At what gestation would YOU want YOUR baby saved?

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I have a good friend with a former 24 weeker (540g) who is doing WONDERFULLY. She is now 16 months and is developmentally normal in all areas. I was talking to her the other day, and she was saying that she couldn't imagine NOT saving her little girl. I just think that it is just SUCH a tough decision to have to make...Even though she ended up with a "happily ever after story" SO many of these little ones end up with IVH, CP, BPD, ROP, PVL, NEC and the list goes on. I don't think that I would have been prepared to deal with the *potential* consequences of saving a baby at 22,23, or 24 weeks. The statistics are just too bleak for the majority of these kids.

I would say that I would request no resuscitation before 26weeks/750g if it were my child. What are all of your opinions?

Stacy

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Specializes in Going to Peds!.

28 weeks OR >1000g The risks below that are just too high for my tastes. I have a 30 wkr, a 33 wkr, and my baby was 34w2d. None of them were on the vent. The smallest baby (30wkr) only received the oxygen hood for about 4 hours.

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30 weeks unless IUGR

I took care of too many of the "not happily ever after" ones after they went home (trached, vented, tube fed, profoundly MR & seizing continuously)

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Depends on the situation (how long was I ruptured, did I get steroids, what were the apgars...). I would probably say 26 weeks.

DEFINITELY not 22-23 weeks. It should be a criminal offense to torture those children the way we do. I work on them when the parents choose it, because it is their choice and not mine, but I would NEVER let my child be treated at that gestation.

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fergus51 said:

DEFINITELY not 22-23 weeks. It should be a criminal offense to torture those children the way we do. I work on them when the parents choose it, because it is their choice and not mine, but I would NEVER let my child be treated at that gestation.

I agree 100%!

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Hmmm.. tough to say. I would probably say 26 weeks, but if less than 28 and made it out or the delivery room I'd definately have a DNR order.

I am sitting here looking at a bunch of

"Success" stories is right. People hear what they want to hear. Those instances are rare.

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Specializes in NICU, PICU, educator.

I'd say 28 weeks...maybe go 25 weeks if it was a girl! Ideally...30 weeks.

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Just a question, is there a gestational age where you are required to do everything you can, no matter what the parent says? For example, if the child was born at 38 weeks and needed a ventilator? Could the parent say no?

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Specializes in NICU.
AnnasmomRNtobe said:
Just a question, is there a gestational age where you are required to do everything you can, no matter what the parent says? For example, if the child was born at 38 weeks and needed a ventilator? Could the parent say no?

This is a serious debate in some NICUs. Some parents don't want anything done if the baby is anything less than perfect, and others want everything done even though there really is no hope. In my particular hospital, any baby over 24 weeks is recussitated. (Under that age, it's really up to the parents and doctors to decide what they plan to do.) Afterwards, if the parents decide to withdraw support, they can't just do it because the baby is premature. Historically, there have been parents who wanted preemies who were actually doing just fine to be taken off the vent, but that is usually considered unethical as there is no evidence that the child won't grow up perfectly normal after he/she grows and matures a little bit. In those cases I believe the state takes custody of the child and continues treatment, so long as the baby is at a viable gestational age. Honestly with those preemies even if they were taken off the vent they'd probably survive anyways. Now, if the baby had some kind of serious condition, organ failure, or brain damage, then the parents do have every right to ethically withdraw support.

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AnnasmomRNtobe said:
Just a question, is there a gestational age where you are required to do everything you can, no matter what the parent says? For example, if the child was born at 38 weeks and needed a ventilator? Could the parent say no?

It really depends on the situation. If a 38 weeker on a vent had grade 4 bilateral bleeds.... they may be allowed to withdraw. A 27 weeker may not be agressively resucitated even though it is over 24 weeks... Generally, it depends on the possible outcomes for that baby. There are more gray areas in the NICU than any other place in the hospital!

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My hospital's policy is 24 weeks and/or 500 grams, but it is somewhat flexible. I understand that policy is under revision right now.

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I would have to go with your numbers dansamy. Though it was never an issue with me, nor will it ever be. Heck none of mine wanted to come when they were due!

dansamy said:
28 weeks OR >1000g The risks below that are just too high for my tastes. I have a 30 wkr, a 33 wkr, and my baby was 34w2d. None of them were on the vent. The smallest baby (30wkr) only received the oxygen hood for about 4 hours.
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