Re: "Never trust a 35 weeker"

There is now a body of literature addressing the needs of the "Late Pre-term Infant". 34-37 weekers. I feel 'validated'! LOL.

Re: "Never trust a 35 weeker"

Originally Posted by prmenrs

There is now a body of literature addressing the needs of the "Late Pre-term Infant". 34-37 weekers. I feel 'validated'! LOL.

And boy, do those needs not get addressed nearly enough.

This is just my opinion, but I really think 34-37 weekers need a few hours to prove themselves in NICU or intermediate before coming to wellbaby. Our goal is to get them out to be with mom....for what? So they can forget to breathe while mom & dad are sleeping?

We've recently had a spell of 34-weekers getting sent to WELLBABY. Can't wait for that to bite us in the backside.

Re: "Never trust a 35 weeker"

Originally Posted by Arwen_U

We've recently had a spell of 34-weekers getting sent to WELLBABY. Can't wait for that to bite us in the backside.

Uch, we do that too, as long as they make weight. I mean, come on, the kid came out early for a REASON, let's figure out what that is before we send them off to either a) mom's room, where they may get checked on once every few hours or b) WBN, where you've got one nurse for twenty babies, and they aren't even on monitors. Great plan.

NB: Not knocking WBN nurses AT ALL, that's just a lot of kids to keep track of. I could never do it; I'd go mad. I like my 1-3 patients, thanks very much.

Re: "Never trust a 35 weeker"

Oh, I completely agree with you, elizabells. No offense taken at all!

Last night at the end of my shift, I (along with two other nurses) had 31 babies to keep track of, ON TOP OF two withdrawing methadone kids (one consistently scoring 16-22), a 35-wk feeder-grower, a bilibed kid, and a kid whose mom is in ICU after almost bleeding to death during her c/s (undxed HELLP). If they'd tried to send a 34-weeker in on top of all that, I would have been, um, less than thrilled.

I know NICU can get very hairy, but when I do go over there, I'm always amazed at the lack of chaos that seems to reign in my corner of the woods.

Re: "Never trust a 35 weeker"

Right after I graduated I started working in a well-baby nursery ..... we didn't do couplet care, so no moms, just babies. Normally we'd have 6-8 babies. I'd get frustrated when I'd call NICU for a grunting baby or a baby with constant hypoglycemia ..... and they'd treat us like incompetent idiots! I wasn't totally stupid and incapable of watching a baby through transition, but please take into consideration that I have all these other babies that need my attention too, so I don't have time to focus on a baby that needs closer monitoring.

Needless to say, I ended up leaving that place. The place I'm at now, I think we do a pretty good job at bringing babies up to the unit that need closer monitoring. When I go over to look at a baby for them, I just feel more comfortable bringing the kid up to the unit ..... a lot of times they just need a bit more time transitioning, but I feel safer in having them on a monitor and on the unit where we can watch them closer.

Well-baby nursery is incredibly chaotic, I totally agree Arwen! Of course I still have some nights in the NICU where it's crazy and the unit is a busy place. But I NEVER in my life ran my butt off more than when I worked in well-baby. A few weeks ago I had to float to couplet care ..... I got a 20 minute lunch break for that entire shift ..... reminded me of those old days, whew!

Re: "Never trust a 35 weeker"

I work as an ALS (Advanced Life Support) Nurse. That means I have advanced training to intubate (for mec aspiration or resuscitation) and insert umbilical lines. I am a NICU RN (24 years) and now "reside" in L&D for the majority of my shift. I attend ALL deliveries, not just high risk deliveries. I am responsible for every newborn infant and their transition to extrauterine life.

I have fought with our Perinatologists for the past 4 years re: inducing labor or not stopping labor in 34-36 week mothers. Their literature indicated that they were just small term infants and NICU does such a great job with them... so deliver them BEFORE the mom gets infected and then let NICU "do their thing".

I had the support of my Neo's and Pedi's but I was getting nowhere.

FINALLY, AWHONN posted articles/data with the "Late Preterm Infant" statistics to include readmission to the ED and hospital, neurological outcomes, readmit diagnosis and of course the cost of having this infant "outside of it's mother" before 37 weeks. NOW they hear me. What a difference AWHONN's data made for me and for all of our LPI's.

I am also on the committee to write/review our Standards of Practice for our NICU. I have just written our new SOP re: Care and management of the LPI. I am sending it out to the post partum and L&D managers/MD's for approval this week.

I have my own share of stories to tell of the "untrustworthy LPI" but will hold them for now. Another time.....

We all have to stand up and fight for these premies and educate our co-workers and parents. They are NOT just cute little term infants! They need supervision!

Re: "Never trust a 35 weeker"

echomoon,

I appreciate your post more than you'll ever know. The last place I worked had a group of "renowned" perinatologists who all seemed to forget that the goal of pregnancy is a healthy mother and baby. Their answer to everything was to deliver IMMEDIATELY.

I'm not talking about moms with life-threatening conditions like HELLP syndrome, or babies with TTTS. I'm talking about moms with multiples who were "not expected" to carry to term (not allowed to try, either) babies with a single U/S showing delayed growth, one mom was recommended to have a section at 32 weeks because her older children had genetic abnormalities. HUH? Thank goodness she was smart enough to refuse, because when she delivered spontaneously at 37 weeks, her daughter experienced mild RDS. How bad do you think it would have been 5 weeks earlier?

It just seemed to me that these people completely lost sight of the second patient.

Re: "Never trust a 35 weeker"

I went to a conference a few months ago that had a lecture on the near-term infant... I'll see if I can dig up the notes. Basically the hope is to make purely elective c/s prior to 39wks a "never event". The problem is that the OBs who allow/encourage this to happen don't have to deal with the consequences. As one said to the group "My expertise ends at the five minute APGAR". Apparently, for some, their sense of responsibility does too.

Re: "Never trust a 35 weeker"

So I've been taking care of the dreaded 35 weeker for the past couple of days. You all know, the kid born at a community level I hospital that comes out and then starts grunting and acting all silly. Came to us, and wound up intubated with a big ol' pneumo. Bought himself some chest tubes and he's got some mild PPHN. He's on HFJV, weaned off of INO today. He's starting to make the turn-around (I pray!) to getting better. I totally thought of this thread when I talked to the parents the other day. I told them that I don't fear admitting a baby born at 24 weeks, cause I know (more or less) what to expect- intubated, on a vent, probably with pressors, blood transfusions, etc. It's the 35 weeker with some "mild" RDS coming in on a transport from a community hospital that I fear. The ambulance ride could cure them, or they will wind up needing everything we've got. Oh, and of course, they are THE nicest people around. Although these kids are scary at times, they are my favorite to take care of. The micropreemies are exciting to me at first, but it's the kids that I can take care of for a week or so and I can see them go from death's door to almost out the door that I really like. Cross your fingers for this little guy (and for his nurses!). Oh, and NEVER TRUST A 35 WEEKER!!!

Re: "Never trust a 35 weeker"

We've had a supposedly 36+6 weeker for a week or so. He's an IDM. Had problems initially and needed respiratory support, umbi lines, then bili lights. Now he's just a poor feeder, but the monitor shows periodic breathing w/HR and Sat dips.

In other words, he ACTS like a 35 weeker! Which goes right along w/the IDM bit. He worries me some, cuz I haven't quite convinced the neo that he acts so immature.