Sick twin

[Nicky30, BSN, RN]

I have only just started my mid program, and haven't been on clinical long.

Yesterday blew me away.

I was with another patient on postnatal ward and midwife was holding a 6/52 twin that was having feeding difficulties (we are the only two in this department at the time).

Babe suddenly goes grey, floppy and RR goes up to 90. Midwife runs to phone with babe in arms to call doctor. I walk in (having no idea what is going on) take one look at the babe and ask to take babe for some O2 treatment monitoring etc. (small hospital we don't even have a monitored nursery).

At the time I was pleased that I managed everything calmly but now I am a mess. I can not imagine myself being that calm if the roles were reversed (I wonder if I am cut out for this??? ).

We have no idea what happened (2 and a half hours post feed) wheezing priror to event but not when I took the babe. Air entry good but tone and colour were very poor. Babe took about 45 minutes to recover properly. Chest xray showed some shadow but bloods were NAD.

So what exactly happened to this baby. Does anybody have any theories?

I can't get hold of my lecturer and I so need to offload this incident with someone I can "hear".

Nicky.

[Imafloat, BSN, RN]

I am not sure what 6/52 means. Did the baby have an emesis? How many gestational weeks is the baby? It is hard to guess as to what happened if the baby wasn't on monitors. Some preemies go through an apnea phase with a lot of apneas, bradycardias, and desats.

[dawngloves, BSN, RN]

Hard to say without knowing what happened prior to the event. If the baby was eating he could have refluxed and had an apenic episode.

[elizabells, BSN, RN]

I also have no idea what 6/52 means, but I'll throw out a few guesses...

Cardiac? How old was the baby? You can honeymoon a bad lesion for quite a while before the duct closes and everything goes to hell.

Sepsis? We have a kid right now who got her 32-week self off CPAP at an outside hospital before some MRSA snuck into an IV infiltrate, and now she has 2 chest tubes and is in DIC.

And the weird one, because I've got it on the brain even though it's incredibly rare ... Surfactant deficiency? Some forms they go down *immediately* after birth and go down hard, some types are more insidious.

[NICU_babyRN, BSN, RN]

I'm guessing a really bad apnea/brady or a cardiac defect, aspiration, or surfactant deficiency also!

[Nicky30, BSN, RN]

Sorry 6/52 is 6 weeks old.

Babe was born at 38 weeks gestation by c-section, and was the smaller of the two babes delivered by 1kg.

Babe could not have aspirated a feed as it was just before the next feed was due (3 hourly feeds). No vomiting was noted, reflux etc (unless a silent episode which seemed unlikely).

When I took obs 5 min after event commenced HR 140-150, RR 90, Temp 36.7, BGL 9.2 (I think we have different standards here??) and saturating at 97-100%.

I have found out that blood cultures are growing a strep bacteria of some description, although babe is showing no outward signs of infection.

Maybe this can account for the episode. I know next to nothing about this. Thanks in advance for any more ideas.

Nicky.

[SteveNNP, MSN, NP]

Sometimes a bad case of reflux can cause a desat/brady episode....

[canoehead, BSN, RN]

A glucose of 9.2 is high, isn't normal between 3.5 and 5?

[Nicky30, BSN, RN]

A glucose of 9.2 is high, isn't normal between 3.5 and 5?

That's what I thought but the midwife and doctor did not seem at all concerned. It was definitely included in our notes when babe was sent down.

Perhaps she does have a rampant infection and that is what sent her sugars up?

Nicky.

[Elvish, BSN, DNP, RN, NP]

GBS sepsis

Reflux, as others have said

This specific episode reminds me of a kid we had about 18mo ago - was doing great, about 30 hours old, had been nursing like a champ. He was late preterm - 36 weeks I think. In for his corificeat test, desats/bradys and turns the color of my neighbor's wisteria. Transposition of the great vessels. Needless to say, won himself a ticket to some immediate cardiac surgery. Mom was a basket case, understandably.

[RainDreamer, BSN, RN]

GBS sepsis

Reflux, as others have said

This specific episode reminds me of a kid we had about 18mo ago - was doing great, about 30 hours old, had been nursing like a champ. He was late preterm - 36 weeks I think. In for his corificeat test, desats/bradys and turns the color of my neighbor's wisteria. Transposition of the great vessels. Needless to say, won himself a ticket to some immediate cardiac surgery. Mom was a basket case, understandably.

Scary!

Cardiac is what first came to mind when I read the OP ...... a closing PDA on a PDA-dependent cardiac kid is dang scary.

[dawngloves, BSN, RN]

This specific episode reminds me of a kid we had about 18mo ago - was doing great, about 30 hours old, had been nursing like a champ. He was late preterm - 36 weeks I think. In for his corificeat test, desats/bradys and turns the color of my neighbor's wisteria. Transposition of the great vessels. Needless to say, won himself a ticket to some immediate cardiac surgery. Mom was a basket case, understandably.

That happened on our unit once. 36 weeker in for r/o sepsis, coded during a car seat test. :uhoh21: Ended up going home on a monitor after a million dollar workup that yielded nothing.