Cardiac Tamponade

[jazzbearyjam]

I am actually a cardiac nurse educator, but had a question about cardiac tamponade as it may relate to my preemie, which unfortunately passed away six months ago. I had twins at 30 weeks, boy and girl, 3lbs 2 oz & 2lbs 14 oz. My little girl was on the vent for a day then quickly weaned off and did very well until day 5 when she had a sudden onset brady with subsequent desaturation. Unlike my little guy, she had never had any bradys before, she was off O2 and doing well. They coded her for 35 minutes gave her 8 rounds of epi, bicarb, intubated etc, none of which she responded to. We had an autopsy done that didn't really reveal anything. She had 15 mls of milky white fluid in her pericardial sac. She did have a PICC line placed two days before and it looks like it was infusing about 6mls/hr.

We had another pathologist review the autopsy and he found it curious about the pericardial fluid, but thought it may have due to the compressions during the code.

I know with adults the pericardial sac can accumulate a considerable amount of fluid before tamponade occurs, but I was wondering how much fluid could cause that in a preemie. I did some research about CVCs and cardiac tamponade in preemies and to me that seems most likely what happened. I also recently reveiwed a case in which a 26 week baby coded, same sort of onset,which they preformed a pericardialcentesis, drew off 4 mls and the baby survived. The PICC tip was in the atria, they replaced the PICC that baby is chugging right along. That's when the little light went on in my head!

Has this ever happened to any of you all and is that a lot of fluid for a preemie?

[SteveNNP, MSN, NP]

I'm so sorry for the loss of your little one. Unfortunately it is not the purpose of this forum to offer medical or legal issue advice. Thanks for your understanding.