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Patent Foramen Ovale

NICU   (4,134 Views 16 Comments)
by strn96 strn96 (Member)

1,194 Profile Views; 59 Posts

Hi! I'm an L&D nurse and had a question for you NICU nurses. When you have a NB with Patent Foramen Ovale, what is the rationale behind using continuous blow-by per NC? I think it has something to do with pressure gradiants, but not sure exactly what; and I can't seem to find this info. Hx on the case that makes me ask: LGA term NB, on O2 originally p delivery, then weaned. About a day later started desatting c feedings, so O2 was restarted. NB was sent for echo, which found PFO, then neonatologist recommended NB have cont blowby RA by NC. This is not a case I am personally involved in, just something that happened in our (small) "well-baby" Nsy that piqued my curiousity about the rationale behind this Tx.

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LilPeanut is a MSN, RN, NP and specializes in NICU/Neonatal transport.

892 Posts; 5,380 Profile Views

I've not particularly heard this for PFOs, but I do know that NC can sometimes be used as a poor man's nasal CPAP. They have it blended to room air, but high flow and that helps to remind the baby to keep breathing.

But I am not sure how it relates to the PFO, or whether it does.

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LilPeanut is a MSN, RN, NP and specializes in NICU/Neonatal transport.

892 Posts; 5,380 Profile Views

dawngloves that's what I was thinking maybe - trying to keep it open because of other heart defects. *shrugs*

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BittyBabyGrower is a MSN, RN and specializes in NICU, PICU, educator.

1,823 Posts; 12,720 Profile Views

usually pfo is asymptomatic unless coupled with a pda. many people walking around right now have pfo's and don't know it until they throw a clot. sounds like the kid had something else, esp if they were using room air with flow.

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59 Posts; 1,194 Profile Views

According to the echo report, no PDA and only other findings were slight regurgitation at atrial and tricuspid valves. Only symptoms NB had (after initially needing NC O2 which was weaned after a couple hours) was murmur and occasional desat - mostly with feedings and with good recovery when feeding paused.

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BittyBabyGrower is a MSN, RN and specializes in NICU, PICU, educator.

1,823 Posts; 12,720 Profile Views

Maybe he was a residual TTN or just slow to get going....we get those big kids that need 02 for a bit...we always joke that they are too fat to breathe LOL. Was his hct okay?

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justjenny specializes in NICU- now learning OR!.

274 Posts; 3,505 Profile Views

This website has info on neonatal cardiac defects:

http://www.pediheart.org/parents/defects/index.html

Unfortunately, nothing on PFO. I have never had a kid with issues R/T the PFO..it is typically another issue going on.

Our term kids in the newborn nursery are not on a pulse ox, therefore the nurses do not know if a kid is truly desatting with feeds. How low did this kid desat to require O2?? Sometimes we have term kids who are uncoordinated for initial feeds (majority are TTN kids) that require RN "pacing" ie: after a few sucks, make the kid pause for a breath before continuing...this usually never lasts more than a day or two at the very most.

Any further details for us??

Jenny

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344 Posts; 4,256 Profile Views

kind of sounds like a feeding issue.... sounds like aspiration to me. We will give NC on RA when there is a needs for stimulation but not necesarily O2 requirement.

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59 Posts; 1,194 Profile Views

Sats were only going into 80s, and only with feeding, and NB had good recovery when feeding was paused. Sounded to me more like poor suck/swallow/breathe coordination than really a need for O2. This was a LGA term baby who would absolutely inhale her bottles. The nurse that restarted O2 is very "generous" about giving O2. My real question, though, is why the BB RA per NC was written as a "continous; do not wean" order after echo results showed PFO. As stated earlier, only other findings on echo were slight regurgitation at a couple of the valves.

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rnpilot specializes in NICU.

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I've seen some doctors give O2 to try to encourage the duct to close. I couldn't begin to explain the physiology off the top of my head. I don't want to explain it incorrectly.

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AliRae specializes in PICU, surgical post-op.

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BB RA per NC

Are things different in the NICU, or is blow-by via NC something of a paradox?

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