Interesting cases anyone?

[Humbled_Nurse]

I work in a medium size nonsurgical level III NICU so sometimes things get a little boring. Sure, on occasion we get a really interesting case, but for the most part it is preemie land. So does anyone have any interesting cases from NICU, PICU, or CICU? I know with all the privacy laws you can't give too many details. I recently heard of a case where a newborn contracted Legionnaires disease from a home water birth.

I really enjoyed when Janfrn would do her "case studies" as a topic. Hint, Hint

[katierobin23]

Has anyone seen a baby with Harlequin color change? I saw one the other day, and it was amazing. Reminded me of the old Star Trek episode with the aliens that were black on one side and white on the other.

Yes! So cool! Freaked me out at first though because no one had mentioned that this baby had it and I was a pretty new nurse...after some research I learned about it and had everyone I saw come over and look, most of them had never heard of it either

[Bortaz, MSN, RN]

Like this. :)

[Humbled_Nurse]

Thanks for all the responses. Very interesting stuff. I definitely see us sharing our "interesting cases" as a learning opportunity. I would much rather read a "case study" in a journal rather than a research study. I learn best this way.

Looks like I will be changing jobs in a couple of months. I will be working in a much higher acuity NICU. The babies will definitely be much more interesting. Very excited and nervous :)

Early in my NICU career I remember seeing lots of interesting babies. Things like superior vena cava syndrome, severe chylothorax, cor pulmonale, lots of syndromes. I was a new nurse at the time so I just assumed every NICU saw that, but that really isn't the case. I do think the babies were much sicker then though and it seems the preemies had many more complications then. This was the late 90's. I think the preemies tend to do much better now. Our approach is much less invasive now. Back then everyone had lines, were intubated, had chest tubes, kept NPO for weeks, etc.... I do think there has been progress. The age of viability hasn't changed much, but I do think the rate of complications have gone down some which is good. NEC doesn't seem quite as common either.

I have seen a baby with the Harlequin color change. Very interesting, but it wasn't quite as dramatic as Bortaz's case

[NNICU-RN]

The only intresting cases for the week is : 1) 39 weeker with dextrocardia and neonatal stroke and 2) VACTERAL 28 weeker with major cardiac defects : ASD, PDA , scoliosis ,no gallbladder, imperfoate orifice and can wean from the vent and hopefully start feed.within 8 days of age. I like happy endings

[HyperSaurus, RN, BSN]

Neonatal stroke? Seriously?

Haven't heard of VACTERL before, glad this little one is getting better :)

[TiffyRN, BSN, PhD]

We've seen neonatal stroke every few years. Friend of mine has a daughter who had it; it was related to the daughter having protein C deficiency. She had a rough start, is still very compromised by the resultant CP. Years later, the protein C deficiency became an issue for the girl when she needed extensive surgery and would be prone to serious clotting.

[TiffyRN, BSN, PhD]

I've seen some interesting arthrogryposis congenita; some that weren't formally diagnosed and no one really seemed to care as these were undocumented migrant workers.

Had a child who had an inherited ectodermal dysplasia. The parents decided to play the 50% odds their kids would be unaffected not once but twice; lost out both times. I don't have words. . .

[lmac0202]

We had a kid who we thought was a hydrops fetalis- but after a few days on the oscillator and numerous paracentesis- genetics came back that the kid had hemochromatosis. We had to consult a doc in Chicago who suggested an exchange transfusion and several medications. He eventually stopped third spacing so much fluid. His lungs were able to fully expand- And he went to level 2- and then home. I wonder if there are any lasting effects he will have to deal with. His mother has 3 other (busy) children and never fully grasped how close we were to losing him several times.

[Elvish, BSN, DNP, RN, NP]

We had a full-term kid who'd had a stroke in utero. First sign was that she wouldn't stay warm under a radiant warmer.

[nocturnalnurse]

to be honest we don't have a freestanding NICU at my institution so when we do see interesting things it can be quite the learning experience (and usually completely unexpected/undiagnosed prior to delivery). I consider working in a NICU every once and a while but can't quite give up my labor and delivery

We had a case of arthrogryposis multiplex congenita that was super interesting- the worse contractures I've ever seen the poor kiddo looked like a pretzel. Baby was doing great otherwise, though, so we were able to keep him. follow up at a bigger hospital with peds PT and ortho docs. Mom brought him back 2 years later and he was ambulatory with a little supportive aide and had gotten decent movement and resting posture in most of the joints. We recently had a gastroschisis that was very large and involved quite a few organs (liver, kidneys, large and portion of small bowel) it didn't look that this baby had any abdominal skin at all. we've seen neonatal strokes a few times, one was quite large and boy did that kid seize like crazy. I really wish I could find somewhere where I could work "the both of best worlds" and do L&D and NICU both.[h=1][/h]

[ru4rns]

Amen......God is good all the time....

[nursecarlie06]

Recently had a baby girl I primaried in NICU for 4 months. She ended up with Tricho-hepato-enteric syndrome. Incredibly rare syndrome. 1/1,000,000. Testing is done only in Germany so had to send off labs to Germany for results. She ended up going home on TPN/Lipids with a broviac. Check out the link below for more info but incredibly interesting!

Syndromic diarrhea/Tricho-hepato-enteric syndrome

We also see a lot of Recombinant 8 syndrome babies in New Mexico. Full Trisomy 13 baby recently as well!

LOVE NICU nursing.