Chest PT on newborns post delivery

[MzRN]

There has been some recent controversy regarding whether the practice of performing chest PT on newborns after delivery is harmful. Currently where I practice when some infants present with coorifice LS after delivery we will perform gentle CPT to the affected lobes for approx 30 sec. Apparently this is an old school practice. I would like to find recent up to date evidence based literature on the pros and cons regarding this practice. I have only been a nsy RN for a 1 1/2 yrs and any would appreciate any guidance as the safety of my babies is my 1st priority.

[MassED, BSN, RN]

when I was in nursing school doing our OB rotation, a child was born C-section and having some respiratory distress. Our nursing instructor said to give the baby gentle PT. Don't know what the standard is for that, but it makes sense.... but it's also not my area....

[Coffee Nurse, BSN, RN]

Following this to see the responses. I can say that all of our RTs (older and newer both) and NNPs will do CPT in the delivery room if a baby is sounding persistently crackly; I don't personally have any evidence to back that up, though.

[DebblesRN, ASN, BSN, RN]

We do CPT with manual percussors where I work for babies with wet lungs (especially after c-section) if they sound like they have fluid in the lungs after delivery accompanied by mild resp distress. If there was meconium, we do not percuss. We do not percuss premature infants.

The Neonatologists where I work feel that CPT does not help, but does not harm the infant either, and it makes them cry most times, so the crying will expand the lungs and help them absorb the fluids quicker. (so I guess you could say it DOES help. LOL)

There have been a few studies that showed CPT can cause an increased incidence of IVH, but if you read some of these links and studies below, you will see that they have decided that it does not actually increase the risk at all.

Here are a couple of links.

http://www2.cochrane.org/reviews/en/ab006445.html

http://www.ncbi.nlm.nih.gov/pubmed/634685

http://neoreviews.aappublications.org/cgi/content/extract/5/12/e534

http://www.ijponline.net/content/36/1/65

Google is an amazing tool. There are LOTS of journal reviews about infants and CPT. I just posted a few. There are plenty more available. :)

[DebblesRN, ASN, BSN, RN]

Here is a link to a picture of the manual percussor we use on the babies.

http://www.1cascade.com/images/products/1/1045_manual_percussor_cup_neonatal.jpg

[NicuGal, MSN, RN]

That is very old school. We do not percuss any kids unless they have a reason such as pneumonia with collapses etc. And percussing can cause IVH in the preterm infant as it causes fluctuations in BP that can lead to rupture of vessels.

Does it hurt them,no not really, but it is also not a standard of care. And if you happen to get a kid that has been sounding crappy for a bit and is GFR for a while you run the risk of agitating the kid and causing pulmonary hypertension.

If you are doing this and it is not a standard of care or written in a protocal and something just happens to go wrong with the baby and it goes to court, you will be held accountable for not having a protocal or procedure. I just sat on a case, not in the instance of clapping but something else, and we didn't have guidelines for it, it was "just what we do" and it worked against the case and made the nurse look awful on the stand when questioned. Just some food for thought, esp since we work in a field where a lawsuit can come in 18-21 years.

The articles above are dated and the last one is not even used in the US. You will get a hundred different opinions and sides.

[DebblesRN, ASN, BSN, RN]

That is very old school. We do not percuss any kids unless they have a reason such as pneumonia with collapses etc. And percussing can cause IVH in the preterm infant as it causes fluctuations in BP that can lead to rupture of vessels.

Does it hurt them,no not really, but it is also not a standard of care. And if you happen to get a kid that has been sounding crappy for a bit and is GFR for a while you run the risk of agitating the kid and causing pulmonary hypertension.

If you are doing this and it is not a standard of care or written in a protocal and something just happens to go wrong with the baby and it goes to court, you will be held accountable for not having a protocal or procedure. I just sat on a case, not in the instance of clapping but something else, and we didn't have guidelines for it, it was "just what we do" and it worked against the case and made the nurse look awful on the stand when questioned. Just some food for thought, esp since we work in a field where a lawsuit can come in 18-21 years.

The articles above are dated and the last one is not even used in the US. You will get a hundred different opinions and sides.

I thought I stated that we did not percuss preterm infants. Didn't mean to confuse you.

We also aren't percussing babies who have been GFR for long periods of time. The ones we perform CPT with are usually directly after a C/S who sound wet and may be showing symptoms of MILD resp distress. Obviously, we are not percussing a child who came from L&D in resp distress requiring oxygen, who have meconium staining, etc.

pretty much, stimulating a newborn to cry is just as effective as CPT.

As far as the articles being dated, I simply was posting some info that had varying opinions about the effectiveness of CPT. Could you post a better article or resource to for the OP??

[BittyBabyGrower, MSN, RN]

Do you all follow NRP?

[DebblesRN, ASN, BSN, RN]

yes--do you??

[BittyBabyGrower, MSN, RN]

Sure do...and I teach it.

[DebblesRN, ASN, BSN, RN]

That's nice. Are you implying that there is something in the NRP guidelines that is for or against CPT in the neonate?? Might be nice for you to reference it for the OP.

[Kattg]

I remember someone telling me something about it and would like to find more info. Is there something in NRP?