Newborn with frothy sputum, please advise.

  1. We had a c-section baby, that had some difficulty breathing for a while. She was full term, mother had no health problems but had elective c/s. Baby was crying but grunting with retractions. I noticed that she also spit out frothy sputum. She did pink up pretty fast, but she was still having difficulty breathing, for at least 15 minutes, and then she improved after some chest PT and suctioning. They took her away for observation, but I would say she was not in critical condition.

    Could anyone say from their experience what this frothy sputum is all about? Thanks.
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  2. 16 Comments

  3. by   RaeT,RN
    Babies born via C/S (especially those that had no labor) do not get thier bodies and lungs squeezed like they do in vaginal deliveries. They often have respiratory difficulties for this reason.
  4. by   mstigerlily
    Exactly as the previous poster said. This is so common that our c-section babies generally spend their 1st two hours under observation in the well baby nursery. It's extremely common for them to have respiratory difficulties and be poor feeders for the first day or two till they get all that fluid out.

    The worst ones (as previous poster said!) tend to be the ones that are elective, that is, the mother didn't labor at all - they just went in and lifted the baby out without contractions starting.

    Quote from epiphany
    We had a c-section baby, that had some difficulty breathing for a while. She was full term, mother had no health problems but had elective c/s. Baby was crying but grunting with retractions. I noticed that she also spit out frothy sputum. She did pink up pretty fast, but she was still having difficulty breathing, for at least 15 minutes, and then she improved after some chest PT and suctioning. They took her away for observation, but I would say she was not in critical condition.

    Could anyone say from their experience what this frothy sputum is all about? Thanks.
  5. by   SmilingBluEyes
    Often, with csection babies, I "de-lee" ( using wall suction at 60-80mgmm) them immediately upon delivery, for the reasons stated above. They just do not get that "chest squeeze" that babies delivered vaginally do, and often when pulled out, often, they take a deep inhalation or swallow of amniotic fluids. I often find, the sooner de-lee'd, the better. I have gotten as much as in excess of 20-25 cc of this stuff from their upper airway! If I can get it before it's inhaled further down the airway, the better. Rarely, babies who are suctioned have problems like this later on---


    ----also having the skill of gentle chest and back percussion helps-----you can "cup" the babies' lung fields with an oxygen face mask to loosen secretions and then stimulate baby to cry them out. It WORKS! But to do this, you must be careful not to go too low---toward the kidneys--just the upper chest and back and you will be surprised what they bring up.

    Most of our babies do fine---few need even one minute in the nursery after csection birth, if percussion/vibration, stimulation and suction are used. Hope this helps.
  6. by   dawngloves
    In our facility. deep suction is contraindicated in a neonate until it is 3 minutes old. It can cause a vagal response that the baby may not recover from.
  7. by   live4today
    When did elective c-sections come about?
  8. by   mstigerlily
    Quote from cheerfuldoer
    When did elective c-sections come about?
    Well, there are scheduled csections for medical reasons and then there are elective ones where the mom just decides she wants one for one (non medical) reason or another. There is another thread going on now about this here:

    http://allnurses.com/forums/f35/why-...on-127274.html
  9. by   SmilingBluEyes
    Dawngloves, you are right about vasovagal-----we get a quick heart-rate before doing this---if low, we don't deep suction right away. That is where percussion and stimulation and bulb suction come in.

    I have yet to see a baby vasovagal and stay down there---- if done quickly and properly in the right conditions, unless baby was already sick. What I have seen is way too many babies struggling for hours to a whole day or more trying to bring up secretions---and poorly feeding as a result. Deep suctioning can prevent this in the right case.
    Last edit by SmilingBluEyes on Nov 1, '05
  10. by   live4today
    Quote from mstigerlily
    Well, there are scheduled csections for medical reasons and then there are elective ones where the mom just decides she wants one for one (non medical) reason or another. There is another thread going on now about this here:

    http://allnurses.com/forums/f35/why-...on-127274.html
    Thanks for the link to the proper thread regarding elective c-sections. I understand having a c-section for medical emergencies, but just for a mom to elect to have one surprised me because I did not know a mom could elect vaginal vs. c-section births without a medical necessity to do so.
  11. by   epiphany
    Quote from SmilingBluEyes
    Often, with csection babies, I "de-lee" ( using wall suction at 60-80mgmm) them immediately upon delivery, for the reasons stated above. They just do not get that "chest squeeze" that babies delivered vaginally do, and often when pulled out, often, they take a deep inhalation or swallow of amniotic fluids. I often find, the sooner de-lee'd, the better. I have gotten as much as in excess of 20-25 cc of this stuff from their upper airway! If I can get it before it's inhaled further down the airway, the better. Rarely, babies who are suctioned have problems like this later on---


    ----also having the skill of gentle chest and back percussion helps-----you can "cup" the babies' lung fields with an oxygen face mask to loosen secretions and then stimulate baby to cry them out. It WORKS! But to do this, you must be careful not to go too low---toward the kidneys--just the upper chest and back and you will be surprised what they bring up.

    Most of our babies do fine---few need even one minute in the nursery after csection birth, if percussion/vibration, stimulation and suction are used. Hope this helps.
    Hi SBE:
    Thank you for the cupping tip. I did observe the nurse cupping "high".

    So, you're saying that swift and early intervention prevents complications, and I should be prepared, especiall with c/s babies?
  12. by   SmilingBluEyes
    I do. But be SURE you check your policies and procedures re: deep-suctioning and percussion. You need to be properly trained and aware when they are and are not indicated. Dawngloves raised an excellent point, re: vasovagal reactions in certain newborns.
  13. by   prmenrs
    Quote from mstigerlily
    Well, there are scheduled csections for medical reasons and then there are elective ones where the mom just decides she wants one for one (non medical) reason or another. There is another thread going on now about this here:

    http://allnurses.com/forums/f35/why-...on-127274.html

    Don't forget that if Mom had an emergency section once, she often needs one again; depending on the aforementioned, it might be 'elected' to skip the labor trial, just section to avoid potentialing life threatening situations.

    Just because it's "elective" doesn't mean it's not really necessary.
  14. by   SmilingBluEyes
    The problem I have with 'elective" csections is when they are in healthy primips without medical indiction or reason. The elective repeat csection is a whole different case altogether. Very good point, prmenrs!

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