So one of the babies that I was in the room with last night had been totally fine. Former 33 2/7 weeker, 5 days old, room air since birth, almost up to full feeds (the twin was exactly the same). All of a sudden around 0200 last night he started having major A/B episodes, drained completely of color, and started puking up his feeding. Suctioned him out - got his entire feeding (and then some) back, and then started getting fresh blood. Ended up being intubated and on a rate of 35. Anderson was getting fresh blood from the stomach... Not good. Only had PIV access (and of course was a terrible stick). Thankfully our attending on that night was able to soak the cord in saline and was able to get UV/UA lines in. By morning he was mostly stablized out... blood gases weren't too acidotic.
When we all came back in tonight, he was on the same vent settings, was on 10mcg/kg/min of doPamine, and the serial x-rays were showing pneumotosis, but no perf. Well his x-rays at 2000 tonight showed that he perfed. So surgery at the bedside (parents came), and it just showed that he is necrotic end to end
Our surgeon is closing everything up right now, and is going to talk to the parents, and then withdraw support.
Not even 24 hours from when he first showed any signs of being sick.
Seriously - NEC is by far the scariest thing I've ever seen here in the NICU.
I know this is a NICU forum, but does anyone know if TPN affects the liver of adults the same way it does with infants? Just wondering if that's strictly a NICU problem or if it occurs in other areas of nursing.
Huh, I don't know. I think adults on TPN long-term probably have so many other serious problems that even if it is an issue, it's not as bad. Or because they're bigger, and their liver/gallbladder system is more developed... I don't know. I'll try to find out today.
Specializes in pedi, pedi psych,dd, school ,home health.
((((sweeper)))) and hugs to all of you who work in NICU... used to be my dream job; but never pursued it. Had several kiddos who were former preemies ... some who had lost twins so i understand where you are coming from.
There aren't a lot of references to it that I could access from Google, but I found one that mentions TPN-associated cholestasis in adults. It says that this is less common in adults, but that it can occur with long-term TPN administration. There is also some mention of prevention or treatment using ursodiol.
Former 30 1/7th week twin who is 9 (or so) days old. Was almost on full feeds. 2000 assessment perfect. No aspirates / emesis at 2300 (had good stool too). 0200 assessment distended belly, huge aspirate, guarding, girth up 3cm from where it was at 2000. X-ray shows pneumotosis and portal air. Intubated by 0500. Big red splotch on right side of abdomen by 0530 (bleeding into abdomen??? according to docs...??). Probably won't make it through today.
Awww sweeper, how awful! Sometimes I feel like a certain black cloud will follow me, for a few months it might be the NEC cloud, then maybe a PDA cloud...I hope you at least get a change of pace soon.
Thanks Aja... lately we had a long run w/o seeing any NEC on the unit. We had a lot of spontaneous perfs, but no NEC. Hopefully this doesn't start a trend.
I hate NEC too. We dont see it that often but twice in the last month we have lost 5-6 week old grower/feeders to it. They had each started around 28 weeks but were doing fine just eating full feeds. Both got septic and when the surgery was done, the entire bowel was dead. We check residuals, measure the belly, check stools for blood, ect. They are fine one feeding, the next feeding the abdomen is distended beyond belief and then they die. I dont get it, these are GROWER/FEEDERS not some 25 week baby that is unstable. Very sad.
I know this is a NICU forum, but does anyone know if TPN affects the liver of adults the same way it does with infants? Just wondering if that's strictly a NICU problem or if it occurs in other areas of nursing.
No, this happens to adults on TPN as well. Someone who is getting all or most of their nutrition from this obviously has numerous other health issues, but in any case, if someone is going to be on TPN for more than a month or so, they are usually put on a 12-hour infusion.
I hate NEC as well. Our unit is on fire with it lately. Seems like 1-2 babies a week NEC/perf (100 baby unit). I think we are ALL getting tired of it. Wish we'd review our practices to see what other options we have...The worst part is the parents saying "but he/she was fine when I was there a few hours ago..."
I have read studies that state that formula fed babies are 79% more likely to develop NEC than EBM fed babies. With those kind of statistics, why can't we mandate that EBM be used for our at risk population??? I know, you can't force a woman to pump but using donor milk and persuading more mommies seems like a no brainer.
elizabells, BSN, RN
2,094 Posts
Huh, I don't know. I think adults on TPN long-term probably have so many other serious problems that even if it is an issue, it's not as bad. Or because they're bigger, and their liver/gallbladder system is more developed... I don't know. I'll try to find out today.