What would you do first?

Specialties Ob/Gyn

Published

With a baby who has respiratory depression due to narcotics before it's birth? Would you give O2 then narcan or vice versa? Everyone seems to have their own opinion so I figured I'd ask here and see what I get.

I'll tell you what our facility does a little later.

Specializes in Emergency.

I just recertified NRP, Narcan hardly gets a mention. If the baby isn't breathing it needs as others have stated positive pressure ventilation. Also one needs a route to give the narcan, and you best be securing an airway ie ET tube before even thinking about IV access.

Rj

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Specializes in Maternal - Child Health.
Just last week a nurse on our unit used narcan for an infant that was NOT breathng despite tactile stim and O2. she has never used it but the infant began breathing instantly..before even the full dose was injected. I too believe it should be used as a last resort...

20 years ago, before NRP was widely taught, Neonatal Narcan was stocked on our resuscitation cart. If I remember correctly, its concentration was 0.02mg/ml. Extremely dilute, and literally useless in terms of reversing narcotic action. I contend that the babies who "responded" to it with improved respiratory effort were actually crying in response to the needle stick. That's probably what happened in your example, as well.

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Specializes in Community, OB, Nursery.

Did I say not to Narcan a baby when Mom had gotten opioids??? Brain fart. I think I meant to say not to narcan unless Mom got opioids. Oops. That's what I get for trying to respond while chasing a 2 year old.

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I'm just a begining nursing student, but this did happen to me with my first child at delivery. He was vacuum assisted, purple at birth, they started 02, then narcan. He is now a very intelligent 8 1/2 year old.

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Specializes in Tele, Infectious Disease, OHN.
Did I say not to Narcan a baby when Mom had gotten opioids??? Brain fart. I think I meant to say not to narcan unless Mom got opioids. Oops. That's what I get for trying to respond while chasing a 2 year old.

Wow, I feel better. I am not a NICU nurse but I was really confused:confused: . Good luck with your 2 year old!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

We can all agree, ABCs first. Narcan per policy. If unclear, one maybe should review the NRP codes and policies. I myself, review NRP more like every 6 months to year, versus every two, (for recert)---because I do tend to get uncomfortable with the unfamiliar. I am no baby nurse expert, so I feel constant review in my mind's eye of what to do is not only a good idea, but absolutely necessary. A couple months back, our NRP instructor pulled a "code" at change of shift. I was coming off a long and bad night shift and resisted even participating, but did. I failed, miserably. So her objective was served, to WAKE ME UP.

Not long after that, we had a routine delivery in the OR, repeat c/section--elective. Healthy mom, good looking fetus on strip. Baby was vigorous on the sterile field, fighting the OB the whole time they worked to get her out and cut the cord. Placed on warmer, BAM, secondary apnea. No breathing effort, no tone, heart rate 50. Just like THAT. Fortunately, I and the baby nurse (I was circulator, but I always go to the warmer when baby is out, to be sure a second set of hands is not needed)--- worked well together.

I went into autopilot , as did the other nurse. She breathed the baby, I did chest compressions. By the time the expert nursery nurse (the NRP instructor herself) came to assist, the baby was breathing, pink, heart rate 120. She said to me, "YOU PASS"---- rofl. Hate tests like that.

So if you are at all unsure, or rusty, you need to review and practice. You never, ever know when a "bad" baby will be handed to you ,and the worst strips can be fine---the best strips can lie. Just be prepared.

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Specializes in Community, OB, Nursery.

Amen to the above about bad and good strips, SBE.

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We have done a mock code as well and boy did it throw me for a loop. I was called to our resus room (which is hardly ever used) and was told they needed help with a baby. I looked around in confusion and said where's the baby:lol2: . The "baby" was our plastic baby. They had me talk them through the "code" and I fumbled alot with the explanations because it usually is automatic, you don't think about what you are doing, you just do it. It was a great eye opener.

Our ob's are good because when something is out of the ordinary they will sit down with us at the end of the delivery and talk about what was done well and what could use improvement.

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Specializes in NICU.

This is a great example of why there should always be at least TWO people who are NRP trained at every delivery whose sole jobs are to care for the baby. If the kid comes out screaming, great. If not, you can't do everything yourself! In this particular situation, it's pretty simple - after drying and stimulating the baby, one person would be using the bag to give PPV to the baby while the other person could be drawing up the Narcan. Then, as others have said, Narcan should be given (or NOT given) per hospital policy. Some places would rather intubate the baby first and give it down the ETT, others prefer to obtain IV access for the med. In some places they don't use Narcan at all unless it is an obvious situation where the mom very recently got opiods and delivered precipitously. In this day and age of drug abuse, many docs are rightly afraid to use this medication. If you've ever seen a baby get Narcan whose mother hid her drug abuse history...it's awful. And the fact is that not everyone is drug tested so you really don't know just by looking at them and interviewing them what the truth is.

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Specializes in Community, OB, Nursery.

Gompers' post highlights why we are not very keen on Narcanning babies where I am.

As an aside: my best thoughts & wishes are with you & your family, Gompers!!!:yeah:

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I have given Narcan several times to infant who's mothers were given Stadol before delivery. Most of the time was when the infant was between 1-4 hours post delivery. The Narcan was administered IM with almost immediate results observed every time. The "Stadol" babies have a distinct respiratory pattern and need continious observation in the nursery on pulse oximeter for a minimum 4 hours post delivery. Only the babies who have more than 1 apneic episode are considered for the narcan and only after verifying that the mother is not a drug addict. I have only given narcan at delivery to an infant of a mother who was given, stadol, morphine and then general anesthesia for a stat C/S. The infant responded quickly to IM narcan.

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