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#1 of 79 Old 01-02-2006, 06:22 PM - Thread Starter
 
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Okay guys.......

ds is now all of 5 weeks old, and came down with a fever w/ pretty much no other symptoms yesterday. By last night it was up to 101 and we were advised that a fever that high was considered an emergency and to take him to the ER. We took him in, and the ER doctor proceeded to tell me that he needed to run blood work, and put in a catheter to get a clean catch urine sample to rule out a uti. I remember very specifically from this board that you arent supposed to retract the foreskin so I asked if he would be retracting the foreskin in order to do so, and he said yes. Then I told him that under no circumstances would I allow him to be retracted and the doctor got an attitude w/ me and asked if I wanted him to do xxx procedure (three long words that I didnt understand). I asked what that meant, and he said it would entail putting a needle in and drawing the urine out that way. I immediately burst into tears and said NO. I was just so stressed and felt that I was being a bit bullied. I told him that a perfectly normal foreskin should never have to be forced back and he kept arguing with me, and finally was just like, "What DO you want me to do?" I told him that I would allow the blood work and that I was uncomfortable w/ them touching him there at all. I requested that we do that little bag thing to catch the urine and he told me that was 'worthless to him' because he had to have a clean catch sample. Couldnt they just do a clean catch the same way women do, just use the wipes or whatever on the outside and then bag him and wait until he goes?

He said that since the baby couldnt pee on command that wasn't good enough. So we did the blood work which came back normal and left.

The doctor said he felt remiss in not checking for a UTI. Did I do the right thing in refusing? I'm so confused.

Please give me your opinions.

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#2 of 79 Old 01-02-2006, 06:28 PM
 
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I don't have the answer to your question (although my intuition tells me that the doctor was being a big jerk SOB and that surely there must be another way to get a clean catch), but I saw this and just had to give you a big - what a stressful night you must have had.

Every baptized Christian is, or should be, someone with an actual (disturbing) experience, ... a close encounter, with God; someone who, as a result, becomes a disturbing presence to others. - Fr. Anthony J. Gittins, A Presence That Disturbs
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#3 of 79 Old 01-02-2006, 06:29 PM - Thread Starter
 
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thanks Heidi.......that's two scary ER room visits in barely over a month of life.......poor little guy!!

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#4 of 79 Old 01-02-2006, 06:32 PM
 
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I don't know enough about the situation to say. My gut says you did the right thing. I'm sorry you were treated so badly, though. The dr. sounds like a jerk. Good job sticking up for your baby!
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#5 of 79 Old 01-02-2006, 06:32 PM
 
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When ds was 10 days old, he was hospitalized for severe jaundice. They had to place an IV and took him to the 'procedure room' to do this, supposedly so I wouldn't be traumatized. They also tried to cath him, unsuccessfully, and I was PISSED. I didn't know that they were going to even try. Once I learned this, I made them just use the bag. I have no idea what else they did in there, I've tried not to think about it. I was still in shock that he was even *being* admitted, and I wasn't thinking clearly. I should have made them do everything when I was there, but I didn't.

You did right by your son. Good for you. I hope he's better soon.

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#6 of 79 Old 01-02-2006, 06:38 PM
 
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You can cath without retracting the foreskin. Next time (hope there isn't a next time) ask for a NICU or pediatric nurse with experience in intact babies to come down and do the blood draws and the catheterizing.
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#7 of 79 Old 01-02-2006, 06:38 PM
 
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Go over to the vaccination board for help ((HUGS)) I don't think that was an emergency at all.

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#8 of 79 Old 01-02-2006, 06:43 PM
 
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You don't need to put in a catheter to check for a UTI! They will do that in ER becuase it's faster, but at the ped's office they always use a bag. It's a clean catch for infants once the penis/vagina is wiped down, and then the bag put over it. I'm so glad you didn't agree to catheter though. Your son would thank you if he had words to do so.

Clean catch for infants:
http://www.fpnotebook.com/URO43.htm

# Urine collection technique for infants (urine bag)

1. Wash hands with soap and water
2. Use povidone-iodine swabs to clean as above
3. Place sterile urine bag over penis or labia
4. Reclean and replace new urine bag if no urine in 30 min
5. Empty bag into sterile urine container

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#9 of 79 Old 01-02-2006, 06:46 PM
 
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Originally Posted by moondiapers
Go over to the vaccination board for help ((HUGS)) I don't think that was an emergency at all.
Ditto! There are some recent and archived threads on fevers over there that you will probably find very helpful.

And . I'm sorry you had to go through that. I think you did the right thing, though.
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#10 of 79 Old 01-02-2006, 07:29 PM
 
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Quote:
Originally Posted by LeosMama
You can cath without retracting the foreskin. Next time (hope there isn't a next time) ask for a NICU or pediatric nurse with experience in intact babies to come down and do the blood draws and the catheterizing.
yes !!

the bag (@ the hospital) did not work for my DS b/c the tape kept sticking to his scrotum & he screamed more...

then I asked for the above & they did a cath & draw in less than 3 min & they barely moved his foreskin!!

*** I think I would have done the cath for a urine to rule out, Fevers in newborns can be really tricky.

My DS has his only UTI @ 4 wks & we went thru all that but his ER people were insisting on Spinal tap : b/f we got the lab tests back (blood * urine) they pretty much called me a monster for endangering my boy :
I told them let's just wait & see if the bloodurine tests showed anything... ugh....

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#11 of 79 Old 01-02-2006, 07:40 PM
 
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Originally Posted by polka123
My DS has his only UTI @ 4 wks & we went thru all that but his ER people were insisting on Spinal tap : b/f we got the lab tests back (blood * urine) they pretty much called me a monster for endangering my boy :
I told them let's just wait & see if the bloodurine tests showed anything... ugh....
This is horrible! But I hear similar stories ALL THE TIME. It's so sad that parents who don't take the doctors word as the word of God are harassed. Sorry you had to go through that.
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#12 of 79 Old 01-02-2006, 07:43 PM
 
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I would have done the exact same thing as you. Just from this forum I KNOW you cath an infant without retracting the foreskin, and if the doctor was that much of an @ss to me no way would I let him near my son's penis. Plus, from USAmma's thread, you don't even NEED to cath them. Total arrogant @sshole. I'd write up a letter to the head of the ER and community relations (or whatever it's called at your hospital) telling them EXACTLY what happened, how that doctor made you feel, and reference the link plus see if there's anything from the AAP about cathing and intact infant, and include that. You were informed and stood your ground, the next intact infant who comes in may not be so lucky and his mom may get bullied by this jerk.

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#13 of 79 Old 01-02-2006, 08:19 PM
 
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I believe you did the exact correct thing! You are the responsible party for the care of your child. If you know better about a procedure, insist that it be done right and by people experienced in doing it right.

My advice: If you instincts tell you "NO" about a medical procedure for your child....listen to them.

In a situation like that, can you request a patient advocate?

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#14 of 79 Old 01-02-2006, 09:00 PM
 
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Sarah, I second the suggestion to write a letter/complaint to the ER your son was seen at. The way you were treated is inexcusable. That doctor was obviously ignorant of intact care, and I shudder to think how many baby boys his scare tactics, pressure, and poor bedside manner may have harmed. It is so upsetting and frustrating to me that parents have to be the ultra-informed ones, and these doctors who are being paid to be experts can be so ignorant and arrogant at the same time. Ug.

Jen
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#15 of 79 Old 01-02-2006, 09:18 PM
 
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Please post the name and city of this hospital. We will get
Doctors Opposing Circumcision to write a letter. They are
very good at addressing these things and getting action.
Time of incident and family name would also be helpful, if you're willing.
You can PM me.
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#16 of 79 Old 01-02-2006, 09:22 PM
 
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Quote:
Originally Posted by babykaoss
and asked if I wanted him to do xxx procedure (three long words that I didnt understand). I asked what that meant, and he said it would entail putting a needle in and drawing the urine out that way.
Actually, it's two words that sound like three, suprapubic aspiration. Just like a blood sample is taken, they go through the abdomen into the bladder to get a urine sample. It's the most accurate way and the least likely to be contaminated. It's probably a little more painful than an injection but not much. Definitely much less painful than getting the foreskin ripped away from the glans.


Quote:
I requested that we do that little bag thing to catch the urine and he told me that was 'worthless to him' because he had to have a clean catch sample. Couldnt they just do a clean catch the same way women do, just use the wipes or whatever on the outside and then bag him and wait until he goes?

It's this doctor that is worthless! He could absolutely bag your son.


Quote:
The doctor said he felt remiss in not checking for a UTI. Did I do the right thing in refusing? I'm so confused.

Please give me your opinions.
You did the right thing in refusing something that you did not understand and had concerns about. Now that you have more information, if the symptoms have not resolved, you can go back forearmed and forewarned.




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#17 of 79 Old 01-02-2006, 09:29 PM
 
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Good for you for standing your ground! I agree with the PP that that doctor was a complete ass, and that you should write a letter and contact Doctors Opposing Circumcision to have them write a letter.

That jerkoff doctor could have done MORE harm to your ds if you had allowed him to retract your ds - and given that your ds would have had a wound from premature retraction in the hospital that then might be susceptible to all sorts of nasty germs present in hospitals like MRSA and other antibiotic-resistant bugs, you absolutely did the right thing in protecting your son. Way to go!

I hope your ds is feeling better soon.

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#18 of 79 Old 01-02-2006, 09:55 PM - Thread Starter
 
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nak.....its hard to type one handed!

thank you all so much! i really appreciate having some confirmation to my gut feelings. the hospital is Children's Hospital in Omaha Ne. I'll get more info to you when i can type. i dont know anything about doctors opposing circumcision, i'm interested though.

as a matter of fact, before we even saw the doctor, the nurse informed me that we would need a catheter, and i immediately felt bells go off in my head and i asked her if i could please request a doctor familiar with the care of the intact penis because we would not be allowing any premature retraction on our son. she smiled patronizingly and tried to interrupt me with a "we do this ALL the time" *shudder* I tried to persist and she said i could discuss it with the doctor...........

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#19 of 79 Old 01-02-2006, 10:28 PM
 
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Well I'll be the odd person out here and say that yes, a baby under 2 mos running a fever of 101 needs to be seen at the ER. I have had sepsis work ups TWICE with newborns, one at 5 weeks (and it WAS a UTI!) and one at 8 weeks (ended up being double ear infections). It is absolutely protocol that a newborn with a fever be checked for meningitis and a UTI. They also do a blood culture to check for sepsis. Think about the alternative....newborns have very weak immune systems and can be very easily overwhelmed by an infection. Because things like meningitis and UTIs are SO common, and be SO easily cured, and can KILL a newborn, it makes common sense for all newborns to be treated this way at the ER.

Now the doctor who said you had to retract your baby to get a cath was wrong. My son was cathed several times in the hospital when he had his UTI and none of those times was he ever retracted. The reason why they have to do a cath is because while a bag might potentially rule out a major infection if dipped right in the ER to look for the presence of blood or white cells, it is useless to culture because it's been contaminated by skin cells, poop germs, and whatever else might be hanging around. If the baby did have a UTI, or even if the dip came back negative, they would STILL have to cath the baby to know if there truly was a UTI, and if so, what the germ was that was causing it and what antibiotics it was sensitive to.

My 2nd DD was born with a solitary kidney and had high grade kidney reflux, so I know about this and have seen my kids cathed more than I'd care to mention.

OP, if I had been in your situation I would have gone ahead with the cath but would have demanded someone else do it. I surprised you didn't get hit up for a spinal tap also, MUCH worse than a cath and also very common when a febrile newborn goes to the ER.

When it comes to a newborn baby IMHO it pays to be aggressive. They can be SO easily overwhelmed with infection.....the situation would be totally different if it was an older infant or young child.

I hope your baby is feeling better soon (((((HUGS))))) BTDT, my children were both hospitalized for several days with IV antibiotics and recovered without incident. My DS who had a UTI at 5 weeks never had another one again.....

ETA an article that discusses treatment of fever in babies under 60 days of age

http://www.emedicine.com/ped/topic2698.htm

"Age: Treatment of a febrile infant has changed significantly over the past 10 years. Previously, all infants younger than 90 days who had a fever without focus were completely evaluated for SBI, including having a lumbar puncture (LP) performed; patients were then treated with parenteral antibiotics and were hospitalized for 2-3 days while awaiting culture results.

Today, febrile patients younger than 1 month should still be completely evaluated and admitted to a hospital for conservative treatment, including antibiotic treatment, pending the results of cultures; however, infants aged 1-2 months may not require admission if they (1) appear otherwise healthy on examination, (2) have benign laboratory findings, and (3) lack certain significant risk factors (see Febrile infants aged 1-2 months). This somewhat less conservative approach varies from region to region and depends somewhat upon the populations served and local practices."

It also says:

"Low-risk patients in this age group are previously healthy infants who do not appear toxic and who exhibit no focal bacterial infection on physical examination (excluding otitis media). Consider the child's home environment (ie, social situation, presence of a reliable caregiver, availability of transportation and telephone) before placing an infant in the low-risk group. Laboratory test results for a low-risk designation must include the following:

Normal UA results (ie, negative nitrite findings and/or <10 WBC/high-power field [hpf]) "

That means a normal Urinalysis is required to be considered in the low risk category.

Where I live, they still follow the protocol of treating all febrile babies under 90 days of age with a full sepsis work up. And I would be especially concerned if the baby was running a fever but had no other signs of illness (very typical of kidney infections).
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#20 of 79 Old 01-02-2006, 10:42 PM
 
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Originally Posted by shaylahc
Well I'll be the odd person out here and say that yes, a baby under 2 mos running a fever of 101 needs to be seen at the ER. I have had sepsis work ups TWICE with newborns, one at 5 weeks (and it WAS a UTI!) and one at 8 weeks (ended up being double ear infections). It is absolutely protocol that a newborn with a fever be checked for meningitis and a UTI. They also do a blood culture to check for sepsis. Think about the alternative....newborns have very weak immune systems and can be very easily overwhelmed by an infection. Because things like meningitis and UTIs are SO common, and be SO easily cured, and can KILL a newborn, it makes common sense for all newborns to be treated this way at the ER.

Now the doctor who said you had to retract your baby to get a cath was wrong. My son was cathed several times in the hospital when he had his UTI and none of those times was he ever retracted. The reason why they have to do a cath is because while a bag might potentially rule out a major infection if dipped right in the ER to look for the presence of blood or white cells, it is useless to culture because it's been contaminated by skin cells, poop germs, and whatever else might be hanging around. If the baby did have a UTI, or even if the dip came back negative, they would STILL have to cath the baby to know if there truly was a UTI, and if so, what the germ was that was causing it and what antibiotics it was sensitive to.

My 2nd DD was born with a solitary kidney and had high grade kidney reflux, so I know about this and have seen my kids cathed more than I'd care to mention.

OP, if I had been in your situation I would have gone ahead with the cath but would have demanded someone else do it. I surprised you didn't get hit up for a spinal tap also, MUCH worse than a cath and also very common when a febrile newborn goes to the ER.

When it comes to a newborn baby IMHO it pays to be aggressive. They can be SO easily overwhelmed with infection.....the situation would be totally different if it was an older infant or young child.

I hope your baby is feeling better soon (((((HUGS))))) BTDT, my children were both hospitalized for several days with IV antibiotics and recovered without incident. My DS who had a UTI at 5 weeks never had another one again.....

Just want to point out that you're not the odd one out....there was only one post suggesting that the fever wasn't an emergency. No other posters suggested that the OP shouldn't have gone to the ER.

Maybe I'm being a little over-sensitive but we have had a rash of people accusing the regular posters here of giving bad medical advice and I don't see any of that on this thread. In fact, it was the ignorant, arrogant doctor who was about to commit bodily injury to this poor sick baby.

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#21 of 79 Old 01-02-2006, 10:51 PM - Thread Starter
 
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he DID suggest a spinal tap, but he dropped it after i refused the catheter and after his white blood count came back normal. could he still have a uti w/ a normal wh blood count? what are the dangers of a uti in a newborn? his temp is now 100.2......isnt that a good sign? now i'm scared......

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#22 of 79 Old 01-02-2006, 10:51 PM
 
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Quote:
Originally Posted by Quirky
Just want to point out that you're not the odd one out....there was only one post suggesting that the fever wasn't an emergency. No other posters suggested that the OP shouldn't have gone to the ER.

Maybe I'm being a little over-sensitive but we have had a rash of people accusing the regular posters here of giving bad medical advice and I don't see any of that on this thread. In fact, it was the ignorant, arrogant doctor who was about to commit bodily injury to this poor sick baby.
Well I apologize if my post seems overbearing, this topic just happens to be very near and dear to my heart since I have lived with it for 6 years since my kidney reflux baby was born. I am sensitive to the lack of information that I sometimes see here, along with this attitude that anything to do with medicine or doctors is evil or wrong. I don't see anything wrong with what the doctor in the ER was suggesting (other than the retraction issue) and it saddens me to see so many people bashing the ER as being overly aggressive in treating this baby. It concerns me that the baby might be seriously ill, and the mother may come here and see all these posts saying the ER doc was wrong for wanting to cath the baby, etc, and this child may not get the help he needs.

Quite often on this board I see medical opinions being tossed around as facts and it can be a very dangerous thing Not trying to step on anyone's toes.
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#23 of 79 Old 01-02-2006, 10:57 PM
 
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Quote:
Originally Posted by babykaoss
he DID suggest a spinal tap, but he dropped it after i refused the catheter and after his white blood count came back normal. could he still have a uti w/ a normal wh blood count? what are the dangers of a uti in a newborn? his temp is now 100.2......isnt that a good sign? now i'm scared......
The way it was explained to me at the ER, is any temperature over 100.1 (taken rectally) in a newborn is considered a "significant fever". If it was my child, I would absolutely take him back to the ER and have him checked. If he isn't coughing, no runny nose, no other signs of illness....it would be highly unlikely that this fever is something viral. JMHO, not to be taken as fact, that is why I suggest taking the baby to the hospital where he can be seen by the people who are best equipped to handle this situation.

HUGS ((((HUGS)))) because I know how scary and heartbreaking it is. But like an ER nurse once told me....meningitis in newborns is SO common, but SO easily treated....why take that chance?
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#24 of 79 Old 01-02-2006, 10:59 PM
 
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yup !! my body has hydronephrosis that needs constant monitoring & I'm so glad we found it via U/S while in utero.

I think a minor mini-cath to rule out infection is not seriously evasive like a spinal tap.
As I said... no retraction is neccesary & if you have a Pro do it, it's no time at all.
I've very medically medical no touch but you can't be too sure with a newborn with fever of UKO

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#25 of 79 Old 01-02-2006, 11:02 PM
 
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Quote:
Originally Posted by babykaoss
he DID suggest a spinal tap, but he dropped it after i refused the catheter and after his white blood count came back normal. could he still have a uti w/ a normal wh blood count? what are the dangers of a uti in a newborn? his temp is now 100.2......isnt that a good sign? now i'm scared......
100.2 should be ok but I'm no med professional.
As long as he's eating & peeing - that's a good sign hon!!
my ds got really listless & stopped nursing so that's a red flag

his wbc should have been elevated if he had UTI.
is he nursing & peeing w/out discomfort?

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#26 of 79 Old 01-02-2006, 11:03 PM
 
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Originally Posted by Frankly Speaking
Actually, it's two words that sound like three, suprapubic aspiration. Just like a blood sample is taken, they go through the abdomen into the bladder to get a urine sample. It's the most accurate way and the least likely to be contaminated. It's probably a little more painful than an injection but not much. Definitely much less painful than getting the foreskin ripped away from the glans.
Frank, I cringe at the thought. To me, the invasiveness (and probably the pain) is probably similar to amniocentesis. They would probably need to significantly restrain him, use ultrasound guidance, and there's probably a risk of poking other organs, infection, and bruising.

I think they're both crappy alternatives to doing a clean catch using a bag or catheterization w/out retracting the foreskin.

I guess I just feel like if the aren't smart enough to 'fish' for a urethra with a soft rubber tube...I don't want them 'fishing' around in my child's abdomen with a long, sharp needle. KWIM?

Jen
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#27 of 79 Old 01-02-2006, 11:25 PM - Thread Starter
 
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i never meant that i wouldnt get medical attention for him. his pediatrician's office, who we called first thing this morning, was closed for the 'holiday'.....so we're taking him tomorrow.....

he sure is eating a lot, every two hours, sometimes he'll do these little cluster feeds every half an hour for a few times too.........his diapers are very wet and full, and dont have a urine smell and are almost clear........his belly has sounded really gurgly and loud though, which i mentioned to them and they didnt really seem concerned........his nose sounds stuffy but there is nothing visible in it, although i have been giving the saline drops when he sounds stuffy, i can't suction anything out........

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#28 of 79 Old 01-02-2006, 11:28 PM
 
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Quote:
Originally Posted by shaylahc
But like an ER nurse once told me....meningitis in newborns is SO common, but SO easily treated....why take that chance?
Not to contradict you, but what exactly does "SO" common mean? 50% of babies? 25%? 10%? 5%? 1%?

This article puts the risk of neonatal meningitis at .25% per 1,000 births: http://www.emedicine.com/neuro/topic239.htm

This information from the AAFP says, "Bacterial meningitis has an incidence of about 20 to 100 cases per 100,000 live births during the newborn period." http://www.aafp.org/afp/990515ap/2761.html

To me, that doesn't qualify it as "SO common".

I know it's a bit OT, but if anyone has any other info showing a significantly higher risk, please share because I'm interested in learning more about this topic.

Jen
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#29 of 79 Old 01-02-2006, 11:33 PM - Thread Starter
 
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Originally Posted by PuppyFluffer
I believe you did the exact correct thing! You are the responsible party for the care of your child. If you know better about a procedure, insist that it be done right and by people experienced in doing it right.

My advice: If you instincts tell you "NO" about a medical procedure for your child....listen to them.

In a situation like that, can you request a patient advocate?
what is a patient advocate?

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#30 of 79 Old 01-02-2006, 11:42 PM
 
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If you do decide to take him back to the ER, would (and this question isn't just for you, it's for the more knowledgable ER patrons too) it be possible to call ahead and tell them you're coming in, you suspect a UTI in your son and he's intact, and that you want someone waiting who is schooled in cathing an intact penis without retracting, and if not you'll be going to a different hospital? Or would that unreasonable? I'm just thinking if you're proactive and give them advance notice to get someone down from Peds or the NICU to cath him maybe it won't be as much of a struggle.

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