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Question about home - birth infant assessment

Posted

It's been while a while since I have worked with newborns... Yesterday I went to visit a friend's 10 day old baby--home birth, lay midwife. Nine pound baby, feeding well q 3h, very slightly jaundiced (mom says resolving), good reflexes, but:

Resp consistently 60 in sleep, and slight, but definite, audible wheeze. No nasal flaring. I didn't undress the baby, so don't know about retractions, and didn't listen to heart. Mom says no fever.

I can't get the wheeze out of my head. This seems abnormal to me. I'm thinking of telling her to see a physician...

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

A resting RR of 60 with audible whezing is certainly not normal for a newborn.

Good color and good feeding tolerance are reassuring, but I would encourage mom to have the baby examined.

Certified nurse midwives are skilled in newborn assessment. I'm not sure how much newborn care experience your friend's midwife has, but that may be a place to start, especially if the parents do not have a pediatric care provider in mind.

Please get back to us :)

Most homebirth midwives recommend that the baby see a Pediatrican in the first 24 hours. Tansient tacyapnea of the newborn? Sometimes babies have very noisy little noses. ?? If the baby is nursing well that is a good sign. A baby who is going south will usually stop/ have trouble eating as an early sign. There is no harm in telling mom that you are worried about the baby. (although she might think that you are worried because of the homebirth)

I called the Mom and told her I was a bit concerned, suggested she visit doctor. She told me the midwife suggested a visit in two weeks -- this Monday. (I think she will do so.) Said the baby had been "stuffy" since birth, and that she had sent husband for saline drops. The baby is still nursing well...

pockunit, ADN, RN

Specializes in Emergency; med-surg; mat-child. Has 5 years experience.

Huh, we took ours in for what would have been the discharge visit at 2d. I'm surprised her mw didn't suggest the same thing. IRRC, that's when they did the PKU stick as well. Mine were all stuffy, but the rr would have me a little ... alert, at least. How about a home health nurse from the county, would she listen to them if they came out? We got free visits and I think most states offer that, hospital or homebirth.

Good suggestions, but...

1) Very rural area, home visits not available from health department (just one nurse for the county, spread thin)

2) Family strongly resistant to any governmental agency being involved (won't take WIC, etc). Probably wouldn't accept Right From the Start, either.

Family does go to the local physician, a youngish D.O. who has a lot of sense and who communicates well with them. If the baby sees the D.O. on Monday, I'll feel okay about the whole thing.

Follow-up. Baby is doing well, about 10 months old, normal milestones.