Respiratory distress in newborns

[MrsAggie]

This is a debbie downer post.

I was working in the nursery last night and I had a mom send her baby to the nursery to get a little rest. I noticed some signs of respiratory distress and his color just wasn't that great. I put him on a monitor and his oxygen levels kept dropping and his respiratory rate was extremely high. When babies are in distress, they breathe really fast to compensate and keep their oxygen levels up. Eventually they burn out, their respiratory rate drops, their oxygen levels drop, and they essentially crash. He maintained his oxygen levels well for awhile but his respiratory rate stayed too high. I called the doctor to wake him up and get the kid transferred to the NICU. The baby was acting like he had an infection but mom was GBS negative.

I looked through the chart into mom's history and found that she had herpes and had an outbreak during her pregnancy. He was a c-section so they still didn't think it was relevant. Turns out today that they think it is in fact herpes, which is rare for a c-section, and his prognosis isn't good. It looks like it has probably infected his brain so he might not make it

I truly love my job but I hate the part where there's literally nothing you can do to save some babies.


I want to share a video of what respiratory distress looks like:
youtu.be/HrTefIoKypg
The rhythmic "cooing" sound is called grunting and is a sign of respiratory distress. Most parents don't know this and think its just a cute newborn noise. When the baby breathes, you can see the retractions around its rib cage which is also a sign of RDS whenever it is constant. A normal respiratory rate is 30-60 breaths per minute but a baby in distress may breathe 80-120 times per minute.

[CheshireGrin]

I'm sorry. Herpes encephalopathy (is that what they think it is?) can be so scary. I hope the baby pulls through.

[Diana Prince]

That's so sad.  Babies & kids can go downhill so fast, it's terrifying.  I'm an ER nurse and last week we had a 3 y/o that had low o2 levels. They were up between 92% & 94% and the kid was watching TV & seemed to be doing better before I left. I left at 4am and they said by 8am he had to be transferred and intubated at another hospital. 

I think pediatric/neonatal/picu/nicu nurses rock. You guys are truly amazing.

[pinkeggs]

Sad story I hope they're wrong ab out his prognosis and he makes it.

But good job doing your job!!!!! Nice acting fast and appropriately. Those women and babies are lucky to have you.

[CheshireGrin]

Dec 11, 2013 1:23:26 GMT -5 Diana Prince said:

That's so sad.  Babies & kids can go downhill so fast, it's terrifying.  I'm an ER nurse and last week we had a 3 y/o that had low o2 levels. They were up between 92% & 94% and the kid was watching TV & seemed to be doing better before I left. I left at 4am and they said by 8am he had to be transferred and intubated at another hospital. 

I think pediatric/neonatal/picu/nicu nurses rock. You guys are truly amazing.

Second this. Another ER nurse here, and I will say that we all HATE when sick babies come in. You guys have my utmost respect.

[JayhawkGirl]

Thank you for sharing this. I noticed my neighbor's newborn was retracting and had a high resp rate last year when I was over helping her. Thankfully she took him in then instead of waiting until the next day's walk in hours. He was hospitalized for a week after being transported by ambulance from his pediatrician's office. It was so scary and I kept searching YouTube thinking surely I was overreacting.

[MrsAggie]

Dec 11, 2013 1:16:49 GMT -5 CheshireGrin said:

I'm sorry. Herpes encephalopathy (is that what they think it is?) can be so scary. I hope the baby pulls through.

That's what they're leaning towards with his temps being all over the place and his blood work and cultures.

Diana Prince and CheshireGrin thank you very much. With all of the different backgrounds, age ranges, and complications that are seen in the ER, I can guarantee you the respect and admiration is 100% mutual.

And thank you pinkeggs !

[MrsAggie]

JayhawkGirl Good for you! Most symptoms aren't common knowledge. I find out about most complications by staying in a room and chatting with the parents.

[JayhawkGirl]

Dec 11, 2013 1:55:45 GMT -5 MrsAggie said:

JayhawkGirl Good for you! Most symptoms aren't common knowledge. I find out about most complications by staying in a room and chatting with the parents.

Thanks.  Her pediatrician had dismissed his rattly breathing as reflux earlier that week. She was tired, worried she was seeing more than was really there and asked me to come up since DS had had bad reflux. I still don't know what made me count his breaths, but that's what got the phone nurse's attention and she insisted he be brought in immediately. He was three weeks old.  He's a happy 18 month old now.

That situation is why I pushed our families so hard in TDaP boosters.  The lag when they were waiting to rule out pertussis, and the outcomes I was seeing on google scared the shit out of me. 

[awick14]

As a paramedic I have seen babies in respiratory distress before, it's terrifying.

I think once you have seen it before its not something you forget easily.

I also have a huge respect for nurses/doctors and other health care workers that work with infants/children. I see 1-2 kids a year and I get so stressed out over those calls. Dealing with teens/adults is much less stressful. (Not that it's not hard but kids is so much harder)

[jenna]

Thank you for sharing, and taking such good care of the babies. H works at a hospital too, and he always has a harder time of it when his patient is a child.

[Deleted]

Another thing, respiratory distress can be a sign of heart disease, a fact that I know way too well. It's definitely a great idea to educate new moms what it looks like, because many do not know (like I did not know), since newborns act so goofy anyway. I am sorry for that baby. . I hope he makes it.

[Deleted]

Poor baby :-(

My nephew has pretty bad VSD and when I went to help when he and his brother were almost 2 months old I saw his retracted breathing. It was so scary. But I am selfishly grateful b/c now I know what that looks like.

[rex]

Poor baby

This is terrifying. I am glad I now know what that looks like but it makes me want to go to my sleeping baby and watch her breathe. Paranoid, party of one.

[Deleted]

This is so sad

When the docs know that a woman has herpes do they not monitor the baby extra careful or something?

[Deleted]

[fryjack2]

Being in peds, I know how hard an infant can work to breath and how fast they can tire out and code

My boys (preemies) were hospitalized last winter for RSV. Watching them retract and grunt and get more and more lethargic was terrifying.


Nice job picking up on the RD. My heart goes out to this little one and his family.

[cuddlyevil]

I hope the baby pulls through, that's terrible.

[karinothing]

That is scary. I thought that babies could only be infected if the mom had an outbreak at time of delivery not just during pregnancy? I guess there is just a small risk it can be transmitted during pregnancy? How sad.

[Jalapeñomel]

[dottyblue]

Praying that sweet baby pulls through. Oh my goodness.

DS was monitored in the hospital for respiratory distress since there was a small amount of meconium in the fluid when he was born. I had two consecutive nights of needing to call the nurse to count his breaths before I was allowed to feed him, and multiple times of standing in the hall outside the nursery at 2 a.m./4 a.m./6 a.m. while they checked his oxygen levels. He was fine, and I thankfully (?) was too sleep deprived to know just how serious it was or I would have fallen apart. We had fantastic nurses though. Sounds like OP is one of these fantastic nurses. Good catch!

[sonrisa]

Thank you for posting this. It's good to get a reminder of what to look for before next week.

I get annoyed at OBs who blow off TORCH infections during pregnancy.

[snickers]

So sad

[cinderbella]

Dec 11, 2013 1:23:26 GMT -5 Diana Prince said:

That's so sad.  Babies & kids can go downhill so fast, it's terrifying.  I'm an ER nurse and last week we had a 3 y/o that had low o2 levels. They were up between 92% & 94% and the kid was watching TV & seemed to be doing better before I left. I left at 4am and they said by 8am he had to be transferred and intubated at another hospital. 

I think pediatric/neonatal/picu/nicu nurses rock. You guys are truly amazing.

This freaks me out. We were in the er last week with my 6 year old because of low o2 levels. She was at 89-90 when we got there and we left when it was around 94-95 after a pneumonia dx and Rocephin /nebs/zpack being started.

[babyrn]

Dec 11, 2013 1:14:17 GMT -5 MrsAggie said:

This is a debbie downer post.

I was working in the nursery last night and I had a mom send her baby to the nursery to get a little rest. I noticed some signs of respiratory distress and his color just wasn't that great. I put him on a monitor and his oxygen levels kept dropping and his respiratory rate was extremely high. When babies are in distress, they breathe really fast to compensate and keep their oxygen levels up. Eventually they burn out, their respiratory rate drops, their oxygen levels drop, and they essentially crash. He maintained his oxygen levels well for awhile but his respiratory rate stayed too high. I called the doctor to wake him up and get the kid transferred to the NICU. The baby was acting like he had an infection but mom was GBS negative.

I looked through the chart into mom's history and found that she had herpes and had an outbreak during her pregnancy. He was a c-section so they still didn't think it was relevant. Turns out today that they think it is in fact herpes, which is rare for a c-section, and his prognosis isn't good. It looks like it has probably infected his brain so he might not make it

I truly love my job but I hate the part where there's literally nothing you can do to save some babies.


I want to share a video of what respiratory distress looks like:
youtu.be/HrTefIoKypg
The rhythmic "cooing" sound is called grunting and is a sign of respiratory distress. Most parents don't know this and think its just a cute newborn noise. When the baby breathes, you can see the retractions around its rib cage which is also a sign of RDS whenever it is constant. A normal respiratory rate is 30-60 breaths per minute but a baby in distress may breathe 80-120 times per minute.

Thanks for sharing this. I'm a nursery nurse and we have so many parents who hear the grunting and think its so cute or that their baby is just "talking" to them and don't realize it is actually respiratory distress.

Herpes is so scary in infants. We are not even allowed to come in to work if we have a cold sore. I had a cold sore when my daughter was born and I was absolutely terrified that I would pass it to her accidentally.

[MrsAggie]

@theycalledherkate They're in the clear if they don't have any active lesions. So no cold sore, no problem.

[babyrn]

Dec 11, 2013 23:08:47 GMT -5 @theycalledherkate said:

Dec 11, 2013 22:34:23 GMT -5 babyrn said:

Thanks for sharing this. I'm a nursery nurse and we have so many parents who hear the grunting and think its so cute or that their baby is just "talking" to them and don't realize it is actually respiratory distress.

Herpes is so scary in infants. We are not even allowed to come in to work if we have a cold sore. I had a cold sore when my daughter was born and I was absolutely terrified that I would pass it to her accidentally.

When does the risk go away? I have a family member who gets cold sores once in awhile and though this person does not see the baby often, I'm hoping they don't have an outbreak when they're around her. I wouldn't even know how to bring it up. I think I read somewhere that like 80% of Americans carry the virus but not everyone actually gets the sores.

As long as they don't have an active lesion when they are around the baby I wouldn't worry about it. You are right, tons of people carry the virus and never get the sores, or rarely get them. I'm not sure when the risk goes away but I plan to always be as careful as possible. Even without the severe risk, once you get one you have it for life and they are awful.

[Deleted]

Dec 12, 2013 0:49:04 GMT -5 MrsAggie said:

@theycalledherkate They're in the clear if they don't have any active lesions. So no cold sore, no problem.

Any update on the baby?

[MrsAggie]

Dec 12, 2013 8:23:14 GMT -5 @lazerus24 said:

Dec 12, 2013 0:49:04 GMT -5 MrsAggie said:

@theycalledherkate They're in the clear if they don't have any active lesions. So no cold sore, no problem.

Any update on the baby?

Still not good Poor baby is really sick.

[Deleted]

Dec 12, 2013 9:46:08 GMT -5 MrsAggie said:

Dec 12, 2013 8:23:14 GMT -5 @lazerus24 said:

Any update on the baby?

Still not good Poor baby is really sick.

Is it definitely the heptathlon thing?