My first case of NEC

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    Came in after 5 days off and found out one of my babes developed NEC and was sent to our nearest tertiary center the day after I had her. I want to throw up. I need to stop with the what ifs, but it's hard to not go there. Three years in our level 2 and this is my first. I hope she comes through ok.
    Esme12 likes this.
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  4. 3
    Hang in there. NEC sucks.
    twinkletoes53, poppycat, and Esme12 like this.
  5. 0
    NEC really does suck.
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    NEC is one of the most dreaded complications that a premature infant can develop. I hate it with a passion. And you can do everything that you are supposed to do---monitor the infant closely, notify the doctor at the first sign of feeding intolerance, abdominal distention, guaiac positive stools, etc. And still lose that baby.
    I cared for an infant once who was po feeding, room air, no pre-existing factors for sepsis, doing "well". Three hours into my shift, at 0200, he had his first guaiac + stool. I notified the on-call doctor, who came and examined him. He had no other symptoms, was still active, responsive, vital signs stable. Abdominal X Ray was negative. Doc said to continue to feed & monitor. Within 12 hours he had died from what his doctors described as "fulminating NEC". I was shocked. So many "what ifs". Should we have placed him NPO immediately? Should we have done blood work? Started serial abdominal films? Started antibiotics? Would it have made a difference? He went from being asymptomatic to being in full blown septic shock from NEC within a few hours.
    Another patient in our NICU was an ex-preemie was in an open crib, po feeding, slated for discharge within a couple of days. The nursing staff went home that morning, only to return 16 hours later to find him with a severe case of NEC, with pneumatosis on X ray, followed by bowel perforation within another couple of hours. He too did not survive. How do you tell a parent that their son, who had battled months of complications related to prematurity, and overcome one obstacle after another, was not going to be going home? It breaks my heart.
    Bortaz, RN likes this.
  7. 3
    The 24 weeker that I oriented on as a new NICU nurse...man, I loved that little girl...she was my first premie, my first time falling in love in the NICU, my first NEC case and my first baby death. It devastated me. We actually lost 2 to NEC that day. Both out of the blue as twinkletoes described. I will never forget that day if I live 1000 years.
  8. 1
    Thanks for the stories. As awful as it is, it does help to know it happens even under close monitoring. We have a lot of grower feeders and all are over 31 weeks, so it was shocking. Especially that she was pink and normal on my shift and the next day she was grey and septic. She was going for an exploratory laparotomy yesterday last I heard, so maybe I'll get an update on my next set.
    twinkletoes53 likes this.
  9. 1
    That so sucks, Bortaz. My first NICU death was a hemopericardium/cardiac tamponade. We tried so hard to save that little girl, but she wouldn't respond to anything. I'll never forget watching helplessly until it was called - by then the transport neo had taken over. Still makes me cry thinking about it.
    Bortaz, RN likes this.
  10. 1
    Quote from boardchic
    Thanks for the stories. As awful as it is, it does help to know it happens even under close monitoring. We have a lot of grower feeders and all are over 31 weeks, so it was shocking. Especially that she was pink and normal on my shift and the next day she was grey and septic. She was going for an exploratory laparotomy yesterday last I heard, so maybe I'll get an update on my next set.
    Have heart..it may not have been obvious when you had the baby.

    One of the two things that I have noticed a baby will start doing, before other symptoms show up, is that they will fail to wake up for feeds (as much) as get really floppy or have less of reaction to pain stimuli from lab draws.

    At our facility, we also tell each other in report if a baby was "early" or a "late" feeder (for a round) and we have a very, very strict protocol on how long to infuse gavage feeds. If a baby is NG fed, we check for residuals at every feeding...which is something some NICU's don't do.
    twinkletoes53 likes this.
  11. 4
    Everyone with any time in the NICU has a NEC story, one that happened to their baby, not just some kid you heard about, it's that common. With the kid I cared for, she wasn't right at the 8pm feed, but nothing you could say for sure, green residual at 11pm, receiving PPV at MN while we set up an oscillator. 18hrs later we were withdrawing support, no viable bowel left.

    NEC is evil.

    Some of the more experienced nurses tell me of the pre-surfactant days and how they watched so many babies die of RDS and what a miracle surfactant was. I want to tell outdated stories about NEC like that one day before I finish my career, how it used to get so many of our kids.
  12. 0
    Quote from Jory
    Have heart..it may not have been obvious when you had the baby.

    "One of the two things that I have noticed a baby will start doing, before other symptoms show up, is that they will fail to wake up for feeds (as much) as get really floppy or have less of reaction to pain stimuli from lab draws.
    ...and we have a very, very strict protocol on how long to infuse gavage feeds. If a baby is NG fed, we check for residuals at every feeding...which is something some NICU's don't do.
    "

    One of the early signs of sepsis is lethargy, as Jory described. You may also note a change from baseline v/s: infant hypo or hyperthermic. Usually hypothermic. If the baby is in an Isolette, you may see a change in his baseline ambient temperature. e.g. he was able to previously maintain a temp. WNL with an Isolette temp. of 29 degree Celsius. As the hours pass, you note that he now requires an Isolette temp of 32-36 degrees Celsius to maintain his temp.WNL. Other v/s will change, too. Hypotension, tachycardia, increased WOB, increase in apneas, bradys, and desats., abdominal distention, visible dilated loops of bowel, etc.
    As in Jory's hospital, we also had a strict protocol for NG feeds, and measured residuals before each feeding. A residual of up to 20% of the previous feed was considered acceptable.
    Anything over that amount was reported to the resident on duty.



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