Premmie with aspiration pneumonia?
- 0Oct 9, '12 by fuyuojoI just wanted to ask what are the possible signs of aspiration pneumonia? We had a patient, a 30 weeker expired recently. The neonatologist says it might be aspiration pneumonia. That night, breast milk feedings via OGT of 4ml every 2hrs was given, and the last feeding was 2 hours prior to code. Tachycardic, no retractions, but with primary apnea, desats frequent. No oxygen was given. She was never intubated.Before endorsement for the next shift, the neonate vomitted suddenly, yellowish and with milk particles, then turned into blue hence a code was called. It was all so sudden, in 2 hours she was pronunced dead. She was pinkish the entire shift, not until he vomitted all over. The neonatologist says it is very impossible that the patient will vommit because we are only feeding her 4ml. However, there were reports of vomitting prior to these event when she was fed with 1ml.Thank you for your responses.
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- 0Oct 10, '12 by prmenrsI'm just guessing, but I suspect the baby was not tolerating feeding. If the pt isn't moving the food out of the stomach, you can have an emesis w/more food than you've been giving. Baby also could've refluxed (brought acidic gastric contents into the esophagus), felt pain ("heartburn") and become apneic. Or the baby could've gotten "septic" and then apnea.
That's actually 3 guesses. There are so many reasons premies "forget" to breathe and turn blue.
- 0Oct 10, '12 by babyRN.Sounds like there might be other contributing factors as well like nec.
I think I would have slapped some oxygen on her and stop the feedings after all the apneas and desats and would have done a septic work-up.
edit: also, if the kid was vomiting one just 1-2mL, that's pretty bad.
- 0Oct 10, '12 by fuyuojoUnfortunately, the parents have not opted to do an autopsy. I wish it was done too. The nurse noticed that when she pulled out the tube when she reinserted that shift, she noticed some green contents at the end of the tube. NEC? There were also instances that his stomach appeared somewhat shiny although his abdominal circumference was close to baseline.She's on antibiotics and the neonat does not entertain the thought of NEC. Although we, nurses, think that it might be NEC.
Too bad coz she's the second of the twin preemies. We thought she'll survive..
- 0Oct 10, '12 by babyRN.oh how sad we had a set of twins once and the first one was a feeder grower at the birth hospital and the other one came here for surgical nec and ended up with bilateral grade 4 IVH with hydrocephalus. Mom decided to send all her breast milk over here to help the more "sick" one and they switched the healthier preemie to formula.
Two days later we got that "healthy" twin over here, who died within the shift of overwhelming nec totalis. Makes you think maybe she should have saved the breast milk for that twin vs the one who already is probably going to have a limited life. totally breaks the heart...