Any 22 weekers out there?

tralalaRN · Jan 7, 2020

There was an article a long while ago, that said the turnover of nurses in the NICU is higher than any other nursing profession. It's that crisis of conscience and the justification you mentioned that always prevented me from ever wanting to go into the NICU after seeing the other side - the years of suffering inflicted upon preemies and their families. One would argue that THEY are the collateral damage in order to save a very few micro preemies who will live normally and independently. It appears the NICU is a place that loves to be lauded as a place of miracle babies, and those who work there then would be miracle workers? The truth is far different, however, as you know, and seldom seen. There was a family who had triplets - 2 survived. They were put on the Children's Miracle Network Telethon for several years (notice the word miracle once again). . but as the surviving triplets grew, and had leg braces and thick glasses, etc., they were not ever again featured. This is what is presented to the world - cute lovely babies - disabled children and adults, not so much.

Wuzzie · Jan 7, 2020

51 minutes ago, tralalaRN said:
There was an article a long while ago, that said the turnover of nurses in the NICU is higher than any other nursing profession. It's that crisis of conscience and the justification you mentioned that always prevented me from ever wanting to go into the NICU after seeing the other side - the years of suffering inflicted upon preemies and their families. One would argue that THEY are the collateral damage in order to save a very few micro preemies who will live normally and independently. It appears the NICU is a place that loves to be lauded as a place of miracle babies, and those who work there then would be miracle workers? The truth is far different, however, as you know, and seldom seen. There was a family who had triplets - 2 survived. They were put on the Children's Miracle Network Telethon for several years (notice the word miracle once again). . but as the surviving triplets grew, and had leg braces and thick glasses, etc., they were not ever again featured. This is what is presented to the world - cute lovely babies - disabled children and adults, not so much.

I don't disagree with you that the families suffer unimaginably and that egos and the media think little of the long term but your vitriol, laser-focused on all things NICU, is a little much, especially when you take down the nurses who are caught in the cross-fire.

You have yet to tell us what the benefit of rubbing NICU nurses' noses in the aftermath of the decisions of others (including the parents) will achieve.

**NICU Guy, BSN, RN** · Jan 7, 2020

48 minutes ago, tralalaRN said:
There was an article a long while ago, that said the turnover of nurses in the NICU is higher than any other nursing profession. It's that crisis of conscience and the justification you mentioned that always prevented me from ever wanting to go into the NICU after seeing the other side - the years of suffering inflicted upon preemies and their families.

I understand that your entire focus is the aftermath of saving 22-23 wk babies in the NICU, but that is a small part of the NICU. You do realize that NICUs are not full of 22-23 wk preemies? Micro-preemies are a small part of the NICU population. There are many babies that come to the NICU, for various issues, that go home and lead a normal life.

Maybe I am getting the wrong impression from your posts, but it seems that you are advocating the elimination of NICUs in order to stop the practice of saving micro-preemies.

PeakRN · Jan 7, 2020

The hard thing about premies is that their NICU course may have little to do with their eventual outcomes.

I have taken care of 23 weekers that code 5+ times and make it out without any serious deficits. I've taken care of 'healthy' 32 weekers who end up neurologically devastated.

Recently I got to take care of a preschool aged ex 22 weeker who came in for an injury after playing. Neuro intact, no respiratory disease, no eye problems. If we hadn't always had a birth history I wouldn't have guessed he was a NICU kid, let alone a kid who was born under 500 grams.

The record holder for our lowest birthweight kid is thriving and doing great.

The assumption that premies are universally going to have poor outcomes or full term kids will all do well is incredibly flawed. And regardless we should always have compassion for our patients and their families.

tralalaRN · Jan 7, 2020

4 hours ago, NICU Guy said:
I understand that your entire focus is the aftermath of saving 22-23 wk babies in the NICU, but that is a small part of the NICU. You do realize that NICUs are not full of 22-23 wk preemies? Micro-preemies are a small part of the NICU population. There are many babies that come to the NICU, for various issues, that go home and lead a normal life.
Maybe I am getting the wrong impression from your posts, but it seems that you are advocating the elimination of NICUs in order to stop the practice of saving micro-preemies.

Of course. I do get that. Hence the topic of this thread. . . the saving of 22 weekers. . Peace.

tralalaRN · Jan 7, 2020

4 hours ago, PeakRN said:
The hard thing about premies is that their NICU course may have little to do with their eventual outcomes.
I have taken care of 23 weekers that code 5+ times and make it out without any serious deficits. I've taken care of 'healthy' 32 weekers who end up neurologically devastated.
Recently I got to take care of a preschool aged ex 22 weeker who came in for an injury after playing. Neuro intact, no respiratory disease, no eye problems. If we hadn't always had a birth history I wouldn't have guessed he was a NICU kid, let alone a kid who was born under 500 grams.
The record holder for our lowest birthweight kid is thriving and doing great.
The assumption that premies are universally going to have poor outcomes or full term kids will all do well is incredibly flawed. And regardless we should always have compassion for our patients and their families.

It's universally accepted that the lower the gestational age, the worse the outcome. Are there exceptions? Certainly. We ALWAYS hear about the exceptions. . those are the miracle baby stories that come into play showing the general public stories of the NICU. Prematurity remains the number one cause of both death and disability in the newborn period. That isn't a secret. We have lowered the mortality rate as newer technologies have been introduced in the NICU, however, the morbidity rate is abysmal among 22-24 weekers. The cost in pain (tortured to life has been used to describe their care in the NICU) and then long-lasting horrific pain/disabilities are far too common. I'm not saying this doesn't happen to 32 weekers, but the chances are far better that they will fare better. IVHs with accompanying acquired hydrocephalus is a huge complication among the earliest kiddos. This cannot be denied. And good for your lowest birthweight kiddo doing great - parents and the general public need to hear the other side once in awhile also.

Wuzzie · Jan 7, 2020

37 minutes ago, tralalaRN said:
We have lowered the mortality rate as newer technologies have been introduced in the NICU, however, the morbidity rate is abysmal among 22-24 weekers. The cost in pain (tortured to life has been used to describe their care in the NICU) and then long-lasting horrific pain/disabilities are far too common.

I don't think anybody here disagrees with you on that.

PeakRN · Jan 8, 2020

5 hours ago, tralalaRN said:
...those are the miracle baby stories that come into play showing the general public stories of the NICU.

I don't say this as an anti religious statement, but those aren't just miracles. Those kids are the result of the hard work, perseverance, and love from their nurses, docs, therapists, pharmacists, and every other member of their care team.

tralalaRN · Jan 8, 2020

11 hours ago, PeakRN said:
I don't say this as an anti religious statement, but those aren't just miracles. Those kids are the result of the hard work, perseverance, and love from their nurses, docs, therapists, pharmacists, and every other member of their care team.

First of all they AREN'T miracles, and should never be referred to as such. This implies that the people working in the NICU are God-like, and of course no one can make that claim to fame. . . secondly, it's very VERY telling that you mention all of the people on the "care team" - but do not mention the parents/family. Hmm. .

PeakRN · Jan 8, 2020

8 minutes ago, tralalaRN said:
First of all they AREN'T miracles, and should never be referred to as such. This implies that the people working in the NICU are God-like, and of course no one can make that claim to fame. . . secondly, it's very VERY telling that you mention all of the people on the "care team" - but do not mention the parents/family. Hmm. .

Because the expectation of parents and family are just that. They aren't going above or beyond, but rather to not be present is to do less. When you become a parent the bar is set at the top. This isn't to say that the family doesn't have a hard go at it, but that is part of having a kid.

Also you're the one who referred to "miracle baby stories."

tralalaRN · Jan 8, 2020

The "miracle baby stories" was a reference to how micro preemies are portrayed in the media, by hospital PR departments, Children's Miracle Network Telethon, etc. It is not MY reference, and never would be.

Also, there was a fabulous article that was written and published by Helen Harrison, author of the Premature Baby Book. . Family-centered Principles of neonatal care - published in Pediatrics in 1993, I believe. It's been referenced in future works many times since, but the original is spectacular. It might be worth a read.

Whull1, BSN, DNP, RN, APRN, NP · May 30, 2020

My son was a former 22 1/7, 499 gms with ETT, tape and drapes. Stayed in the NICU for four months, discharged home on 1/4 NC three days past due date PO feeding. Grade 2 left sided IVH. He's now seven and full of life. Just lost his second tooth and just completed first grade. Loves watching cartoons and eating chocolate. Hates homework.

The healthcare team asked what we wanted. We said "we don't know." The team said, "If he comes out crying and active. We'll do what we can for him." When my wife pushed him out, it was the longest moment of silence. No one moved, no one breathed. We all just waited and he cried three times and the team was on him.

Intubated for two months. Born October 28, extubated to BCPAP December 24. Feedings started DOL 3. Oral care started within first hours of life.

Did he get septic during his NICU stay? Yes, but his nurses were amazing and advocated for him constantly. I mirror my NICU nursing care after these amazing nurses.

Did we have a Neo pull up a chair, while we read to him in his incubator and tell us our son "would never amount to anything and be a vegetable." "He has a 15-22% chance of being CP or a 46-67% chance of being cognitively developmentally delayed." Sure did. After this, the Neo never came back to talk to us.

But this kid is everything to us. He solidified my passion for NICU, so much so I am graduating this December with my DNP-NNP. I fight for these micro's and give their parents hope. I allow them to have their joy and share their pain if their little ones don't make it. I know what it's like being in their shoes and seeing their kid be poked and prodded and not being able to do anything about it. I fight to let parents do skin-to-skin with these "fetuses" because literature says it helps. I comfort the parents when they cry because they got to touch their kid or hold their kid, cause no one else would let them.

Do all of them turn out like my son. Nope, but some do. They deserve this chance.

"A person's a person, no matter how small. And you very small persons do not have to die. If you make yourself heard."

Here is my son's page: https://www.facebook.com/littlemiracle2012/

Every kid deserves a chance.