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General Question About Neonates


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#1 Medic09

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Posted 24 November 2009 - 01:19 AM

I know that we see various immaturities in neonatal development. The liver and newborn jaundice is common. So are breathing irregularities. I had a 3 day old patient last night whose heart rate was quite variable. When awake - 130s. When asleep 112-120; but it would dip into the eighties. Listening to his little heart it chug along in the hundred-teens, and thus skip a beat and drop into the eighties. When stimulated the heart rate would come back up. When awake, the monitor show NSR; when asleep it was a little irregular.

Baby didn't seem especially dehydrated, but we did give a couple of fluid boluses. May have had a UTI, so we gave Abx. I observed the kid latched on and fed well at the breast, adjusting his breathing to recover and maintain his sats. Eventually our doc and the kiddo's pediatrician decided he was safe to go home and follow up in the morning.

Is the variability in the heart rates fairly normal? Is it just another neonatal immaturity to goes away with development? I had a chance to briefly ask my favorite FP doc who did a lot of OB and peds, and she says she would see this quite a bit, and wasn't concerned at all.

Anyone able to teach me a bit more about this? Thanks all! Reading material is good, too!
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Mordechai Y. Scher
NRP, FP-C, RN

It's all about kind, competent patient care; and getting home safely to tell about it.


#2 HeloRT

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Posted 24 November 2009 - 02:35 AM

Yes, heart rate drops do happen often. If the child is near term, say greater than 36 weeks gestation, it's usually no big deal. That is once you've ruled out infection and cardiac. Indicators to severity include how often it happens, if the child's heart rate comes back without stimulation or if apnea is associated with the bradycardia. Younger gestation infants may need caffeen.
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#3 NeoPedRN

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Posted 25 November 2009 - 04:08 AM

This sounds very normal. The biggest thing that you have to assess is not so much the heart rate alone, but how the baby is tolerating it. If the baby is sleeping with a HR of 85 and is pink, warm, dry, with good cap refill and without respiratory distress, I would not be worried. On the other hand, a baby with a seemingly normal HR of 130 but who is pale or ashen with poor refill or significant distress would really worry me. Its all in the context :)
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#4 Macgyver

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Posted 25 November 2009 - 07:46 AM

Younger gestation infants may need caffeen.


So where can we get this IV caffine for EMS? :P
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Ken BHSc, RN, REMT-P

#5 Medic09

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Posted 25 November 2009 - 03:12 PM

So where can we get this IV caffine for EMS? :P


When I started nursing, I thought I'd want to work in NICU. Other nurses getting booted for diverting narcs; I just wanted to divert caffeine. :D
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Mordechai Y. Scher
NRP, FP-C, RN

It's all about kind, competent patient care; and getting home safely to tell about it.


#6 insen...

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Posted 25 November 2009 - 04:34 PM

What was the originating chief complaint? Was was the gestational age?

What was the bili level?

Had the baby been feeding well prior?

Diaper frequency and volume?

What kind of bolus's did you administer? (NS?, D5 1/2 NS?).

Just ruling out electrolyte imbalances (first thought on a jaundiced baby that might not have been feeding well), and the neuro behavior sometimes associated with elevated bili levels...the effect of which can be bradycardia related to apnea.
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"Miserere stultus qui dicit latin." Contemporary French Linguist Insenescence

#7 Medic09

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Posted 25 November 2009 - 09:30 PM

What was the originating chief complaint? Was was the gestational age?

What was the bili level?

Had the baby been feeding well prior?

Diaper frequency and volume?

What kind of bolus's did you administer? (NS?, D5 1/2 NS?).

Just ruling out electrolyte imbalances (first thought on a jaundiced baby that might not have been feeding well), and the neuro behavior sometimes associated with elevated bili levels...the effect of which can be bradycardia related to apnea.

Hi insen, I considered most of that when I inherited the patient shortly after they arrived in the ED. Parents (first timers, very sweet and conscientious). They thought the baby was lethargic and more yellow. 3 days old, born 6 days before EDC. Hyperbili, don't recall the numbers; but not enough we wanted to do anything about it. Feeding: Mom had just started producing real milk that morning. I observed baby at the breast and he latched on well, sucked well, and adjusted his breathing to recover and maintain Sp02. Mom said he always stayed on for at least 10 minutes, usually more. Baby was pooping and peeing. Don't recall freq/vol but sounded pretty good. The boluses were before me, so I don't recall what they were. He recvd Gent and Amp for possible UTI.

The variability in the HR is as I described it. I just didn't know if it was simple immaturity. All the other indicators were pretty reassuring.
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Mordechai Y. Scher
NRP, FP-C, RN

It's all about kind, competent patient care; and getting home safely to tell about it.