on tele - HR 70-120's.
Respiratory: Membranes pink and moist, chest symmetrical with bilateral expansion; breathing alternating between quiet and crackles and mostly unlabored, except when suction required. Lungs clear in all 4 lobes with occasional rhonci, indicating suction required.
Gastrointestinal: Abdomen soft and flat, bowels sounds hypoactive in all 4 quadrants, wet diaper count 2 (heavy), no BM.
Genitourinary: Male, uncircumcised. Right testes descended, left orchiopexy 2/8/17. Voids with diaper. Urine is straw-colored without unusual odor.
Integumentary: skin cool to warm and dry, NFE with slight jaundice, no odor or edema noted.
Musculoskeletal: Patient is smaller in stature for expected growth development; arms are equal in length with symmetrical movement. Grasping with left hand but right hand has some finger deformities/malformation- index and pinky fingers cross-over middle and ring finger.
Psychosocial: Mom arrives daily at approximately 8am and is active in the care of patient; very loving and attentive, clearly shares a strong maternal bond. Patient's maternal grandmother also visits frequently.