pneumothorax question

[RNagain]

Hi ladies. I was hoping that someone here could help me out with a few questions. My neice was born yesterday a healthy 8.1lb ball of love. She had a little meconium aspiration at birth which they suctioned out and they said was very little. About 4 hours after birth she stopped breathing. They rescucitated her with oxygen and some stimulation and put her in the NICU. There they found a pneumothorax in her left lung. They put her under an oxygen tent and she did great all last night. A repeat film showed that the pneumo had substantially decreased from yesterday and was all but gone so they decided not to put a chest tube in. Around noon today they released her from the NICU and let her go back to room in with my sister-in-law. However about 4 hours later she turned cyanotic and was rushed back to the NICU and was found to now have a larger (about 1/2-1/4 of the original size yesterday) pneumo. She is refusing to breastfeed today also. I guess my questions are is this pretty normal? I don't really mean normal, but is it not life-threatening or that unusual. My brother and SIL are a wreck obviously, plus this is their first baby. I was hoping I could give them some comfort and hope. The MDs are being cautious of course in what they tell them. Also, how long do you think they will end up keeping her if all goes well from this point forward? Any help will be greatly appreciated.

[Mimi2RN, ASN, RN]

We usually don't put chest tubes in, the pneumos resolve on their own. Occasionally the doc will needle it. We do keep them under O2, sometimes at 100% oxyhood for several hours. We tend to keep them NPO and on IV fluids at least for couple of days, sometimes they treat with abx, after running labs. Baby probably isn't eating because she doesn't feel good.

She will get better, just give her time, I work in a level II and those babies usally recover w/out needing to be transferred to a level III NICU.

[RNagain]

Thank you for replying so quickly. They did start her on abx today. I thank you for the good news and for the hope that she will be alright soon.

[prmenrs, RN]

At this point, I would be worried about sepsis, too. Babies are very vague in their responses to infections, and they can also have some big consequences b/o of their immature immune systems, hence the tendency to treat first, ask ??'s later.

Babies w/meconium have more problems w/pntx, but they can have a pneumo w/o any indications of problems. Since there is air in the lung (21% O2), you can put them in a tent w/100% O2, and "diffuse" the air out. In our hospital, once they pulled a stunt like that, they would get to stay in the NICU, and possibly have antibiotics, till ready to go home.

I don't blame the her for not wanting to breast feed--she probably is not feeling all that great, and may still be having some difficulty breathing. If mom is pumping and saving the milk to be fed to the baby, there is still a very good chance for success. Have her see the lactation specialist @ the hospital for help.

Good Luck!!

[RNagain]

thanks prmenrs - she is pumping and hopefully they will have success. She was under the 100% o2 tent for about 20 hrs and the pneumo was all but gone. Is it of concern that it now has come back? Thanks for the info, you guys have made me much more comforatable. I knew that this was the place to come.

[NicuGal, MSN, RN]

Sometimes they will come back, but it isn't that often. prmenrs said it all :) In big kids like that we rarely put chest tubes in..we try the nitrogen washout (100 hood) and if it is still there then they needle it and do the washout.

As for not eating...she just probably feels pretty icky. We don't feed kids with pneumos until it is resolved and they have a nice easy repiratory effort.

[RNagain]

Thanks NICUgal. She is doing much better today. They took her out of the hood yesterday afternoon and she has been doing good. She ate a little yesterday and today she seems hungry! So, they took out her IV and they said she might be able to come home tomorrow. Thanks for all the help everyone!!