Aspiration Pneumonia in Neonates

[ilovetiggerdear, LPN, LVN]

Hi. I'm a fairly new NICU nurse and it was my first time last night to encounter a neonate who expired that was initially diagnosed with aspiration pneumonia. I would just like to know what would be the initial management for newborns with those condition? For those who were managed early, what's the prognosis?

Just a background: Infant was only 2 days old, delivered by a midwife @home and according to the mother was being breastfed when he suddenly started coughing. After tapping his back, he was apparently well until few hours PTA when he became cyanotic. When the baby was transferred from the ER to the NICU, he was already limp, has a plethoric face? pupils were fixed and was being ambubagged. He expired. Thank you very much in advance.

[BittyBabyGrower, MSN, RN]

My best bet is that the baby had something else wrong besides aspiration.

[dawngloves, BSN, RN]

Agreed.What did his films look like?

[HappyBunnyNurse]

Undiagnosed congenital heart disorder? Malformation of the digestive system?

[dawngloves, BSN, RN]

It could have been something as simple as sepsis. A neonate can go down the drain just like that if not managed ASAP.

The reason I don't think it was asp. pneumonia is that a term baby aspirating while breastfeeding is unlikely. A healthy term baby expiring from such an event is very unlikely.

In the event we think a pt has aspirated, we'd follow them clinically, serial x rays, o2 requirement, gases. Intubated if necessary, may need a jet vent, a term kid may end up on nitric.

[NICU_babyRN, BSN, RN]

This doesn't sound like asp pneumonia. TEF maybe or heart condition. maybe a ductal dependent lesion. Autopsy?

[EricJRN, MSN, RN]

To go along with what the others have said, consider that the presentation for congenital heart disease tends to be pretty subtle at first. In hospitals that don't routinely see pedi cardiology cases, it can be a very tough thing to catch, even if the baby is brought back to the ER semi-stable.

Most commonly, the baby with CHD begins hours to days after birth by just breathing a little fast - with no increase in O2 requirement (sometimes referred to as being "comfortably tachypneic"). As the hours go by, a big red flag is that the baby will start to tire with feeds or refuse them. Later, the cyanosis occurs - often during a subsequent feed. Because CHD kiddos can sound "wet" when they come in and because the onset often seems linked with a feed, it is natural to think aspiration.

Almost all of the aspiration seen in neonates is related to meconium. As dawngloves says, high-frequency ventilation and inhaled nitric oxide may be needed. For our mec aspiration babies that don't respond to nitric, we can evaluate them for ECMO. (In fact, mec aspiration is just about the ideal diagnosis for ECMO and has awesome outcomes.) I haven't seen a significant non-meconium aspiration in a neonate, but I know that these therapies can be used for various forms of pedi and adult aspiration.

[SteveNNP, MSN, NP]

I'm a little late to this discussion, but the first thing I though of reading the description was that the baby had some form of ductal-dependent heart disease. It was a classic presentation.

Aspiration pneumonia does happen, but doesn't usually kill that soon. The baby often ends up on the vent, Vanc/Zosyn for broad-spectrum gram positive and negative coverage, and sometimes iNO.