The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Infant Response to Monitoring of lung Sounds in the Newborn ICU: ElECTRONIC-REMOTE VS Stethoscope

Michael R. Jackson NPS-RRT CPFT – Brigham & Women’s Hospital, Boston, MA, Andrey Vyshedskiy, PhD - Faulkner Hospital, Boston, MA, Anna Wong NPS-RRT CPFT RN - Faulkner Hospital, Boston, MA, Paul Nuccio RRT FAARC - Brigham & Women’s Hospital, Boston, MA

Background: Auscultation of infant lung sounds may cause them disturbance & introduce infection. That disturbance may compromise the patient’s well being. The infant’s agitation may effect the quality of breath sounds. Bedside nurses may try to protect the babies environment by limiting RT access to the patient. We wondered if breath sounds could be monitored without disturbing the infant.

Methods: Twenty events of lung sound auscultation were monitored. Half were monitored by stethoscope and half by pre-placed electronic biological sound sensor. Each patient served as their own control. No patient was auscultated unless the normal care plan called for it. Wires from these sensors ran to the outside of the infant’s isolette, where they connected to the auscultation device. Five mechanically ventilated breaths were monitored. Infant motor response was assessed by NIDCAP trained nurses before during and after sound auscultation. Respiratory Therapists monitored for changes in ventilator synchrony (per waveform monitoring) and O2 saturation (per pulse oximetry). Infant state (wakefulness) and attention related responses (eg. fussing,) were not documented.

Results: Results showed that stethoscope auscultation had significant effect on infant O2 saturation, autonomic (ventilator synchrony) and motor response. Remote sensing of sounds was associated with no obvious response by the patient.

Conclusions: Contact of the (often cold) stethoscope disturbs the patients sleep pattern, & causes O2 desaturation, agitation of the patient, effects the breathing pattern & ventilator synchrony. A breath sound monitoring system may be placed on an infant so that the infant state is not disturbed and sound may thereby be more effectively analyzed. The electronic system tested cost $250 for the monitor and $5 each for the sensors. A reusable conventional stethoscope (dedicated to individual patient) may be purchased for ~$70.

* NIDCAP – Newborn Individualized Developmental Care and Assessment Program provides a neurologic assessment system for newborns.

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