Acidosis

Throw3ks

Hi ladies. I intro'd a few weeks back about anticipating a preemie. We had Ella Ruth on 8/22 at 29w4d. She weighed 3.1oz and is 15.5 inches long. I PROMd on 8/21, got one shot of steroids in as well as the handful of other meds that I am sure you are all aware of. I was given the steroid shots back at 23w when they first thought I was in PTL. As well as mag and all the other goodies. She came out in 3 pushes, had to be resuscitated. She came back in less then a minute. Her head U/S was Normal! She was given surfactant. She was on vent for 6 hours, had 2 blood transfusions, changed to CPAP for about 12 hours and has since been on cannula room sir with 2% flow. They just changed her to cannula room air to 1% flow. They started 2cc of breast milk every 3 hours and so far she is tolerating it great. However they have stopped the feeds due to acidosis. The neo has said there is no kidney problems but they need to watch the sodium bicarbonate. I am unfimilair with this and the explanations they gave me still confused me and dr google scared me. Can anyone give me some clarification?

thishappyhouse

Is she on any meds right now?  diuretics? how about poly-vi-sol?  My DD had lots of issues with her sodium levels as well as calcium levels.  There was no magic answer and no definitive diagnosis, her kidneys were just very immature and sensitive.  

Dont be afraid to ask lots and lots of questions of the docs and nurses.  

Throw3ks

@thishappyhouse she is not on any diuretics. Only her "food". A lipid drip and electrolytes. They have talked about changing those around so we will see. Ella's nurse today is a royal biotch. So when I ask her questions I get these weird vague answers and her doctors take forever to come and talk things over again so I figured I'd ask. Thanks for the input. @wallace323 I ask a milllllllion questions. They all ask me "are you in medical" because I ask real in depth questions but today's issues of acidosis is foreign to me. It helps that I am a research RN but I am certainly no expert in NICU. I'll just keep asking until its clear. They restarted her feeds so I guess things has somewhat settled down as that was sopped because of the issue. Hope your little ladies are doing well too!!!

Mrs. Alice

I remember my boys getting blood gases drawn frequently when they were on the vent and cpap.  From my nursing background I know that acidosis can be related to respiratory issues, for instance if a person is not able to breath in and circulate enough oxygen to  (one reason why blood gases are done often on intubated babies).  And wiki tells me it can be related to hypovolemic shock, which could be related to her anemia and need for blood transfusions at birth.  However it sounds like she is progressing very well with her respiratory status so hopefully her levels will improve very soon and she can resume feeds.  I also agree ask the neo and nurses lots of questions and to help explain it to you in terms you can understand. 

thishappyhouse

@throw3ks  I hope you can get more answers tomorrow.  Like Mrs. Alice said I am more familiar with acidosis and c02 levels in relation to respiratory issues and as indicators for more or less vent or 02 support.  I vaguely remember the terminology being thrown around regarding her kidney issues too which were mostly related to long term diuretic use and TPN/fortifier formulations.  

I think it can be caused by a number of things, so it may be best to just ask them if they have determined what is causing the acidosis. With such great strides in her respiratory support it seems unlikely that it is from that but perhaps it was too much too fast.  Restarting her TPN sounds like a good sign.  Have they done an echo to check for a PDA?

thishappyhouse

ps If you dont jive with a nurse and dont like the way that she is answering your questions don't hesitate to speak with the charge nurse.  Almost all NICUs are under family centered care now and there is no reason for a nurse to be vague or haste with you.  You are being a great advocate for her! 

Throw3ks

@thishappyhouse @mrs. Alice

They restarted her feeds at 2cc every 3 hours again. Her PH is off then normal and they have said it could be part of immature kidneys still. Typically they are this around 3-4 post delivery. They haven't made any reference to her breathing or any oxygen issues. It's still very confusing to me. They have tested her blood gases quite a few times. At this point I guess we just wait and see what they say. I don't want to get ahead of myself and suspect they are moving her to fast. My H assures me they know what they are doing. As I am sure they do. Just scary as hell.

jnsmith85

Lurker NICU nurse here, coming from Oct '13 If your nurse is bad, then you should definitely let the charge nurse know They won't assign her to your baby anymore (at least they shouldn't!)

As for stopping feeds, I don't know why they would do that, unless she hasn't been tolerating them otherwise (belly gets big, bowel loops, etc).

Usually, they can switch up the amounts of her TPN and Lipids til they find what works best for her to try and resolve the acidosis issues.

But ask lots of questions, make a list if you have to! And if the Neo is hard to get ahold of, ask for the nurse Practicioner, they are some awesome resources and will usually answer every question you throw at them!!

Good luck, T's and P's that your baby gets out of there sooner rather than later!!

Throw3ks

@jnsmith85
They stopped her feeds as from what they explain to not over work her. To give her body one thing to focus on at a time. However they have been started again. They have given her sodium bicarbonate to help with the acidosis and are thinking of adjusting the TPN again. Still kind of confusing.
I shouldn't say her neo is hard to get ahold of. She has been great coming to me whenever I need something but it just takes a while. She's very good. The NP is great too. I just have to understand my baby isn't the only baby that needs them.
I did get the nurse managers phone name and will be contacting her ASAP. The NICU unit at the hospital we are at has over 200 RNs and a group of about 40 working at one time. so I am sure they can work it out.
Thanks for your help!