Specialized micro-preemie team in your unit?

Specialties NICU

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Specializes in NICU- now learning OR!.

Does your unit have a specialized team or specific policies or protocols above and beyond the "norm" for 23 and 24 weekers?

Any info. on any "cutting edge" research on this population at your facility?

Do the Neos round any differently on these babies and/or do you have rounds similar to adult "Keystone" ICU grand rounds?

Thanks!

Jenny

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Specializes in Neonatal ICU (Cardiothoracic).

No specific team..... everyone takes care of everyone. The same neos round on the same pts. Usually ends up being whomever gets to the baby first. (we only have 4 neos, no residents or fellows) We do use a IVH protocol that includes several developmental interventions for our

Stephen

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Specializes in NICU- now learning OR!.

Thanks for the reply. So far, that is the same as our unit. There has been a proposal to employ different practices for 23-24 weekers in an attempt to increase survival and/or decrease incidences of IVH, ROP, BPD, etc. and I wondered if anyone else did anything differently already.

Anyone else?

Jenny

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Specializes in NICU, Infection Control.

The tertiary center we send our babies has what they call "ELBoW" nurses--I don't think they have different docs, tho, not sure of the specifics.

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Specializes in NICU.

No specialized team or anything, but we do have a specific small baby protocol that we follow for these babies. One thing we do with the small mircropremies is make them 1:1 for the first 7 days of life, even if their acuity isn't all that high to start with. Even if the baby doesn't need a lot of 1 on 1 attention, the parents usually do. But then again, some of those babies have high acuities that do warrant the 1:1. Then after the first 7 days we reevaluate and see if they still need 1:1 or not.

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Specializes in NICU, PICU, educator.

We have a small baby protocol and some of the things are head midline, HOB up 45 degrees, no direct heat to head (ie heat packs), gel pad/donut under baby upon admission (also helps with the temp problems), depending on the doc, aquafor to the whole body, no PIV's unless absolutely necessary, minimal stim...usually hands on only every 8-12 hours and this includes the parents, minimal suctioning to decrease the risk of raising intracranial pressures and minimize risk of pulmonary bleeds (remember, RDS is not a secretion producing etiology), no saline down the ET tube unless it is an emergency (saline damages the little alveoli these kids have).

They are usually one on one because they are sick as can be.

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Specializes in nursery, L and D.

All of our nurses and docs go to all the deliverys....no special teams. Certain docs have certain age requirements.....ie, won't resuscitate any baby under 26 weeks, etc. Most docs "limit" is 24 weeks, but a couple are 26 weeks. Then sometimes the OBs will write DNR orders on 24-26 weekers. I feel like this is "too many cooks in the kitchen" and we need a specific, clear policy at our hospital. A ELBW team sound like a great idea!

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Specializes in Community, OB, Nursery.
All of our nurses and docs go to all the deliverys....no special teams. Certain docs have certain age requirements.....ie, won't resuscitate any baby under 26 weeks, etc. Most docs "limit" is 24 weeks, but a couple are 26 weeks. Then sometimes the OBs will write DNR orders on 24-26 weekers. I feel like this is "too many cooks in the kitchen" and we need a specific, clear policy at our hospital. A ELBW team sound like a great idea!

I have a couple questions about that:

1)Why is it that the OB writes the DNR orders & not peds? That seems like something OB would be better off leaving alone.

2) I thought the nonresuscitation cutoff for NRP was 23 weeks in absence of other things like anencephaly etc. What gives?

I know where you work and I agree with you that your hosp needs a specific policy. One day that will probably bite you guys in the backside! This is not an attack on you, ok? I realize it might sound that way. I just can't believe they'd operate like that!

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Specializes in NICU.

Yeah I thought they had to resuscitate at 23 weeks (unfortunately), if the parents wanted them to. Do not all places follow NRP guidelines (within their capabilities)? I'm interested to hear more.

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Specializes in Community, OB, Nursery.
Yeah I thought they had to resuscitate at 23 weeks (unfortunately), if the parents wanted them to. Do not all places follow NRP guidelines (within their capabilities)? I'm interested to hear more.

I definitely agree c the "unfortunately" part. I'm fairly certain, knowing what I know, that I would not want my 23, 24, maybe higher than that weeker baby resuscitated for what they would go through in NICU. Nothing personal against NICU nurses, you guys are terrific, but a lot of the tx is torture for babes that small.

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Specializes in nursery, L and D.
I have a couple questions about that:

1)Why is it that the OB writes the DNR orders & not peds? That seems like something OB would be better off leaving alone.

2) I thought the nonresuscitation cutoff for NRP was 23 weeks in absence of other things like anencephaly etc. What gives?

I know where you work and I agree with you that your hosp needs a specific policy. One day that will probably bite you guys in the backside! This is not an attack on you, ok? I realize it might sound that way. I just can't believe they'd operate like that!

Oh Boy am I waiting for it to bite us. We don't resuscitate any baby under 24 weeks, period. The OB's just tell the mom we don't do it, so sorry. I feel pretty safe in saying this here, b/c any OB or Ped at my hospital will tell you this is our unofficial policy. As far as OB's writing DNR orders, a couple will do that without even talking with the Ped doc. That is why I said there are too many cooks in the kitchen. I remember a 24 and 3 days that the doc wrote a DNR on , baby started crying at about 20 min. old, and mom demanded we do something to save her baby, so we did. Baby is A OK now. Looking back baby was probably more like 26 weeks but the OB doc refused to allow us to attend the delivery so we couldn't make a judgment call about this. I waited and waited for that to come back to us, I mean a 20 min. delay in resusitation? Pretty bad. Lots of stuff at this hospital have really bothered me, and I am scared that we are gonna get "bit" and someone might want a big bite of me! Any openings where you are Arwen? I have been really considering sending my resume. Oh, just let me say, in defense of us nurses, that most of the screw-ups are the docs, or the hospitals, not us!

BTW, that didn't feel like an attack, if fact, I wholeheartedly agree with you Arwen and do my best to CYA like crazy and "go up the chain" with things I feel are gonna come back to us. But I really feel for some of these poor moms and babies.

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