24 weeker - how bad is it?

Specialties NICU

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a friend of mine has just had her baby at 24 weeks 4 days. as a theatre nurse, all I know of preemies is their tendency to develop NEC, so can someone please give me the lowdown - obviously this is not good, but how bad is it? what can she expect?

You have an incredible story, no doubt, especially for the progress of NIC medicine at that time...but I caution you in saying "things always turn out okay" because they do not a lot of the times....micropreemies can and do live, but are often left with devastating complications of prematurity and parents' dreams of having that "perfect normal child" have been shattered. They are so grateful to the NICU for saving their child, but are also exhausted knowing how long the road ahead is at home.

Thanks for a much needed dose of reality. (said as someone that makes a good portion of her living off of ex-preemie frequent flyers.)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
See this link. a baby in California (US) just went home this week. All are cautious about the outcome. Good luck to you and your friend.

Melinda Star Guido: California's Tiniest 'Miracle Baby' Goes Home - ABC News

Not that I agree with their life choices.......the Duggars last live birth was a micro-preemie

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Specializes in Emergency Medicine.

On a positive note....My little niece Emma was born at 24 weeks gestation weighing right around a pound. She is now 9 months old and still thriving...and growing.

She was delivered already at a hospital with a level 1 NICU. Thank God. They were ready for her when she came out. Spent the next 4 months there. She was flown a couple times to another big medical center to have heart surgery to close her little valve. She did develop NEC. But recovered with no complications. Thank God she never developed an intracranial bleed or any brain issues. They repeatedly checked her after birth to watch for it. After she came home she was not doing so well. She was having swallowing difficulties and put in a little feeding tube. She has been home since Christmas and is doing great. Has a nurse come in every day to help with everything. She thrived from birth and really fought to stay in this world.

Prayers to your friend's little one.

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Specializes in Specialty Oncology Pharmacy.

I meant more along the lines of positive thinking. I know thing's don't always turn out okay. To me, there is always a light of hope. I have noticed in the course of my life, that if you think positively, most of the times things work out...I'm not saying it will in this particular situation, but it doesn't hurt to try.:heartbeat

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Specializes in NICU.
On a positive note....My little niece Emma was born at 24 weeks gestation weighing right around a pound. She is now 9 months old and still thriving...and growing.

She was delivered already at a hospital with a level 1 NICU. Thank God. They were ready for her when she came out. Spent the next 4 months there. She was flown a couple times to another big medical center to have heart surgery to close her little valve. She did develop NEC. But recovered with no complications. Thank God she never developed an intracranial bleed or any brain issues. They repeatedly checked her after birth to watch for it. After she came home she was not doing so well. She was having swallowing difficulties and put in a little feeding tube. She has been home since Christmas and is doing great. Has a nurse come in every day to help with everything. She thrived from birth and really fought to stay in this world.

Prayers to your friend's little one.

Do you mean a level III NICU? Level I is a nursery :)

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Specializes in CDI Supervisor; Formerly NICU.

Anecdotal stories of everything turning out rosy are good for morale, but they truly discount the reality of the high probability that a baby born at 24 weeks WILL suffer great, negative consequences IF they live to leave the hospital.

Your friend has a long, stressful journey ahead of her, and I pray that her baby survives to become the next great anecdote.

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again, thanks for the information, and the mixture of cold realism and promising anecdotes. together they give me a nicely rounded picture of how things are.

baby is now onto day 4 on the outside, and so far things are going as well as can be expected.

can someone please tell me, is there a point where the risk of things going wrong decreases, or is it a case of 'i'll believe she's ok when she leaves NICU/turns 5/starts university'?

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Specializes in Nurse Scientist-Research.
can someone please tell me is there a point where the risk of things going wrong decreases, or is it a case of 'i'll believe she's ok when she leaves NICU/turns 5/starts university'?[/quote']

Really with a 24 weeker, they will always be referred to (in report) as "a former 24 weeker". At least while they are in the NICU. That's because they will always be at higher risk for all the complications. I like to think that infants don't get NEC as much after about 30-32 weeks adjusted, then I will see another overwhelming case to remind me of the reality.

Maybe holding your breath until little girl starts university is a bit excessive. . .

Hard to say otherwise, I think once the kids start school and either prove or disprove they have learning disabilities might be a time to relax. I think the standard is for the child to be 2 years old before they formally diagnose CP, though it can be done later.

Sending good thoughts from Texas to the little one.

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Really with a 24 weeker, they will always be referred to (in report) as "a former 24 weeker". At least while they are in the NICU.

Believe me, longer than just in the NICU. A lot of neuro deficit is wait and see. The heart/lung stuff that doesn't pop up until after discharge usually shows up pretty quickly. GI stuff tends to make itself known before NICU discharge. It's the neuro stuff that will get them though. Because if that's not good, the other systems will eventually go down with it. But it's hard to tell if they've got a deficit and/or how much it can improve for a few years. I'd agree with the above, university is a bit long, starts school would be about right.

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I was being a bit silly with the 'starts university' bit. what I'm really asking is in terms of survival, rather than appearance of deficits.

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Specializes in Emergency Medicine.

ooops. Yea. I am a ER nurse. Thanks for clarifying.

Do you mean a level III NICU? Level I is a nursery :)
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Specializes in NICU.

Another sad reality is that the first day or week can be a "honeymoon" period, with the baby cruising along on low vent settings and 21% oxygen. Fast-forward 10 days and the same baby may be on the oscillator, 60% oxygen, on a dopamine drip, sedation and still drops O2 sats to nothing & gets bradycardic with a diaper change. It's a LOT of ups and downs for the first month, often two. It's two steps forward, one step back, two steps forward, three steps back, one step forward and so on.

Talking with our NICU grad moms...they say they appreciate the people who acknowledge and validate their feelings. They often do NOT like to update people with each day's changing medical status, sometimes because there are days with no changes (no progress) and also because of the ups and downs (they don't like reporting 'bad' changes). Practical help like meals, childcare for the sibs is usually welcome - though IIRC, you are not geographically close to your friend.

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