There are so many disturbing issues as the case is presented here. First, NEC is a real concern in premature and SGA babies. An even greater occurrence in SGA and premature babies. An 800 gram SGA infant would be at high risk for this. Gastric residuals like those described should have had all providers in this baby concerned for NEC. It would be an early presentation but could happen. There could also be other abdominal issues like malrotation which could cause such bilious residuals. Reflux is not an issue in a newly born SGA infant, and meds used to treat it actually put babies at higher risk for infection. When you alter the stomach pH you open the door to infection. Bottom line any neonatal provider worth their salt should have been thinking rule out NEC, or worse, malrotation and a possible volvulus. Was there any xray of the abdomen?
Re the respiratory failure, it is common that a preterm infant may initially have acceptable respiratory function but then start developing airway collapse (atelectasis) and more distress as the lack of surfactant production makes keeping the alveoli open more difficult. This baby was intubated. Did he get surfactant?
No idea how anyone looks at this baby's course and says it was a nurse injecting aiir into his belly. This baby at high risk for NEC seems not to have had NEC seriously considered, seems based on this account to not have had an xray to evaluate for NEC, has a course (apnea, brady events, a belly exam that does not seem was normal...could have been cpap but in this context all should have considered NEC..acidosis, and then an arrest) and then is declared to have dies from natural causes???? Natural causes? Was there an autopsy? Did docs try to get an autopsy?
The whole treatment investigation and schedule seems a mess. "black bilious aspirate" - surely you would want to rule out the worst cause for this? No one seems to have a plan.
There are so many disturbing issues as the case is presented here. First, NEC is a real concern in premature and SGA babies. An even greater occurrence in SGA and premature babies. An 800 gram SGA infant would be at high risk for this. Gastric residuals like those described should have had all providers in this baby concerned for NEC. It would be an early presentation but could happen. There could also be other abdominal issues like malrotation which could cause such bilious residuals. Reflux is not an issue in a newly born SGA infant, and meds used to treat it actually put babies at higher risk for infection. When you alter the stomach pH you open the door to infection. Bottom line any neonatal provider worth their salt should have been thinking rule out NEC, or worse, malrotation and a possible volvulus. Was there any xray of the abdomen?
Re the respiratory failure, it is common that a preterm infant may initially have acceptable respiratory function but then start developing airway collapse (atelectasis) and more distress as the lack of surfactant production makes keeping the alveoli open more difficult. This baby was intubated. Did he get surfactant?
No idea how anyone looks at this baby's course and says it was a nurse injecting aiir into his belly. This baby at high risk for NEC seems not to have had NEC seriously considered, seems based on this account to not have had an xray to evaluate for NEC, has a course (apnea, brady events, a belly exam that does not seem was normal...could have been cpap but in this context all should have considered NEC..acidosis, and then an arrest) and then is declared to have dies from natural causes???? Natural causes? Was there an autopsy? Did docs try to get an autopsy?
The whole treatment investigation and schedule seems a mess. "black bilious aspirate" - surely you would want to rule out the worst cause for this? No one seems to have a plan.