I had a situation the other night and need some insight on and also need to learn what was going on. I had a G2P1, come in @0030 and delivered by 0123. She only pushed for 20 minutes. Babe was a good size 3672Gm. UPon initial assess I thought he sounded a little "crunchy" on the left, while listening to left lung field. Heart rate good @ 136. A little extremity cyanosis, nothing I thought to be worried about. Mom attempted nursing, and with much difficulty got him to latch about 10 minutes each side. At 0300, I went to do a blood glucose, it was 2.1(in Canadian terms) approx 38 in US terms, which by our accounts is pretty low. Normal in infants, I think is 4-8. So I cup fed him 20cc of similac, mom was ok with this, she had to supplement 1st babe for the first few days. At 0400, babe blood sugar was 2.5(45 US). Not great I thought, but kid beared close observation. 2 hours post-delivery and kid had not mecced or voided. OK, I did frequent checks on sleeping baby. At 0600,whether it was a gut instinct, 6th sense or something just didn't right in my mind, I woke him up for a full assessment. Temp 36.2C, R 44. HEART RATE 96. My heart rate was faster than his. I double checked/triple checked. Then put him on telemetry to check again and I was correct. I then put him in our isolette, put an O2 sat monitor on him. Sats were,92-95%, okay now I'm nervous. I then called the Dr. and he said he would be right round to see him. (30 minutes later). Prior to calling him ,I tried to a blood sugar that would not read, said error for some reason. I then called lab and extra staff member. I am the only RN on nights, with and LPN. BLess her heart, she is one of the best, but their scope of practice is very limited in our facility. She made phone calls for me, got equipment AND took care of the other 10 patients on the floor. Our Lpn's cannot give meds,etc. As it turned out the blood sugar @ 0700 was 2.8(50). The DR showed up just as the lab tech was drawing blood and of course the kids heart rate increased to 120-130, but was still lethargic. I turned over care @ 0730, just as we were getting a B/P, 74/15. To say the least @ that time I got the hell out of there. Turns out our doc, phone the neonatal team in the city and they came and got the kid. Prior to the team getting there, day staff, did a CXR, started an IV and gave him some Amp and Gent.
Bottom line guys A) did I do ok? B) What the heck was a matter with him. I believe (correct me if I'm wrong), kids compensate very well, but when their heart rates go down, you can be looking a some serious trouble.
Thanks for listening to such a long-winded post, but your guidance and input are valued. Will keep you updated on kids condition if you like.
My thoughts, exactly. (well, except for I wouldnt have said it so well :).
How well the baby tolerated the ambulance ride to the tertiary care facility may be very telling. Nothing like bumping a kid over rough roads for 30 minutes to make a mildly ill newborn crump, or a perfectly normal newborn wake up and become vigorous!
Aw, thanks. :)
Seriously agree about the ambulence ride! I've gone on so many transports for term newborns that were r/o sepsis or mild RDs - and by the time we get back to our unit with the kid, the child has transitioned and is doing great - only now is NPO and madder than heck! :rotfl:
I do understand that things are different in NBN than in NICU. In NICU, you have the luxury of "watching" kids to see how they do, knowing that neo nurses and docs are right there. In NBN, I too would be a bit more cautious because having a kid crump there is scary as heck.
Guess the kid's hypoglycaemic because of insufficient feeds and that can contributes to lethargy. You didn't mention any blood gas results so therefore may not be conclusive that it's a respiratory condition, must find out how's the x'ray. It's not surprising for term infants' heartrate to be in the 90s when they are resting however always remember to keep newborns warm because cold stress can lead on to other complications especially respiratory. A PDA may be a reason for the wide pulse pressure anyway you'll have to call the hospital and find out what happen to the kid anyway.
I find the ' dump baby syndrome ' description very interesting and funny probably it's also applies to some of my babies in the unit too.:rotfl:
Dumb babies...non-NICU nurses, please don't get offended by that term - it's one that we use almost endearingly towards big, healthy looking babies that should be at home with their mothers but are in the NICU instead, having minor problems with eating and breathing.
Whenever I hear that term, I think about this one article from The Onion that my husband always laughs about. Now, don't read this article if you are easily offended. The Onion is 100% sarcastic 100% of the time. It's a great little newspaper that is just complete satire. You usually find it in the doorways of record stores and city bars, and all over college campuses.
"Big Wimpy White Boy Dumb Baby Syndrome" Kind of a mouthful don't you think?
I love this diagnosis! Too true! With us, he would probably have had 4 hours being observed, but not admitted Also he'd have been fed at least 1 1/2 ounces of warm formula after his blood glucose was drawn. If he didn't get his act together in that time, then we'd probably do a septic work-up,depending on the doc.
:roll 
Gompers, BSN, RN
2,691 Posts
Aw, thanks. :)
Seriously agree about the ambulence ride! I've gone on so many transports for term newborns that were r/o sepsis or mild RDs - and by the time we get back to our unit with the kid, the child has transitioned and is doing great - only now is NPO and madder than heck! :rotfl:
I do understand that things are different in NBN than in NICU. In NICU, you have the luxury of "watching" kids to see how they do, knowing that neo nurses and docs are right there. In NBN, I too would be a bit more cautious because having a kid crump there is scary as heck.