Cutoff for admission to NBN (or room c Mom)

  1. I am just wondering what your facility's criteria are for a babe to be admitted to well-baby nursery or mom's room (besides the usual bit that they are breathing....)

    What are your criteria for gestational age? Ours is 35 weeks and over 4lb 14oz. But the reason I'm asking is that a few nights ago, neo resident calls our NBN charge and asks if she will take a 34 6/7 weeker who is pink & breathing. She calls out to the floor charge nurse who says she (floor charge) wouldn't take him. She asked a couple others of us who routinely do NBN charge and we all said no way. To close to call and that close, it's impossible to know that that kid is going to stay stable enough to go out c Mom.

    Neo then calls back (this is around 0445) and says that technically he's 35 weeks as of midnight. So they kind of forced this nurse to take this baby even though she was obviously not comfortable with him being in well-baby nursery.

    Outcome: kid comes in and about 5 minutes later quits breathing, desats (of course) and needs to be on O2. Needless to say he went right on over to NICU....

    I personally feel that kids that close to the cutoff (since dates can be off by a couple days/weeks either way) need to go to NICU for obs at the very least. I was very irritated by our neo resident that night, even though I wasn't in charge in nursery. Most of our Neos/NNPs are great but this one really bothered me. I don't mind taking babies -- that's not the point -- but my goal is to get babies ready to back to Mom's room.

    Venting done. Any input would be appreciated. Thanks!
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  2. 14 Comments

  3. by   prmenrs
    My recommendation would be to document this incident, including charge nurses names, etc., and kick it up the food chain. Let management work out a better policy. At least the kid should've stayed till day shift!

    Resident was trying to save him/herself some work, IMHO, but the attending might not see it that way.
  4. by   ElvishDNP
    Quote from prmenrs
    My recommendation would be to document this incident, including charge nurses names, etc., and kick it up the food chain. Let management work out a better policy. At least the kid should've stayed till day shift!

    Resident was trying to save him/herself some work, IMHO, but the attending might not see it that way.
    Your last sentence was kind of my humble opinion too. In the end it made more work for us all. I do intend to let mgmt know.

    BTW, I wondered what you would have to say, since one of your by-lines is to never trust a 35-weeker.
  5. by   prmenrs
    That pretty much sums it up!

    See this thread: http://allnurses.com/forums/f33/neve...er-137874.html
  6. by   33-weeker
    Our limits are 35 weeks & 2000 grams, no oxygen needs, etc. Of course, if the baby develops any problems, gets cold repeatedly or can't nipple well, it goes to level II.

    On the one hand, I'm glad to see docs giving them a chance (the other place I used to work sent anything under 36 weeks to level II), but in my experience, some 36-weekers and most 35-weekers will end up in level II anyway due to temp instability and / or feeding issues.
    Last edit by 33-weeker on Jan 20, '07
  7. by   AF-NRS
    I think this incident definitely needs to be written up and let the higher-ups battle it out---the protocol states 35weeks and up not 34+6 weeks and up....i'm with you, that baby should have gone to the NICU or SCN for a minimum of 24hr obs....
  8. by   SmilingBluEyes
    We dont' have a "well baby" nursery; they are either well enough to room in with mom or are special care babies who require nursery care.

    Some examples of criteria are:

    Pretermers (35 weeks or under with feeder-grower, supplemental O2 sugar issues, etc)
    Babies needing supplemental oxygen
    Sick babies requiring antibiotic/IV therapy
    Babies with unstable temps, sugars, etc
    CPS hold cases

    Babies needing higher-level care or earlier than 35 weeks generally go to the NICU for such care.

    Other than that, well babies are to room in with moms, as a rule.

    By the way: I agree w/prmenrs NEVER TRUST A 35-WEEKER.
    Last edit by SmilingBluEyes on Jan 20, '07
  9. by   ElvishDNP
    Thanks for everybody's input! I am glad to know there are others out there who think like I do.

    I am all for babies being in rooms c Mom 24/7; however, I am not comfortable with sending a just-barely-35-weeker into her room when he hasn't proven himself that he can breathe on his own!!

    Waiting for the fallout of this incident.....
  10. by   kate1114
    BTW, I wondered what you would have to say, since one of your by-lines is to never trust a 35-weeker. [/quote]

    LOL, I was thinking the same thing . Everywhere I've worked has had 35 weeks be a cutoff, with a lot of open communication between well baby and NICU so that the infant could be carefully monitored. If there was any question about the health of the baby, he or she would be a "transition" baby in NICU. Things can go wrong so quickly with these little ones, and I hate to see people playing games with such a potentially dangerous situation. Another thing to remember is that these dates are seldom written in stone. Unless you have an invitro pregnancy, you aren't ever totally sure of the date of conception. Sonograms can be off by up to 2 weeks, so that always bothers me to see those dates held as the ultimate authority
  11. by   ElvishDNP
    Quote from kate1114
    Another thing to remember is that these dates are seldom written in stone. Unless you have an invitro pregnancy, you aren't ever totally sure of the date of conception. Sonograms can be off by up to 2 weeks, so that always bothers me to see those dates held as the ultimate authority
    That is exactly what bothered me most about them wanting to admit a just-barely-35-weeker into wellbaby without him proving himself. Who's to say that I'm not really admitting a 32 or 33-weeker?? I can do O2 and bag&mask just like anyone else but why risk it?

    By the way, as we transferred this kid over to NICU, he began breathing on his own and was pink. The resident (or someone else, but I think it was the resident) goes, "You sure look okay to me!" in her smarmiest voice. This little boy proved her wrong about 60 seconds later when he stopped breathing...
  12. by   prmenrs
    Yep--those "in-between" kids will more than happy to define unpredictable.

    Hmmm. Shall I breathe? Maybe. Maybe not. I have to eat? Interesting. I'll give it a try. Not bad. No, wait, I changed my mind. Now I've got a belly ache! Is anybody watching?? Great! I think I'll stop breathing and turn blue. Is that a germ over there?? It's mine, mine, mine, MINE!!
  13. by   ElvishDNP
    Staying warm? What's that? I thought I was supposed to live at 95.9 rectal.

    I have been meaning to tell you that I think your avatar is so sweet, prmenrs.
  14. by   SmilingBluEyes
    35 weekers would be in our SCN for observation for at least 24 hours. they are never considered routine "well' babies where I work. I guess that is what I mean when I say we dont' have a "well baby" nursery.

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