I am a geriatric nurse who recently delivered my first child, a son at 33 weeks, very unexpectedly. Sam spent 15 long days between the NICU and the CCU at Baystate Medical Center in Springfield, Mass.. The nurses and ta's were all wonderful. It's one thing to feed or suction a geriatric patient through a NG tube, but to have one in my son was absolutely terrifying. IVs, CPAP... All situations and procedures I was familar with in older people came to haunt me as I thought of the associated complications, and in a preterm baby who was mine. I felt absolutely helpless, and Sam luckily was one of the healthier babies. He was 5lbs 1oz and had a relatively uncomplicated stay. The staff encouraged me in his care and made me feel capable and comfortable as a mother. The nurses were right, once all the leads and IVs were off, he was easier to care for. You NICU nurses are wonderful and are truly lifesavers I hope that you are well rewarded. I am forever grateful and in awe of the skills that you preform so expertly. thank you .....ps..occasionally I've observed my son having an extremely pale (ghostlike) episode: respirations normal, no cyanosis, occurring when he is sleeping. When I startle him I see the color come back to his face suddenly we have had this worked up and all tests wnl. Any suggestions??? Could it be reflux?? Keep up your wonderful work, we need you.
Jun 5, '03
Thank you for your kind words, and congratulations on your new son! Let me just say that I am equally amazed by what you do every day, caring for elderly and frail patients, and am grateful that you and your co-workers are there for people like my elderly aunt. I am amazed by your skills and patience, as I know that I would never be able to do what you do.
Now for your question... call the pediatrician ASAP and ask to have your son evaluated. It is possible that he is refluxing, and it is also possible that he is having obstructive apnea. With obstructive apnea, the baby appears to be breathing normally, but the airway is blocked, so despite the appearance of normal respiratory effort, no air is getting into the lungs. This will cause a drop in oxygen saturation and possibly a color change, as well as decreased heart rate. When you startle him, he gasps and/or shifts positions, thus relieving the airway obstruction.
Did he have a cardio-pneumogram prior to discharge? If not, this may be a good time to do one to determine whether a monitor or medication is needed.
Good luck to you. Let us know what you find out!
Jun 6, '03
thank you, Sam did not have a cardio-pneumogram, and an apnea monitor was not reccomended since his sats were always above 94%. I will speak to his pedi about it. His tongue does stick to the roof of his mouth frequently during feedings. I now recognize the suctionlike sound even before I open his mouth. It used to make feeding very difficult but is now lessening. When I told his pedi and the ER doctor about these pale episodes they were clueless and I could tell they thought I was an over anxious new mother of a premie. The ER nurse even asked me if while I burped him could I possibly be constricting his carotids. That just gives us a glimpse of the type of people emergency room nurses run into. WOW.
Jun 6, '03
try acid test from his mouth with a lithmus paper(will turn pink if+) to see if he`s got a reflux.Everything is still related to prematurity.I can imagine how worried you are about the pale episodes,they have that sudden onset maybe once or twice in 24hrs.,they recover quickly as soon as you stimulate them or open the airway or sometimes burp them, and when you rush to ER sats will be 100% then docs will think you are an over anxious mom coz if the baby will be admitted for observation he might not have it in 24hrs or more.It is your baby if you are really worried and for your peace of mind ask your doc about apnea monitor coz you still got a long way before his muscle control/airway etc. r sorted.b4 you go to sleep try to position him in a way that his airway is not obstructed(neck on neutral position f difficult,improvise with tiny cloth roll that can`t cover his face),if u suspect reflux slightly elevate his head part(maybe a small pillow under the mattress) in a way he is not going to slide down to the very bottom of the crib.At the moment try to relax(easier said than done),sometimes your baby can empathize with what you are feeling.