35 weeker with dips in heart rate-concern?

[t2000JC]

Hi,

general question--I was taking care of a 35 weeker whose heart rate would dip to the 80s briefly--I mean a second or two and then it would come right back up. It correlated with the pulse ox as well. Once it was 77. Other than that he is okay--he was admitted mainly because mom had prom. he isn't the greatest feeder but he eats. Is that dip normal--his pulse ox would stay steady at 99%. I read that 40% of pretermers have these dips, and as long as they don't last greater than 15 seconds they are benign and don't require treatment. I see self limiting bradys with a 25 weeker but a 35 weeker? Thoughts? I wasn't too concerned b/c he was doing well and the rns that endorsed him to me didn't mention it. But, now as usual I am racked with guilt the more I think about it; if his fdg improved he would have been d/c'd by now. please respond --thanks! t.

[prmenrs, RN]

sounds more IMMATURE than his/her dates would indicate.

I would definitely report my observations to the doc, along w/the slightly poor eating issue. Try not to let them d/c this one too fast.

Also try to advocate for a CRgram (or whatever your institution labels a 12 hour recording of the babies HR, RR, sat, and possibly nasal flow probe reading--they put a little thermister on the upper lip to see if air flow thru mouth/nose matches chest wall movement to determine if apnea is central vs obstructive).

Sometimes kids that old don't "meet criteria" for the CRgram, but in this case, I think it would be justified.

See my motto below:

[dawngloves, BSN, RN]

When does he brady? After or during feeds? While sleeping? Whenever? He does sound a little immature. Or maybr it's reflux?

[t2000JC]

He did it a couple of times in the AM right when I came on; and then I did not notice it after 12 noon. he has a low resting heart rate(90 to 100s). I did not notice it during feeds.

[KRVRN, BSN, RN]

If his normal resting HR is in the 90's or low 100's most of the time, I wouldn't think a brief dip into the 80's would be worrisome. I might be more concerned if his normal resting HR was more like 120 or 130. Then a dip to 80's is a 40+ drop. Am I understanding something wrong? We actually set our low HR limit at 80 for this age.

[Teshiee]

I have taken care of some babies with a low resting heart rate and they are fine w/occasional desat that self resolves. They sat in the high 90-100% I don't worry about it too much.

[carriec]

I Also think it is a low resting heart rate...

But with the feeding issue also, it makes you think that maybe there is something else that you need to look at...Was the mom GBS positive? Maybe baby showing some signs....

[prmenrs, RN]

old thread, check dates.....

[carriec]

Sorry, I'm new at this........

moving on......