Admission criteria

dawngloves, BSN, RN · Apr 15, 2003

Man! You gotta get a policy and fast! Off the top of my head, we don't bring anything

NicuGal, MSN, RN · Apr 15, 2003

Ours is over 22 weeks and 500gms. I would have refused that one. That was ridiculous. Please tell me that you let the resident have it...and the OB staff for letting him take that baby!

I would have said...here, let me take my Bic pen apart and you can intubate with the inside of it...what an idiot!

Heather333 · Apr 16, 2003

Ours is 24 weeks but no weigh limit. We had a 450g 27-week IUGR that did fine and went home.

Heather

NICU_Nurse, BSN, RN · Apr 17, 2003

I checked this morning at work- our admission policy is 22 5/7 weeks with no weight requirement. We have had some smaller babies...18 weeks, I think?...that were admitted to Level II, but they were comfort measures only. NO interventions on anything smaller than 22 5/7. It's sad, really, because it's a fine line to walk but it seems that more often than not no one considers the long-term outcomes of resuscitating these tiny babies. We were just talking about that last night. Down here, there is an abortion clinic that does procedures up to the 25th week. 25 weeks! We admit MUCH younger babies than that- there's a world of difference between a 23 weeker and a 25 weeker, you know? Just interesting to see how the rules are different depending on where you go.

dawngloves, BSN, RN · Apr 17, 2003

Here's a question; What if you had refused to help that doctor? What would the ramifications of that be? If I went to a delivery and a 300g 20 weeker came out and the doc asked me to assist with intubation, could I just back up and say, "No way!" ?

KaroSnowQueen, RN · Apr 17, 2003

IttyBitty, I was upset by the visual image of babies "gasping in the sink." Are these miscarried babies? Shouldn't they be with their parents as they die? Or at least in a basket with comfort measures?

As the nurse grandmother of an 18 weeker who recently died, I fully understand the futility of resuscitation of a tiny baby that size, and the plethora of handicaps many small babies have if they are "successfully" saved, and feel as many of you do that tiny ones should be allowed to pass with dignity into the next world.

However, why on earth don't these residents leave these babies with the parents with comfort measures?

karenelizabeth · Apr 18, 2003

We resusitate from 24 weeks and intubate and admit if the baby gasps from 22 weeks. Although personally having delivered a 19 weeker at 300g I find these little ones really hard I wouldnt have wanted my daughter to go through this and yes she gasped. We have no weight limit our smallest surviver was a 410g 25 weeker who is now 8 and an absolute beauty

NicuGal, MSN, RN · Apr 18, 2003

I just found out that they have lifted the weight issue. We used to get the ones that were less than 500gm if they were IUGR, etc. Now, it is anything goes in the weight dept.

dawngloves, BSN, RN · Apr 18, 2003

We use weight as a critera because of equipment. Terribly traumatic to intubate a 450g neonate. We had a 26 week IUGR, 450ish, that we just could not get a 2.0 in. We put her on CPAP and parents made her DNR. She hung on for a day. So sad.

nicudaynurse · Apr 18, 2003

A NICU I worked in had a 26 weeker IUGR that weighed 14 ozs. She survived, but had a pretty rocky NICU stay. She was discharged after 9 months. She is now 6 and does have some disabilities, but is a very happy child and has the best family ever!!

This NICU pretty much saved 24 weeks or more, but occasionally we did have 22 or 23 weekers. Sometimes it depended on what doctor was on as to how aggressive the treatment was. It also depended on how aggressive the parents wanted us to be. If they said "save my baby" then we did.

NicuGal, MSN, RN · Apr 19, 2003

We had an IUGR that was 25 weeks and weighed 400 grams...went down to 350gm! She survived, but I can't say that it was for the best.