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The first 24 hours
Sean’s premature arrival along with his crying and grunting means that the labor and delivery staff is on the lookout for common problems seen in premature babies, such as cardiopulmonary instability. Immediately, pulse oximetry is used to track minute-by-minute HR and SpO2 levels. Sean’s oxygen saturation readings are low per neonatal resuscitation protocol and he requires CPAP respiratory support.
He is moved to the NICU for continued management of mild respiratory distress.
24 hours & after
Although Sean continues to require NIV+ noninvasive ventilation for his ongoing respiratory distress, his condition has stabilized over the past week. However, Sean’s nurse reports that he seems to be deteriorating with clusters of bradycardic events, no wet diapers for 24 hours, and lethargy. At the direction of his neonatologist, he undergoes a septic work-up and is started on antibiotics. Group B streptococcus (GBS) grows on hemoculture within 12 hours, and he is diagnosed with late onset sepsis (LOS). His condition worsens and he develops septic shock. Although he ultimately responds to the treatment, his course is complicated by anuric acute kidney injury (AKI) for which he requires dialysis.
His neonatal sepsis escalates with an uncontrolled systemic inflammatory response activated by hostile stimuli; including desaturation, metabolic acidosis, and enteric bleeding which cascades to distributive shock.
The lungs of an infant are the last organ to mature. As a result, babies born preterm often have underdeveloped lungs and need to be monitored for respiratory insufficiency — especially right at delivery. It is important to achieve just the right amount of oxygen and intervention per the neonatal resuscitation protocol (NRP).
Nellcor™ pulse rate (PR) readings are strongly correlated with ECG heart rate. In a head-to-head prospective observational comparative study with Masimo, Nellcor’s™ time to a stable oximeter signal was, on average, 12 seconds faster.1 With no recorded instances of false bradycardia1, (compared to Masimo recording false bradycardia in 35% of newborns tested1) the labor and delivery care team can rely on Nellcor™ pulse oximetry for fast and accurate results.
During Sean’s delivery, the team ensures a portable SpO₂ patient monitoring system called the Nellcor™ PM10N is ready to begin surveillance of Sean in labor and delivery. Sean is born and a gentle, accurate Nellcor™ OxySoft™ SpO2 sensor is promptly placed on his foot. The Nellcor™ system quickly detects continued low oxygen saturation, so Sean is resuscitated and moved into the NICU for respiratory support.
Experience a small, lightweight, ergonomic handheld pulse oximeter to use wherever your patient is, including immediately following birth in labor and delivery. Nellcor™ portable SpO2 patient monitoring system also incorporates Nellcor™ digital signal processing technology to deliver accurate, reliable SpO2 and pulse rate values even during difficult monitoring conditions such as low perfusion and signal interference, including patient motion.
Our Nellcor™ OxySoft™ SpO2 sensor helps you stay connected to your patients and their data with bright LEDs on a flexible circuit that protects fragile skin. Our sensor has gained an improved signal acquisition and time to post during simulated low perfusion and thicker tissue.
The Nellcor™ pulse oximetry monitoring system should not be used as the sole basis for diagnosis or therapy and is intended only as an adjunct in patient assessment.
The NICU is a difficult environment, and clinicians manage unique critical tasks like managing oxygenation within extremely tight ranges. Because of a neonate's fragile lungs, invasive tools are used as sparingly as possible.
Sean’s post-delivery respiratory distress needs respiratory support. His respiratory therapist puts him on Puritan Bennett™ 980 ventilator with NIV+ software to reduce the uncertainty around effective pressure delivery.
A multipurpose ventilator for noninvasive and invasive ventilation to help clinicians manage neonatal respiratory care:
Helps clinicians provide ventilatory support to neonates weighing as little as 300 grams by delivering tidal volumes as small as 2 mL. The NeoMode 2.0 software was developed specifically for neonates to address and improve some of the issues critical to their care and safety, such as accurate breath delivery, responsive triggering, lower elevated oxygen preset for procedures, effective alarm management, and automatic leak compensation.
Please refer to the instructions for use for the indications, contraindications, warnings, risks, and precautions associated with the Puritan Bennett™ 980 ventilator and software referenced in these materials.
“CRRT procedures performed for critically ill infants using previously available technology are not optimal, largely because dialysis machines available in the United States are not designed to treat these small, fragile patients, and can potentially expose them to many risks.
This new system is designed specifically for these patients which enables increased precision of neonatal CRRT treatment and, potentially, reduces these risks. We are grateful to be the first site in the United States with this technology to help the children in our care.”
– Stuart L. Goldstein, M.D.,
Professor of pediatrics and director, Center for Acute Care Nephrology at Cincinnati Children’s Hospital Medical Center
Support and partnerships
The NICU team is more than just a group of highly trained and specialized medical professionals. It’s a genuine smile at the sight of a milestone achieved. It’s an emotional and sometimes heartbreaking end to a shift. It’s a supportive shoulder and life coach to a concerned parent struggling with their new reality. It is a family. At Medtronic we strive to be more than just a medical technology company; we aim to be a supportive member of that family.
† These narratives feature fictional patients, based on real clinical scenarios and product use. At all times, it is the professional responsibility of the practitioner to exercise independent clinical judgment in a particular situation. Changes in a patient’s disease and/or medications may alter the efficacy of the therapy, or product features. Results may vary.
Khoury, R., Klinger, G., Shir, Y., Osovsky, M., Bromiker, R., Monitoring oxygen saturation and heart rate during neonatal transition. comparison between two different pulse oximeters and electrocardiography. Journal of Perinatology, 2021; 41(4):885-890.
Internal head-to-head bench testing against MaxN.
Based on head-to-head testing with MaxN – CSR 2021 0312v1 S20-12.
Keszler M. Mechanical ventilation strategies. Seminars in Fetal and Neonatal Medicine. 2017;22(4):267-274.
Dargaville PA, Tingay DG. Lung protective ventilation in extremely preterm infants. Journal of Paediatrics and Child Health. 2012:48(9):740-746.
Puritan Bennett™ 980 ventilator operations manual.
Ronco C, Garzotto F, Ricci Z. CA.R.PE.DI.E.M. (Cardio-renal pediatric dialysis emergency machine): evolution of continuous renal replacement therapies in infants. A personal journey. Pediatr Nephrol. 2012;27(8):1203–1211.
Carpediem™ dialysis system [Operator’s manual]. Minneapolis, MN: Medtronic; 2021.
Vidal E, Cocchi E, Paglialonga F, et al. Continuous veno-venous hemodialysis using the cardio-renal pediatric dialysis emergency machine™: first clinical experiences. Blood Purif. 2018;31:1–7.
Garzotto, F, Zaccaria M, et al. Choice of catheter size for infants in continuous renal replacement therapy: Bigger is not always better. Pediatric Critical Care Medicine. 2019;20(3): 170-179.