by iyqyqr

We often have 'ghost babies' on vents or Cpap with heart rates of 180-200, poor weight gain, frequent desats, but our neos do not transfuse until the hemoglobin reaches 7-8. These babies are anemic due to lab draws only and have several weeks left in the NICU before discharge. These are C phase babies that in past years we would transfuse regularly to keep their hemoglobins above 11. Our I phase kids get real low also, but the Neos will at least do occasional retic levels on them and have them on Fe. When we query our neos about the need for transfusing they tell us, "they aren't symptomatic enough to be transfused" and they won't transfuse when they reach 9, but will when the baby hits 7-8, even though he is clinically unchanged. Our unit views frequent desats and bradys in this ELBW population as normal, tolerating up to 120 in a 12 hour shift. We follow OWL protocol and set our sat alarms at 85-93 and our babes will routinely hit 30-60's on desats and require manual breaths on the vent to bring them up, since we are not to play with the oxygen much. Often, we have to ambu them up AND our ambus are set on 100% wall oxygen, because we do not have enough blenders for all ambu bags. These desats occur all shift long, but are often more prolonged with nursing cares. Our preemies are not on sedative drips or rescues, UNLESS they are on an oscillator or post surgery. The constant desats and bradys make these kiddos 1:1 in care, but we often have 1-2 other patients assigned with them. Some of our staff resort to ignoring OWL parameters and changing the sat alarm settings and giving them more oxygen so they high sat, rather than low sat. This explains why after a year on OWL our ROP was unchanged. I worry constantly about what the low sats are doing to their developing brains and I cringe whenever I walk by one of these patients and see that they are satting 100, their alarm is silent, and when I mention it to the nurse caring for the baby, she says," I don't have the time to chase him all night." Please tell me how your units are managing these babies! Have you found something that lessens the desats, yet enables these kids to be slowly weaned off the vent? What is the EBP for NOT transfusing these little ones???

Re: How low do you let your hemoglobins go before transfusing?

How do the patients get any rest with kids alarming 120 times a night? There is no way...

Re: How low do you let your hemoglobins go before transfusing?

If they are retic-ing and the Hg is above 8, we don't transfuse either. But I have seen those to young to retic transfused at 10 because they are bradying often.Is it postional? Are they refluxing? What is their history? Sometimes they do just need to grow out of it.
When it comes down to it, we are saving 24 weekers now. All the PRBCs in the world aren't going to fix the CLD in these kids.You need to pick your side. Brain function or eyesight? Despite what people hear on the news, a 500g baby will not leave the NICU unscathed.

Re: How low do you let your hemoglobins go before transfusing?

Depends on the patient status...

Generally, any hct under 30 (unless an otherwise healthy infant), frequent desats/bradys...

Re: How low do you let your hemoglobins go before transfusing?

We have different levels that we will transfuse for based on resp. needs, age, gestational age at birth, discharge expected soon. We go by Hematocrit, not hemoglobin. Generally, our room airs/cannulas have to be <25 or very symptomatic to get blood. Everybody else is generally <30, sometimes <35 in new micros. Also sometimes if a baby's hct is fine but needs volume we will go ahead and order blood and/or FFP.