I think every NICU has had a broken arm in a tiny premie at one time or another. The very premature babies usually have relatively demineralized bones, for a combination of reasons, and it's easier to break them than it is the bones of a term baby. On the other hand, most tiny premies get through their NICU stay without a broken bone, in spite of demineralized bones, so if a baby has a broken arm, something has gone wrong. We don't know exactly when this baby broke his humerus. I suspect it occurred when he was being turned over or something like that, and perhaps his arm caught under him and snapped. The nurse wouldn't have even known it happened until the swelling started or they noticed it wasn't moving.
This was discouraging, to say the least. The parents were understandably upset and immediately started talking about transferring their baby to another NICU. I sighed to myself. We had maintained a good relationship with them through the baby's rocky NICU course so far, keeping them informed and being open with them, and it was disappointing to see that dissolve so quickly. Interestingly enough, they didn't seem that upset about the actual fracture itself but were angry that it hadn't been noticed and reported sooner (although, since we didn't know when it occurred, we don't really know how long it went unnoticed.)
It goes to show, I think, that we can never let our guard down in the NICU. You have to have a certain degree of compulsiveness to do well there. We can grow comfortable working there - we have to, or we couldn't stand it - but we cannot become complacent. You have to always be careful, whether you're writing IV orders, calculating an antibiotic dose, adjusting ventilator settings - or merely repositioning a baby with demineralized bones. Part of me is a little ticked at whoever did this for letting his or her guard down, but also, I know we all make mistakes.
The fractured bone is lined up nicely and the baby's arm should heal well. In fact, compared to the baby's lung and infection problems, plus his risk for neurodevelopmental problems secondary to prematurity, the fracture is a relatively minor thing. But for now, it takes center stage for the parents and therefore for us.