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Glad to see someone else is shocked! We used to be 24 and 500 and now we have these attendings that will resusictate anything! We have a few 22 weekers that have lived..need I tell you what they are like? The rest just suffer for awhile, get infected, on Ampho, end up ocillating forever and then die. It isn't pretty and that is when I really hate my job!
We do 24 weeks or 500 grams. I only know of us doing one 23 weeker. We got him shipped to Level 3, but he only lived about 24 hours. Long enough to get mom shipped up to the same hospital after her ceasarean. I think at 23 weeks it's still kind of up to the parents?? but I don't really know.
Our neo will bring in anything that the mother begs him to. He gets paid even if it only lives for a day or two.
the smallest I have seen brought was a 462g with the tube in. But, he is wy one miracle story. Kid left at almosst 5#, no ROP, no BPD, never had a real episode of NEC. Nippled like a demon and was very approprtiate for a newborn. Of course he is one of I lose count of how many that we have tortured till they died.
I have only seen two 23 weekers so far and they have both gotten septic and expired after weeks of torturous PICC insertions, vents, drug after drug..... I question the acceptable parameters we now have.
We'll save down to 23 wks. No real weight guidelines. Earlier than 23 they won't attempt. I suppose if the woman had really unreliable dates they MIGHT go to the delivery for a 22 weeker--I've never seen that scenario. We once had a 450-ish gram 28 week-IUGR twin. She LOOKED like a 23 weeker until you looked closer and saw that she had lanugo, could open her eyes, etc. Kinda strange.
The most amazing preemie I ever cared for was a 450g, 24 weeker. The nursing staff was upset at the resident for resuscitating her. She spent 4 months in the NICU, with long-term ventilation, NEC, sepsis, you name it. She was discharged at 5lbs, and was absolutely healthy. No head bleeds, no evidence of CP, normal eye and hearing tests, no persistent respiratory or GI problems. That was in the days before surfactant, high frequency ventilation, or even PICC lines. She is now 15 years old!
You are all absolutely right that for 1 success such as this, many babies suffer, but in the delivery room, how can we possibly predict who will do well?
In my experience, physicians and NNP's will respect parents wishes regarding resuscitation. It is vitally important that they have a frank discussion of the risks and benefits of resuscitation BEFORE the baby is born. Too often that does not happen.
Jolie...I can't tell you how many kids they bring over and never say two words to the parents...and then the parents realize it was a mistake and want to withdraw life support...uhuh..no go. That is the worst part of the whole thing. I believe that a parent should have that option...they are the ones that have to make life altering changes and take care of that child...and take on expenses once their insurance, if they have any, runs out. It is so sad! And it truly pisses me off!
A lot of our attending do tell the parent...you know, you just don't know...for every one Miracle baby I have seen, 10 more are devastated beyond belief.
We [consider this post "past tense"since I'm now retired!] have the fellow do a pre-delivery consult, try to tell Mom and Dad what to expect, REALISTICALLY, but even if they may agree to 'no resus', it's all out the window if the baby cries, which almost all of them do. At that point, Mom will want to do everything, Dad too as a rule. so we try, even though we may have TOLD them the baby will cry. Before things start looking hopeless, family conferences should be held as often as necessary to keep them up-to-date on progress [or lack of], meeting spiritual needs, etc. Then if things go south, it's easier for them to withdraw support.
The important thing is communication, esp of realistic expectations, and it needs to culturally appropriate for the family. Communication w/nursing is crucial. too, because, often we are an extension, in a sense, of the family. We have more contact w/the family, and contact sometimes of a more intense nature.
Adequate social work support, and good collegial support are critical factors as well. Nothing's worse that getting the micro-baby/fetus to care for for 12 hours and having other nurses, ie, your FRIENDS, make comments like, how can you take care of that poor little thing, or what are they doing torturing that baby? Better to say: "You're doing a good job today w/him[or her]. If I can help you, let me know." You are offering your colleague support and strength. It really does help.
If you want to vent, ask for a staff support meeting w/social work and or docs, NM, away from the bedside. This might help you express how extremely difficult it is to care for a patient about whose ultimate outcome you have serious doubts. (And rightly so).
I worked Newborn Nursery in a military hospital in 1991. We had a mom deliver a baby that weighed LESS THAN A THOUSAND GRAMS. The Docs let the baby die without trying to save its life. I was told policy dictated the baby weigh MORE THAN 1000 GRAMS for the physicians to maintain life on the baby. I was TEE-TOTALLY PISSED at that policy! Had that been my baby...Ohhhhhhhhhh...we don't EVEN want to go there!