Pseudomonas (aeruginosa) infection in neonate

  1. Hi everyone,
    I'm an adult SICU nurse, so I don't really know much about this subject, except that I do frequently see patients with respiratory pseudomonas. I just spoke with a friend whose friend's baby died a couple months ago from a pseudomonas infection. Here's what I know about the case: the baby was post-term, and mom was induced. She labored for 21 hours after her membranes were ruptured before they did a C-section. The baby (boy) apparently came down with a respiratory pseudomonas infection very quickly while in the hospital, was transferred to a more advanced NICU, was on ECMO, but died at 2 1/2 days old (they withdrew care). The other thing they told me was that there was meconium in his amniotic fluid.

    How common is this? What do you think is the likely cause of his infection? Is pseudomonas common in L&D?

    Thanks,
    Hillary
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  2. 10 Comments

  3. by   Gompers
    If he was only 2 days old and on ECMO for meconium aspiration syndrome, I don't think it's fair to say that the pseudomonas was the problem. I don't think I've ever seen any kind of bacterial pneumonia in a baby less than a week old. In the blood, sure, but not the lungs. True, if he acquired pneumonia very early on it didn't help, but the meconium aspiration is the bigger problem here. I'm guessing that if he was on ECMO, he was in full persistant pulmonary hypertension mode (blood shunting through the PDA out to the body and not stopping at the lungs to get oxygen), and that, in itself, is much more serious than pseudomonas.

    Just my opinion, of course.
  4. by   N.I.C.U._RN
    I have to agree with Gompers, that the Mec. Aspiration and PPHN probably was the bigger issue. Now if the baby had psuedomonas also, he could have had that from birth...2 days isn't very long time to acquire it from the hospital. So sorry for your friend's loss.
  5. by   HillaryC
    I guess it's peculiar that the parents were even told about pseudomonas, if the NICU team didn't think it was an issue. From what they told me, they were given the impression that the pseudomonas was the big factor in their son's death. However, as I said before, I'm not a NICU nurse, so I'm very unfamiliar with all of this. Could the fact that mom went 21 hours after ROM before C-section have something to do with it? At what point are sections usually done? 24 hours is the max, right?

    If the pseudomonas came from mom, where was she likely to have picked it up? Also, since someone said it's seen more often in the blood, am I correct to assume it's for the same reasons as in adults (i.e., often from central venous lines)? I'm pretty sure my friend (the mom's best friend) said it was respiratory, but I haven't talked to the baby's mom directly. She did, however, mention that they were wondering if the baby could have gotten the pseudomonas during suctioning, so that leads me to believe it was indeed respiratory.

    Such a sad situation.
  6. by   BittyBabyGrower
    Wow, sorry about their loss. I have to agree...I think that it is more the MAS than anything. Those kids do tend to get pseudomonas, but it is usually down the line as they had literally crap in their lungs and it can be a wonderful medium for stuff. I can't say that I have ever seen a baby born with pseudomonas in the 20 years I have been working, that is more a hospital acquired bug. It is also pretty rare to get it from aeseptic technique. I think that the facts are a bit messed up, and it being 2 or 3rd hand info makes it harder. Usually those kids that need ECMO for MAS are pretty bad off and the outcome isn't usually good. He could have been septic in utero, but pseudomonas would be pretty rare.

    They do let mom's labor for up to 24 hours if there aren't sign of distress or infection. It is a hard call without knowing all the straight facts.

    In the neonatal population, most of the time the pseudomonas starts in the lungs, and if they are colonized we don't treat usually, but then if they become symptomatic they do cultures of blood, urine, etc and begin treatment.
  7. by   dawngloves
    I'm sorry to hear of your friends loss. I have never seen a baby expire from pseudomonas. Usually the pts that end up with it in our facility are long term vented kids, never a newborn or anyone less than a month for that matter.
  8. by   babynurselsa
    I have seen in twice. Tragic outcome each time.
    After which Infection Control swabbed anything water related in the unit. The water bottles at the bedside we used for oral care, the one for the leads,, the humidifiers for hoods ands vents,etc . Nothing difinitive was found though it did grow in one of the oral care bottles.
    I think L&D also got cultured.
  9. by   HillaryC
    Thanks again to everyone who responded. I'm seeing my friend next week, so I'll hopefully get more information. I hear what you all are saying about the meconium aspiration being the more likely culprit for such a rapid onset illness.

    Are C-section babies more likely to have problems when there's meconium in the amniotic fluid (because their lungs don't get "squeezed")? Also, I've never understood this: what causes the baby to have a BM in utero? Does something bad have to be going on for the baby to have a BM, or does it just happen sometimes?

    Thanks again to everyone. I'm fascinated with NICU. At some point I may have to give up on grown-up patients and join you guys!
  10. by   Jolie
    Quote from HillaryC
    Thanks again to everyone who responded. I'm seeing my friend next week, so I'll hopefully get more information. I hear what you all are saying about the meconium aspiration being the more likely culprit for such a rapid onset illness.

    Are C-section babies more likely to have problems when there's meconium in the amniotic fluid (because their lungs don't get "squeezed")? Also, I've never understood this: what causes the baby to have a BM in utero? Does something bad have to be going on for the baby to have a BM, or does it just happen sometimes?

    Thanks again to everyone. I'm fascinated with NICU. At some point I may have to give up on grown-up patients and join you guys!

    My sincere condolences to your friend and her family. I can't imagine a more heartbreaking situation.

    I agree with the others that the MAS and PPHN are far more likely causes of the baby's death than a pseudomonas infection. Pseudomonas is usually hospital acquired, a late onset infection. Babies who develop pseudomonas have usually been on long-term ventilation. I haven't been able to find any articles describing pseudomonas as a cause of infection at birth.

    Babies can pass meconium in utero for a couple of reasons. At about 35-36 weeks gestation, meconium makes its way to the lower gi tract. From that point on, anything that causes the anal sphincter to lose tone can result in meconium being passed into the amniotic fluid. A period of hypoxia can cause loss of sphincter tone. This can result from temporary cord compression, temporary drop in mom's B/P, baby gripping the cord, etc. Also, in breech babies, sometimes gravity and the pressure of the baby's anus against the cervix is enough to cause the anus to dilate.

    When the stool is passed, it mixes with the amniotic fluid that surrounds the baby. As the baby practices breathing movements, meconium stained fluid is drawn into the baby's upper airway. This is not a problem until the birth of the baby, when actual breathing movements draw this stained fluid into the lower respiratory tract, where it can cause a severe chemical pneumonia, and interfere with the respiratory and circulatory changes that normally occur at birth. This can result in persistent pulmonary hypertension, a life-threatening complication of meconium aspiration.

    At birth, a nurse, respiratory therapist, or physician must immediately suction the meconium out of the baby's upper airway, then visualize the baby's vocal cords. If they are stained with meconium, the child is intubated and the lower airway is also thoroughly suctioned to remove as much meconium as possible. This procedure has been effective in significantly reducing the morbidity and mortality from meconium aspiration in newborns. I am sorry that it didn't help in your friend's case.
  11. by   babynurselsa
    Passing meconium prior to delivery denotes that the baby was experienceing stress inutero. This may have been due to decreased placental perfusion, cord compression, etc. Usually something anoxic in nature that causes the anal sphincter to relax and the baby passes stool. The larger issue is usually how long prior to delivery that this occurs. Babies that have had thos occur many hours or days prior to delivery are more at risk than a baby that passes meconium shortly prior to delivery. The bile salts which is what meconium is largely composed of can damage the lungs much like a chemical burn as the infant "breathes" in the amniotic fluid. This in turn will cause an inflammatory response, along with an aspiration pnuemonia. The meconium gets trapped into the alvoeli causing a ball valve effect which will result in hyperinflation of the alveoli.
    Any one of the things that happened in this situation as you know it can cause a very sick baby. Combined, even worse.
    I am so sorry for this mom and dad.
  12. by   Deidre Shiobhan
    Very sorry for the loss, from what I gathered this baby sounded like a case of PPHN and MAS. The very bad ones don't usually make it, its rare for newborn to acquire pseudomonas this early as it's always acquired after a period of prolonged ventilation.
    Prolonged labour can be both very stressful for the mom and the baby. It's very important to have good CTG tracing to serve as a guide so intervention can be make apoppriatelly.

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