Newborn Breathing Problem
My nephew baby, 7bls 4 oz, was born three days ago has had trouble breathing through his nose. They have used meds to take swelling if any from inside of the nose. The oxygen levels are at 95% to 97%...Is this ok? They have a monitor and alarm on him at this point.
They are at a small Hospital in rural Arkansas. Would you suggest going to a children’s hospital at this point?
If a newborn has problems breathing through the nose, he should be checked for Choanal Atresia, also knonw as Choanal Stenosis. Choanal Atresia occurs when the nasal passage is too narrow or obstructed. The narrowing or obstruction can occur in one or both nasal passages. Either a membranous or bony septum between the nose and the throat is responsible for the obstruction.
When Choanal Atresia is present on one side, the symptoms can be very mild and may not surface until the baby develops his first cold. Signs of unilateral (one-sided) Choanal Atresia include the absence of air moving in and out of the nostril and nasal discharge from the involved side. These signs tend to become more pronounced during a respiratory infection.(1)
If Choanal Atresia is present on both sides, the child can suffer from respiratory distress. The severity of respiratory distress depends upon the degree of obstruction. Signs of bilateral Choanal Atresia include difficulty breathing after the initial cry at birth. The baby may turn blue and develop retractions. The baby also develops sucking in motions of the lips. The distress can be relieved by opening the child’s mouth (1)
If there is a concern that an infant has Choanal Atresia, the Doctor uses a firm catheter and passes it through each nostril, one at a time. If there is difficulty with this maneuver Choanal Atresia is suspected. The diagnosis can be confirmed by direct Nasopharyngoscope or Bronchoscope performed by an Otolaryngologist. In some cases the diagnosis may also be confirmed through a special type of x-ray.
The presence of nasal congestion in the newborn period that interferes with breathing can also be due to other conditions such as Gastroesophageal Reflux or a respiratory infection such as RSV or Sinusitis. The Doctor in charge of the case is responsible for determining the cause of your nephew's symptoms and providing interventions that are necessary to alleviate the problem.
Hemoglobin O2 saturation or pulse oximetry(a number given in a percentage) represents the total oxygen-binding sites on the hemoglobin that are bound with oxygen.(1). Generally speaking, a pulse oximetry reading between 95 and 97% is normal. How this one number relates to your nephew’s overall condition can only be interpreted by the Physician who is caring for him.
A pulse oximetry reading in and of itself is only one measure, one piece of a very large puzzle. Other factors need to be taken into consideration when interpreting a child’s respiratory condition which includes other diagnostic tests, findings from the physical examination and the need for artificial breathing devices or supplemental oxygen. In other words, the O2 saturation reading on a child breathing room air as compared to an O2 saturation reading on a child who is receiving oxygen represents two very different things, even if the number is the same.
Whether or not your nephew needs to be transferred to a Children’s hospital or a higher level Special Care Nursery can best be determined by the Doctor in charge of his case. This generally is a decision made by the Neonatal Intensive Care Physician. If your nephew’s parents do not see any improvement in their child’s condition, are unhappy with the care or are seeking a second opinion they do have the right to be transferred to a different hospital. If this is the case, they should discuss this with their Doctor because this is a decision that should be made in conjunction with the Physician in charge of the case and with the child’s Pediatrician.
It is a very difficult to be in the position of an Aunt, because you are concerned about your nephew’s health, but at the same time, you do not legally have the right to review his medical records, discuss his condition with his Doctor or make decisions about his care. Only his parents have that right. It is very stressful for parents to have a sick newborn. There is a lot of information to absorb and a lot of decisions to be made. In some cases, the opinions of others makes the situation more confusing. Many times parents need time and privacy to make these decisions on their own.
If your nephew’s parents asked your opinion about his medical condition, then it is very admirable of you to seek out the information that they need. In this case, the information that you give them can be very helpful. If they did not ask your opinion about their child’s medical condition then the best thing that you can do is ask them what you can do to help their life run a little smoother.
Congratulations on the birth of your Nephew and I hope that his health issues resolve quickly so that he can go home soon.
If you are interested in other Pediatric Advice Stories covering this material:
Baby with a Stuffy Nose
Baby with Cold Symptoms
Gastroesophageal Reflux in infancy
(1)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1265, 1177.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice For Parents with Newborns