Patient age limit?

[VintageSwagger]

Hello all,

I am just curious about what age limits you have set for transferring of patients out of your NICU. I have heard some hospitals that transfer at 3 months (corrected age) and others that have kiddos up until 2yrs old. And if you wouldn't mind sharing, I would also like to know:

1. Level NICU

2. # beds

3. location (state is fine)

Thank you for sharing

"For us who Nurse, our Nursing is a thing, which, unless in it we are making progress every year, every month, every week, take my word for it we are going back."

- Florence Nightingale

[NicuGal, MSN, RN]

Level 3, we have had up to 18mo old waiting for a gut transplant. We never transfer anyone out unless we are way over census.

[bmsrn]

Level 3. 70 beds. We had someone celebrate their 1st birthday in our unit. Our docs will NOT transfer them out. When we are full we are continually transferring babies to nursery.

[VintageSwagger]

Thanks for sharing....

I was just curious what other hospitals are doing in their NICU's. I am in a large level IV NICU and we also have kiddos older than a year (some closer to two years). We don't transfer anyone either unless we are full yet, sometimes we still double-bunk rather than transfer them.

[HazelLPN, LPN]

I can remember only one patient that we had who was over a year old. Came in as a 23 weeker with the typical problems associated with micro premies....and this was about 20 years ago when we didn't have the technology we do now. She graduated to chronic status and spent months and months in the development unit and was probably the crankiest chronic I had ever seen....I didn't take care of her very much as she had three primary RNs and about 15 associate nurses. I think I had her for half a shift until one of her regulars got there. When she was ready to go home, she was adopted by an RN who worked in peds home care. I ran into her at the grocery store a few years ago with her mom. She no longer had a trach, she walks and talks and even managed to graduate from high school and now works at a university as part of a special program for handicapped people.

In recent years, nobody has even come close to being there a year, although I don't think there is an age limit.

[VintageSwagger]

Yeah, it seems like it is more of a "preference" thing of the chief neonatologist who decides the ultimat culture/age of the NICU patients.

[NicuGal, MSN, RN]

Pretty much our docs mentality is "I grew this baby and now it is mine and no one else can manage the care like I do"

[umcRN, BSN, RN]

We don't transfer out often, I've seen a few instances:

1. chronic ex preemie with pulmonary hypertension being followed by the PH docs in house, they will often transfer to the cardiac icu somewhere around their first birthday, especially if they get a cath to measure pressures or do any intervention (asd closure)

2. older stable gut babies (usually bad gastroschesis) they might go to the intestinal rehab floor to work on feeds and transitioning home on tpn

That's all i've seen. 56 bed level 3c, *not* a delivery hospital which also might make a difference

[VintageSwagger]

NucuGal,

That is so true... I have seen that a lot.

[milkglass]

Pretty much our docs mentality is "I grew this baby and now it is mine and no one else can manage the care like I do"

This right here! I don't agree with it. For one, since we're saving babies at earlier gestational ages, we're growing "chronic" babies with BPD that stay for usually their first birthday or more.

As an example of why I feel NICUs aren't made for this is

1. Our unit was never set up to hold the developmental toys and floor space these kids NEED to grow and catch up on milestones.

2. A neonatologist is not a pediatrician. Case in point -- we have a chronic kid who a little over a year old. They were acting very fussy unless held and pulling their ears. The nurses who work frequently with said patient kept suggesting an ear infection in rounds based on symptoms and their own maternal experience. The Neo kept saying no, no. A few days later, the ear drum burst and out leaked the infection. So, that's my anger.

We have transferred very rarely to a nearby level 4 for things like organ transplants or a chronic kid that we just couldn't handle anymore. But RARELY.

Level 3. 45 bed unit.

[TiffyRN, BSN, PhD]

The older nurses tell me they used to frequently have kids up to 2 years old, severe BPD kids with trachs that weren't ready to go home even though they would scoot around in those old baby walkers (the ones that have been off the market for years now).

In my dozen or so years I've seen a few that made it to nine months or older. We don't transfer out just due to age; they must have need for medical or nursing services we don't offer (not for child life services, we tried that, didn't fly). In the past it's been for certain pediatric specialties we didn't offer (now they have admit privileges at our hospital), ECMO, cardiac surgeries beyond PDA ligations, maybe a couple of other processes so specific I feel it would blow my cover if I got too detailed.

55+ bed level 3C delivery hospital