Blue baby

Dr. Jacques knocks on the door.

"I just assited an uncomplicated vaginal delivery, but the baby is having espiratory distress. The nares are flaring, the intercostal muscles are retracting and he's just having a hard time. I tried aspirating to see if he had any mucus but it seems his nose is blocked...it's like there's just no connection to the throat."

In my mind I'm thinking, "yeah, right, he must just not know how to stick a tube down a baby's nose..." but my better judgement says I should just go and look.

I enter the dimly lit corridor and push open the labor and delivery room door into a brightly lit, but small chamber. A quick glance takes in a young woman lying comfortably on the bed, not much blood around, and breathing and glancing around normally. She's fine.

I turn to the baby reanimation table and see a chubby, bluish gray baby with a disproportionately tiny head (normal newborns heads are huge compared to their bodies) lying staring up and grunting but not really breathing.

I grab him around the chest, flip him over on my hand and slap him hard on his back. He starts to cry vigourously. I think that must be it. They just are afraid of these supposedly fragile little beings and don't stimulate them enough.

I flip him back over on his back on the green, brightly patterned cloth underneath him and reach for the aspirator. A tiny tube goes into a small canister with a slightly larger tube coming out the same top. I slip the bigger end in my mouth ready to suck and slide the smaller tube into the baby's nose. It only goes in 1-2cm and is stuck. I wiggle it around and then try the other nostril. Still no passage. I stick my finger into the newborn's mouth straight back into his throat. He starts to gag as I feel around and confirm, there's no opening between his nostrils and his airway.

Now, here's the problem. Instinctively, a newborn is an obligatory nose breather. This allows him to nurse and breath at the same time, two very important things God makes sure they now how to do instinctively because there's just no spare time to have to learn it in. He only breaths through his mouth if he cries.

We can't just make him cry all the time, he just won't do it. He cries a little and starts to pink up and then goes back to sucking in impotently on his blocked up nostrils.

What to do? I think quickly and go to the OR to find some probes and see if there isn't some passage back there after all that's just blocked up.

The probes go nowhere. I've brought the hemorroidectomy kit as that's the only one I know of with probes.

I call the father in and explain the situation.

"He can't breath through his mouth because it's against his instinct and he can't live without breathing and we can try to poke a hole through but he could bleed a lot and die or we could damage some important things, but the bottom line is he won't live if we do nothing. What do you think?"

"Do what you have to, it's in God's hands."

I grab a Kelly clamp and probe downward in the right nostril to where the palatte seems thinnest between the nose and mouth. I poke through. I then do the same on the other side. However, he still can't breath because the mucosa of the mouth just falls back in place. We need something to keep it open. I grab the aspirator and cut off a piece of the bigger tubing. I reach the clamp through into the mouth, grasp the tube and pull it out through the nose. The first time it pops all the way out. I then attach another clamp onto the mouth and and pull it through again, this time the clamp prevents it from coming all the way out. I repeat it for the other
nostril.

I suck up some blood out of the nose and mouth and down the tubes using what's left of the newborn aspirator. He's still struggling but I can hear and feel air coming out the two tubes.

I then insert a feeding tube in the mouth and the mother starts squeezing out breastmild which we feed the baby through the tube with a syringe.

He's already pinking up, only his hands and feet stay blueish gray.

Yep, he's in God's hands all right.