What are your parameters for resusitation at delivery? - page 2

Regarding preemies, how many weeks, and weighing how much? We do 23 weeks and 500 gms or greater. I nearly fell over when NICUgal mentioned tubing 22 weekers!:eek:... Read More

  1. by   nurseiam
    We save 23+ weeks, no real weight requirement. The worst was a set of triplets ?23 weeks. The first delivered lived for about 24 hours had 2 doses of survanta but never absorbed either. The other two were born the next day they lived for 24 and 48 hours. The saddest thing was it all occured around July 4th. But we have another family that had a 24 weeker then 18 months later had a 25 weeker. They both went home on O2 but no GI or CNS issues! They are done having babies now!
  2. by   chook
    We had a 24wkr last week only 500grams who lived for exactly 5 hours, had 1st dose survanta, blew huge pnemothoraces and we put in four chest drains before we commenced cardiac massage etc to try and save him- I was a mess by the time I got home and I didn't know what to say to the mum who was all alone-dad was 1000 kilometres away. IVF baby- so sad- she watched us doing cardiac massage and then she decided we should stop. Some of these Dr's are incredible the lengths they will go to. It is a hard job at times but somebody has to do it right?
  3. by   nursecheryl
    I've seen many 23 weekers make it in our level 3 nursery. I only saw one 22 weeker they saved which I think was a mistake. He was less than 500 grams. Some of the nurses joked that the team put a finger on the scale to get the kid through. He died within 48 hours of struggle.
  4. by   dawngloves
    Originally posted by nursecheryl
    Some of the nurses joked that the team put a finger on the scale to get the kid through. He died within 48 hours of struggle.
    Our joke is, "Did you take the hemostat off the scale?"
  5. by   KRVRN
    We got 23 wk. quads the other night. Two are still alive, but barely. One will be dead sometime today, had a HR in the 60-70's which we chose not to treat most of the night last night. The other one is doing better but has bad cath toes and fingers on one hand. I mean black and shriveling bad... Poor little things, they probably shouldn't have been saved in the first place.
  6. by   HollyWA
    I've only worked in a high level 2--and did agency in level 3.
    You all just reenforced my decision to never work in a level 3!!!
    Give me a feeder/grower--any day!!
  7. by   NICU_Nurse
    I'm still learning...what are cath toes? ;>P
  8. by   mark_LD_RN
    one hospital i work at 23 weeks and 450 grams. one military hospital i worked at in the past tried to save every thing when i asked them why they said the residents need to learn procedures some how and this is the way they get to do them. i finfd that appaling to do alll that torture to a baby that has no chance.
  9. by   prmenrs
    "Cath toes" are when the UAC impedes distal arterial flow to the feet, and the toes get dusky or worse. It's possible to get "cath back"--a blotchy pattern of duskiness on the mid to lower back of the baby. It's because sometimes the catheter doesn't "make the turn" towards the head in the aorta, and goes down the leg or some other place it doesn't belong.
  10. by   KRVRN
    Prmenrs

    I've never heard of cath back. Isn't it true you can have the same problem in the fingers? This particular baby also happens to be on dopamine so maybe that's how her fingers turned necrotic. And damn it all we don't have a UAC and they don't want to subject her to a PAL.
  11. by   prmenrs
    KRV--I only saw it on the back once, thank goodness. Unless the catheter is really in the wrong place, the fingers are not usually involved. Can't figure how her fingers got necrotic. How were they giving the Dopamine? Did they say it was due to the line?

    Once, way, way, WAY back in the "olden days", we transported a baby from another hospital that the pediatrician had put a VENOUS line in, managed to thread it through the foramen ovale into the left side of the heart, out into the circulation and into the brachial artery--where it became lodged and cut off the circulation to the baby's arm!!! The baby had to have her arm AMPUTATED at the elbow. Can you imagine? Ortho actually did it in the unit. That baby died, eventually, sicker than anything I'd ever seen at the time.

    p.s. I LOVE being retired. I came in for 3 hrs tonight for my first "cuddling" assignment!! NO CHARTING!
  12. by   KRVRN
    I investigated and the dopamine was given via a UVC and they removed the UAC d/t the cath toes. The fingers were turning black at the same time as the toes. The necrosis has continued up her fingers and is starting to threaten the hand and she's only on a renal dose of dopamine. Poor little thing also has a gray tummy, not good...
  13. by   prmenrs
    KRV--I wonder if she threw a clot? It's just not making sense.

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What are your parameters for resusitation at delivery?