Things that make an ER nurse go hmmm...

[AnnieOaklyRN]

Hi all,

I am just looking to get your oppinions or posible dx of a case I had the other night in the ER.

So the mother calls ambulance to bring her 5 day old baby into the ER after a prolonged episode of apnea. Mother states baby was just released from the hospital after treatment with lights for high bili the day before comming into the ER. During that stay mother states baby had multiple episodes of apnea (not always associated with feeding), she told the nurses, who told the physicians who didn't think they were anything to worry about.

Mom stated that the baby had had multiple episodes at home of apnea which were occuring both during and when the baby was not feeding. She called 911 because seh was feeding the baby and this time the apneic episode was prolonged and the infant became cyanotic.

So anywho so I placed the baby on teh monitor, so far no problems, baby looks wonderful and was crying becasue she was hungry so mom decided to give her a bottle. I happen to come in during the beginning of the feeding, baby starts with a weak cough during the feeding followed by about a 30+ second period of apnea with circumoral cyanosis, mottling of the trunk and extermities, and an unresponsive, limp baby. So this was a bit of a suprise to me, so I take baby away from the mother try and give her some stimulation to get her breathing again which doesnt works alittle, but the baby remained limp with eyes half open ( I think there was a gaze, but it happened so quick I do not remember). I kept stimulating the baby to get her to breath and eventually her RR was back up to 64 and she returned to an awake normal colored flexed baby. leaving me to say hmmmmmmmmm.

I had someone call for the ER physician to come into the room and by the time she got there the baby looked fine again so unfortunatly she did not see it. I do however take a majority of the pedi patients in the ER when I am working so I can usually tell when somehting just isnt right. This was not just a brief period of apnea this was more of an episode. It might be important to know that the mother had two siblings die at about 6 months do to heart anomolies.

OK so help me out NICU nurses, What do you think caused this episode??

Sweetooth

[Preemienurse23]

I agree with everyone else, it sounds cardiac or neuro related. Its hard to imagine that a nurse, esp a NICU nurse would not take a apnea spell seriously. I would have at least had mom call me prior to a feed so I could hopefully witness one of the episodes.

[AnnieOaklyRN, BSN, RN, EMT-P]

I will try and get an update if possible when I go to work tomrmow. Thanks everyone for your ideas and replies.

sweetooth

[elizabells, BSN, RN]

If you have trouble getting info, try having one of the docs call. I get calls all the time from physicians at referral hospitals asking for updates.

[BittyBabyGrower, MSN, RN]

Hmmm....were you guys able to pull the kids chart and see if the apnea's were documented? I find it really hard to believe that that kid made it out of there acting like that. We've had kids like that with esophogeal dysmotility act like that too.

eliza...we won't take calls from outlying hospitals unless we have a contact name due to privacy issues.

[prmenrs, RN]

The hospital our transport go to faxes progress notes/admission/discharge notes every day. That way we don't have to call and beg for condition reports, but we do get updates on the kids we send them.

I think there is a provision in HIPAA to allow professional comunication like that.

[Elvish, BSN, DNP, RN, NP]

Was going to say the exact same thing, prmenrs. :)

[AnnieOaklyRN, BSN, RN, EMT-P]

hi,

So I called the hospital to get an update, all I got was that the baby was still in the NICU receiving antbiotics. No heart defect that they could find. His blood culture did come back positive for strep salivarious (or something like that) which may be just contamination. So who knows, maybe sepsis or maybe just a fluke thing????

Sweetooth

[Peanut_RN]

Could be sepsis... we had a baby a few weeks ago doing wonderfully and then just went apneic one night, heart rate to the 20's, and died after 3 hours of working on her... very sad case!!! But diagnosis was: overwhelming sepsis.

[rph3664]

Baby's got something wrong w/it. I don't suppose you could retrieve the part on the monitor when she was feeding the baby and the episode started.

IMHO. The baby should have been admitted, monitored overnight and had @ least a Heart ECHO, better yet a consult w/the same cardio's that saw her other babies. And maybe gone home on a monitor.

I'm going w/Liz's differential, plus maybe a neuro issue.

It wasn't the mom's other babies that died around 6 months of age, it was mom's siblings.

Unless the mother is relatively young and grew up in the area, it's unlikely that this baby would be seen by the same physician.

[KatRNC]

Sounds like sepsis. Or reflux? Do you know what the end result is from the hospital the baby was transported to?