why do the babies chests thump?

NeoRNtobe · Oct 28, 2004

I volunteer in a NICU stepdown but got a chance to see the Level 3 NICU the other day. I must say nothing I imagined compared to the NICU babies I saw. I was wondered why were some of the babies chests thumping? They were on some machine that caused this. I thought it had to do with gaseous exchanges..is that right?

I thought I wanted to work in NICU but it blew me away...did any current NICU nurses feel this way?

cswain12000 · Oct 28, 2004

Hi!! I think that what you were seeing was a high frequency oscillating ventilator, or what we affectionately call "The Oscillator". It is kind of the big guns of ventilators.

When preemies are on conventional ventilators, they often develop stiff lungs caused by barotrauma of the inflate-deflate cycle and also from the pressure required to push the air into those lungs, thus developing a nasty cycle--stiff lungs--require higher pressures to ventilate leading to more trauma and stiffness.

The oscillator pushes very very small tidal volumes very rapidly across the lungs, and because of the mechanics of how it works, the alveoli stay at a constant state of "openness". Thus there is not the need for high pressures to reopen the alveoli after each breath as on a conventional ventilator. Because of the frequency of these very tiny, very rapid "breaths"--it appears that the baby's chest is vibrating. Hope this helps explain what you were seeing. I have a hard time putting it into words. I know how it works, and why it works, just don't know how to explain it :) cindy

cswain12000 · Oct 28, 2004

Hi!! I think that what you were seeing was a high frequency oscillating ventilator, or what we affectionately call "The Oscillator". It is kind of the big guns of ventilators.

When preemies are on conventional ventilators, they often develop stiff lungs caused by barotrauma of the inflate-deflate cycle and also from the pressure required to push the air into those lungs, thus developing a nasty cycle--stiff lungs--require higher pressures to ventilate leading to more trauma and stiffness.

The oscillator pushes very very small tidal volumes very rapidly across the lungs, and because of the mechanics of how it works, the alveoli stay at a constant state of "openness". Thus there is not the need for high pressures to reopen the alveoli after each breath as on a conventional ventilator. Because of the frequency of these very tiny, very rapid "breaths"--it appears that the baby's chest is vibrating. Hope this helps explain what you were seeing. I have a hard time putting it into words. I know how it works, and why it works, just don't know how to explain it :) cindy

NeoRNtobe · Oct 28, 2004

Well I thought that was very well explained b/c I understand it! Thanks! I have another question for ya. My roommate has a test question that she doesn't know the answer to. Maybe you do?

In reference to food allergies, why are parents with babies under 6 months told not to feed solid foods?

She is in a masters program to become a Registered Dietian so the answer should have to do with metabolics.

thanks in advance

NeoRNtobe · Oct 28, 2004

Well I thought that was very well explained b/c I understand it! Thanks! I have another question for ya. My roommate has a test question that she doesn't know the answer to. Maybe you do?

In reference to food allergies, why are parents with babies under 6 months told not to feed solid foods?

She is in a masters program to become a Registered Dietian so the answer should have to do with metabolics.

thanks in advance

Gompers, BSN, RN · Oct 28, 2004

Yes, the oscillator is a pretty scary thing when you first see it, or shall I say HEAR it. It's very loud, very big, and makes the babies vibrate something crazy! A regular ventilator is just like what Darth Vader uses...breath goes in, breath comes out, breath goes in, breath comes out. Oxygen goes in, carbon dioxide comes out, oxygen goes in, carbon dioxide goes out. An oscillator blows up the lungs and then keeps them inflated, pushing new air into the lungs at the same time as the old air is seeping out. So you have a constant state where the lungs are getting fresh oxygen while getting rid of carbon dioxide. It makes for a much better gas exchange because it's continuous, and since there is better gas exchange you often need less pressure, which means less lung damage. The reason the baby vibrates is because the machine sends well over 100 breaths per minute into the baby!

The way I always explain it to parents is pretty basic, but gives enough vital information, I think:

A regular ventilator...if you have a balloon, and you keep blowing it up, then letting it deflate, then blowing it up again, etc...eventually that balloon is going to loose it's elasticity. It's going to get brittle, develop weak spots, and eventually it'll either get too hard to blow up, or it'll bust when you do get it inflated. The more pressure you're having to use blowing up that ballon each time, the quicker that balloon is going to go bad on you. If you don't need to blow that hard to inflate it, it'll probably be okay because you're not stretching it to the limit... but if it's a tough old balloon, and you're blowing like crazy to get it inflated...not good!

An oscillator...air blown into the lungs continuously, so the lungs never deflate. It's like blowing up a ballon, then keeping the end in your mouth and blowing in and sucking out at the same time, so that the amount of air in the balloon stays pretty much the same. Yep, the machine can do that! The less you inflate and deflate that balloon, and the softer you have to blow...the longer that balloon is going to last without getting damaged.

I also use the balloon analogy with surfactant - you know, the whole thing about how preemie lungs are like balloons with no powder in them? If you add powder, it's much easier to blow up the balloon without it collapsing and sticking together inside.

Gompers, BSN, RN · Oct 28, 2004

Yes, the oscillator is a pretty scary thing when you first see it, or shall I say HEAR it. It's very loud, very big, and makes the babies vibrate something crazy! A regular ventilator is just like what Darth Vader uses...breath goes in, breath comes out, breath goes in, breath comes out. Oxygen goes in, carbon dioxide comes out, oxygen goes in, carbon dioxide goes out. An oscillator blows up the lungs and then keeps them inflated, pushing new air into the lungs at the same time as the old air is seeping out. So you have a constant state where the lungs are getting fresh oxygen while getting rid of carbon dioxide. It makes for a much better gas exchange because it's continuous, and since there is better gas exchange you often need less pressure, which means less lung damage. The reason the baby vibrates is because the machine sends well over 100 breaths per minute into the baby!

The way I always explain it to parents is pretty basic, but gives enough vital information, I think:

A regular ventilator...if you have a balloon, and you keep blowing it up, then letting it deflate, then blowing it up again, etc...eventually that balloon is going to loose it's elasticity. It's going to get brittle, develop weak spots, and eventually it'll either get too hard to blow up, or it'll bust when you do get it inflated. The more pressure you're having to use blowing up that ballon each time, the quicker that balloon is going to go bad on you. If you don't need to blow that hard to inflate it, it'll probably be okay because you're not stretching it to the limit... but if it's a tough old balloon, and you're blowing like crazy to get it inflated...not good!

An oscillator...air blown into the lungs continuously, so the lungs never deflate. It's like blowing up a ballon, then keeping the end in your mouth and blowing in and sucking out at the same time, so that the amount of air in the balloon stays pretty much the same. Yep, the machine can do that! The less you inflate and deflate that balloon, and the softer you have to blow...the longer that balloon is going to last without getting damaged.

I also use the balloon analogy with surfactant - you know, the whole thing about how preemie lungs are like balloons with no powder in them? If you add powder, it's much easier to blow up the balloon without it collapsing and sticking together inside.

mitchsmom · Oct 29, 2004

In reference to food allergies, why are parents with babies under 6 months told not to feed solid foods?

I am not the person you were addressing but I may be able to help with the question...

"Delaying solids decreases the risk of food allergies.

It is well documented that prolonged exclusive breastfeeding results in a lower incidence of food allergies (see Allergy References and Risks of Artificial Feeding). From birth until somewhere between four and six months of age, babies possess what is often referred to as an "open gut." This means that the spaces between the cells of the small intestines will readily allow intact macromolecules, including whole proteins and pathogens, to pass directly into the bloodstream.This is great for your breastfed baby as it allows beneficial antibodies in breastmilk to pass more directly into baby's bloodstream, but it also means that large proteins from other foods (which may predispose baby to allergies) and disease-causing pathogens can pass right through, too. During baby's first 4-6 months, while the gut is still "open," antibodies (sIgA) from breastmilk coat baby's digestive tract and provide passive immunity, reducing the likelihood of illness and allergic reactions before gut closure occurs. Baby starts producing these antibodies on his own at around 6 months, and gut closure should have occurred by this time also. See How Breast Milk Protects Newborns and The Case for the Virgin Gut for more on this subject."

from http://kellymom.com/nutrition/solids/delay-solids.html

She lists more references and sources of info on the page.

There are other reasons for the recommendation as well. Waiting until 6 months of age to start solids lengthens infertility that some women have, thereby spacing babies further (which is healthier), maternal weight loss is affected, and there is an increase in certain cancers (breast, ovarian). For the infant, giving solids earlier results in a general increase in morbidity and mortality, lower IQ, the introduction of less nutritional food earlier, disrupting the healthy flora of the gut, etc. etc. These are many reasons, these were just some notes I wrote about it at a presentation about it at a conference in 2002 by Audrey Naylor. She is the CEO of Wellstart Intern'l - here is a page about how the recommendation went from 4-6 months to 6 months of exclusive breastfeeding: http://www.wellstart.org/exclusivebf.html

Some of the aspects apply to certain populations more than others.

Probably more than you wanted to know, hope it helps! :)

prmenrs, RN · Oct 29, 2004

re: the nutrition question: current studies (the reference is @ work of course) indicate that if the baby breastfeeds (not drinking breastmilk from a bottle, not the same thing) exclusively for 6 months, they have fewer food allergies, fewer ear infections, and ?score 10pts higher on IQ. Try to find a Lactation Consultant to talk to about all that.

mischievium · Oct 29, 2004

There are other reasons for the recommendation as well. Waiting until 6 months of age to start solids lengthens infertility that some women have, thereby spacing babies further (which is healthier), maternal weight loss is affected, and there is an increase in certain cancers (breast, ovarian).

mitchsmom-- did you mean to say there is a DECREASE in certain cancers?

mitchsmom · Oct 29, 2004

mitchsmom-- did you mean to say there is a DECREASE in certain cancers?

yes, I meant decrease... I reworded that phrase when I should have left it alone... :)