NICU: Do you remember when...?

[twinkletoes53]

i have worked in a level iii nicu for 26 years. i remember "way back when"; things we used to do, or not, that are considered routine today. i'm asking other nicu "veterans", what do you remember about neonatal nursing when you started practice?

i recall the siemens vents and baby birds. surfactant, ino, ecmo, oscillators and high frequency vents were unheard of. it was common for us to have infants in our unit for over a year, due to bpd. they would be trached, and some went home on home ventilators. the preception of preemies feeling pain was just coming into focus.

in regards to family, visting was more restrictive. we had not recognized concepts of family focused care--invloving the family in day-to-day care of their babies. also, we did not know about develpmental care and appropriate positioning of babies.

what are your visions for the future of neonatal nursing? what do you see in the coming years? and what do you wish would happen?

[ginger58, ASN, RN]

I remember when NICUs were noisy and bright lights. Then came NIDCAP to help reduce stimulation in the environment.

I wish they could come up with Isolettes that don't make any fan noise.

I'd like to see heelsticks go away.

[Gompers, BSN, RN]

I wish they could come up with Isolettes that don't make any fan noise.

I actually like that noise and think it helps the babies. It's white noise, which they say the baby is surrounded by in utero. I know that whenever I put a crying baby into an isolette, especially when he or she is within a few days of birth, that the baby seems to sleep much better and be less fussy. I often attribute that to the fan noise.

What would I like to see?

Definitely need to find another way than getting heelsticks! The smaller the baby, the more labs they order it seems!!!

I would like to see the current trend of early extubation and "kinder, gentler ventilation" continue - I'd like to see more studies about how babies fare after being allowed to have higher CO2's and to see if the decrease in BPD outweighs those risks. I'd like to see a Vapotherm-type cannula that is able to give breaths in addition to positive pressure, to help babies that otherwise might fail extubation - like when we used to do cycled CPAP on the old Sechrist vents.

I would like to see some studies showing the long-term effects of giving mild antifungals like Diflucan to babies as a preventative measure whenever they're on major antibiotics. There's nothing worse than bringing a micropreemie back from the depths of sepsis using antibiotics, only for him or her to develop overwhelming yeast a week later and then get REEEEEEAAAAALLLLLY sick. Yeast is the worst!

I would like to see us using Bactroban cream intranasally on babies colonized with MRSA, rather than just cohorting them. We did this only once and it worked, no obvious side effects either. Why keep MRSA on the unit when you can irradicate it???

I want to see more studies on hypothermia and how it can help our bigger babies.

*****************************************************

A few years back, I saw a medical special on the BBC that showed some of the things that they were researching in Europe with regards to NICU care. One thing was hypothermia studies, and another was just completely wild - a simulated uterus!!!

If I remember correctly, they showed a team doing a c-section on a ewe, taking her premature baby and putting it directly into a tank of some solution which I believe included liquid oxygen. The sheep never took a breath of air - the first breath was under water in the tank. I believe they placed either umbilical lines or a feeding tube to nurish the animal. I forget how it all turned out, but I know the sheep lived for a bit that way...

My coworkers and I agree, though - the day we come to work and are placed in front of an aquarium with a floating baby is the day we leave the NICU! FREAKY!!! But you know it'll happen within the next century.

Neonatal care is such a young science, and look what they've accomplished so far?

[Gompers, BSN, RN]

what are your visions for the future of neonatal nursing? what do you see in the coming years? and what do you wish would happen?

wonderful topic, by the way. welcome to the forum!

[BabyNurse513]

I would like to see us using Bactroban cream intranasally on babies colonized with MRSA, rather than just cohorting them. We did this only once and it worked, no obvious side effects either. Why keep MRSA on the unit when you can irradicate it???

We use bactroban in our NICU for MRSA colonization, i thought that was standard practice?

[Gompers, BSN, RN]

We use bactroban in our NICU for MRSA colonization, i thought that was standard practice?

Nope, not yet. Interesting topic, though - I think I'll start a thread to see what everyone else is doing...

[preemieRNkate, RN]

One of our "veterans" where I work keeps telling us "young girls" that someday we'll being running over to the DR and bringing back petri dishes!

[dawngloves, BSN, RN]

:uhoh21:

[dawngloves, BSN, RN]

Way back when I could mix up my own Ca, K , MSO4, Dopamine, ect, ect.

[t2000JC]

"My coworkers and I agree, though - the day we come to work and are placed in front of an aquarium with a floating baby is the day we leave the NICU! FREAKY!!! But you know it'll happen within the next century."

I joke with my coworkers about this all the time! Yup, it really might happen!

I would like to see more with pain management, and a better awareness in the public about what having a preemie baby means..t.

[Elvish, BSN, DNP, RN, NP]

... and a better awareness in the public about what having a preemie baby means.

I so totally agree with you on this one. Many of these moms have no idea what their babies go through born early. (I do postpartum so I hear a lot....) If I had a penny for every time someone told me their 26-weeker was doing "fine" I would be writing you from my vacation home in the Caribbean.

[2curlygirls]

I had a fussy npo 4 week old with a chest tube (had gone home and come back with a Chylo)

A coworker, who has been a NICU nurse since before I was born, said they used to use whiskey nipples for fussy babies. They'd soak cotton balls in whiskey and put it in nipples for baby to suck on.

This was at UCSF!!!!