I am really upset and confused, for a change.

  1. An e buddy of mine with a history of IUGR delivered twins 2 weeks ago at 34 1/7 weeks due to PROM. Both were fine, feeding, growing, some hyperbili.
    Well last week they both got septic and one was dead within 24 hours, the other is tubed and is in organ failure and DIC.
    How could this happen? I mean 30 weeker, OK, I can see it, but 34 weekers?
    This buddy is an L&D nurse and was as shocked as me. I mean the family is devistated. You get past the magical 32 weeks and you think the only thing these kids have to do is learn to eat.
    She hated the hospital she was at and I wonder if they missed something or didn't give abx.
    What I really wonder is how often this happens?
    Thanks, just really bummed.
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    About dawngloves

    Joined: Oct '00; Posts: 2,537; Likes: 369


  3. by   delirium
    What a sad situation.
    I have nothing profound to say except that I will pray for your friend and her family. And you, of course.
    I had a girlfriend who recently lost her baby at term, no problems in her pregnancy at all, and one day she didn't feel her baby move as much, and she was dead. Tragic.
    Its all so heartbreaking.
    Anyway, I know I wasn't of any help to you, but I just wanted to let you know you and your buddy will be in my thoughts and prayers.
  4. by   nell

    I am so sorry about your friend's babies.

    I really have not seen this kind of thing in years. We have a 16 bed mid level III NICU (no ECMO, nitric oxide etc.) We routinely draw CBC and blood CX and put all pretermers on ABX (Amp & Gent). If our kids get sick and they have previously had a course of Amp/Gent, then they go on Vanco and Cef unless CX sensitivities indicate something more effective. We also have a broad screening protocol and run CBC and CRP on many term babies that meet the protocol. I think we catch a lot of things early, particularly with the CRP.

    Was mom checked for Group B Strep? Although I would have thought with GBS, they would have gotten sick a lot sooner. Were they incompletely treated with ABX, maybe? Our kids stay on ATB until CRP is <1.0. We have had some kids get really sick (one cultured out bacteria, yeast AND influenza!!! Sure hope it wasn't due to bad nursing practices!!!) but none that died.

    What kind of hospital were these poor little kids in? I suppose sometimes these things just happen, but if she's up to it (or her lawyer is) she should look into it for the sake of other kids/parents.
  5. by   Jolie
    My prayers to your friend and her family. This sounds like a case of late-onset sepsis, possibly due to group B strep. Even if a mom's prenatal cultures are neg, most OBs will opt for antibiotic therapy during labor for any pre-term patient. The babies would then require monitoring and possibly antibiotic therapy for at least 3 days until infection is ruled out.

    I once saw a 12 week old infant (born at 28 weeks) die of overwhelming sepsis the morning he was to have gone home. Just 12 hours before, his parents held him, fed him and dressed him in his going home outfit for pictures. His twin sister also was infected, but survived. It really made clear to me the importance of infection control measures, and the necessity of discharging babies as soon as they are stable, to get them out of the germ-infested environment of the NICU.

    Again, my prayers.
  6. by   dawngloves
    Thanx you guys. This hits home on so many levels. I worry this may happen to a patient I dismiss af a "feeder/grower and it brings also back memories of my own experience with my daughter who was 36 weeks and had a septic work up. I didn't know where to go for support because Preemie groups really shun you if your baby is over 34 weeks! Like nothing could be wrong with your baby! I felt so alone.
    My friends GBS was unknown so she had Amp on admission and was sectioned 12 hours after rupture because twin A was transverse. I haven't heard from her because she is afraid to leave her other baby now. I do not know if they started prophelatic abx as we do at our facility on 95% of admissions.I hope they did a 3 day course while they ruled out! The cultures have not grown anything and they think it's viral.
    These babies were/are around 5 pounds each! This just blows my mind. And she hated the hospital. Called them bumpkins and wanted to transfer the kids to the local Children's. Before they went under the bili lights the nurse would tell her she couldn't hold them! They were stable and on room air then!
    The first thing I thought is 'Who's fault is this? Call a lawyer !" But I dare not mention this to my friend now.
    And Jolie, I am right with you on D/Cing ASAP! I have fought with doctors about this. Keep a healthy baby here one more day around all these nosocmial infections???!! DUH!!
    Maybe it's teaching me a lesson. What is that quote? "Never trust a 35 weeker" ?
  7. by   prmenrs
    But it IS a reminder that PREmature is really IMmature. Every body system they've got is NOT READY to be here. And none more so than the immune system in this particular case.

    I often use the analogy that "premature" just sounds like the baby just got to the party early. "Immature" means they got to the party in the wrong clothes, unshowered, unshaved, unbrushed, uncombed, etc. (That goes for the parents, too; they aren't ready for the "guest" to be there either--no Lamaze class, no baby shower, no "waddling")

    It may well have been late onset sepsis, it would be impossible to tell w/o more info. My heart goes out to your friend. I am so sorry she's had to go through this. Remind her that she didn't do anything for this to have happened to her--no one signs up for a trip to the NICU! Try to minimize the 2nd guessing. Right now it might be better just to feel devastated and heartbroken. In some cultures, it seems like a big thing to find out who's "fault" it is--and often the Dad's family jumps all over Mom, analyzing every morsel she ate, and every activity as well.

    I do hope she requests a "post" conference. By that I mean, ask to discuss the results of the autopsy w/the attending. And be sure to find out what organism(s) grew. It would be a good idea to wait a while before this meeting, to make sure all the reports are in, but this way she could find out why this happened. It probably won't make her feel any better, but at least she'll have more information to help her cope later on. She can probably do that thru the Social Worker.

    And, yes, the quote IS:
  8. by   dawngloves
    Thanks prmenrs, that is a good analogy.
    She just told me that both the the babies CSF had enterovirus. She was carrying it and was asymptomatic.
    I don't know much about this, can anyone clue me in?
    Twin B is doing better, PTT and CBC improving, down to 21% O2.
  9. by   amber munchkin
    I really have nothing to add to what has already been said, I just wanted you to know that I will be thinking of you and your friend. One of the sisters on my unit says that the bigger they are, the more they fool you! On our unit we treat all babies with Benpen and Gent for 24hrs, the AB's only get stopped if the blood cultures taken at birth show CRP less than 2. I am glad that the 2nd twin is getting better, please keep us posted, sorry don't know much about enterovirus.....things like this certainly stop you getting complacent dont they?
  10. by   prmenrs
    Enterovirus caused my son's meningitis a couple of years ago--had to have his entire V-P shunt replaced, and he was in the hospital for 2 wks. I'll try looking up some more info for you.

    At least that's an answer. Remind her that she didn't go out and find enterovirus on purpose. Also let her know she's being thought of and prayed for...
  11. by   prmenrs
    Boy, do I like this computer thing!!

    Last edit by prmenrs on Jun 6, '02
  12. by   prmenrs
    I tried it and the link works, much to my surprise. Scroll ~ 3/4 down page and it talks about neonatal infections.
  13. by   KaraLea
    I am now 35yrs old, but when I was born it was in January, in Chicago during the big blizzard of 1967. I was only 3wks old when I got very, very sick. Horrible bloody diarrhea. Wouldn't eat anything, was getting extremely dehydrated. My mom says that I looked like a racoon, I was so dark around my eyes. My mother called the doctor and found out that there were 3 other babies born at the same time I was who were sick like I was. (BTW, my mother said that what I had was actually a Staph infection of the bowel tract.) He told her what to do and my father had to walk a couple of miles through that blizzard to the pharmacy for my medicine because he couldn't get the car out of the driveway. My mom says that if I had not gotten better by the next day, the doc said that he was going to have my airlifted to the hospital.
  14. by   dawngloves
    Thanks for that link prmenrs. They did present with those symptoms, but they truely are non specific. I mean, what preterm infant doesn't have lethargy, poor feeding and jaundice?
    Karalea, isn't it funny now that we have a 24 hour drug store on every corner?!