At what gestation would YOU want YOUR baby saved?

[StacyC417]

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

[LaNICUnurse]

LPN,RNNow said:

This makes me very sad. I had a 23w/480gm daughter. They did give me the choice of what to do. They also told me the possible outcomes. She is not a happily ever after story, but she is a joy. She has CP, she had bleeds, and got NEC. I watched her code twice, they did it right in front of me. I wouldn't take it back either. She has a lot of challenges and so does our family. But she has brought my husband and myself closer together. She is progressing along her own curve. Since I have a preemie, I have met a lot of people who have preemies. There are a lot of 24 weekers who do just fine. For this reason I have chosen to want to be in the NICU. I want to support the parents in their decision whichever it may be and care for that 23-24 weeker. I believe that the choice to go all out on these little ones should be on a case by case basis. There should not be a black and white. JMHO

I agree it should be on a case by case basis. No one can tell by looking at an infant in the beginning how it will turn out.

[LaNICUnurse]

fergus51 said:

I'm sorry my comment made you sad and I am glad your daughter has been a blessing in your life RNNow. I have looked after plenty of those babies and I do support the parents in their choice because like I said in that old post, it is THEIR choice and not mine. I even became the primary nurse for a family with a 23 weeker who insisted on treatment despite the docs telling them it was a lost cause (she did survive and her parents love her to bits). I agree with you that the decision to rescucitate should be black and white for someone else's baby, but the question was what would I want. I've been in the NICU for a few years and I still would never want MY baby treated at 22 or 23 weeks. I've seen too much and it breaks my heart.

I also agree with you. But, I have never yet had children, so I don't truly know what my answer will be if the time comes for it. I do believe that it does matter what the child acts like. I, also, know what most of these babies turn out like. I would hope that my Neo, would respect my wishes whatever my decision. Even if she disagrees with my decision.

I, also, believe that when a family makes the decision to remove an infant from life support, that decision belongs to them, and for whatever reason they made this decision, it should be respected, and their wishes followed.

This can NEVER be an easy decision to make.

Whether we think the child has good chances, or not. Unless, it is so obvious to everyone, that the child is doing so well that it would be criminal to remove the child from life support.

[LaNICUnurse]

danissa said:

Saw a programme on TV about practice in Holland where they don't actively resucitate less than 25 weeks. Makes you think. Have just done two long days looking after a tiny babe born at 24weeks. so precious to her parents after a totally awful obstetric history. she was 16 days old today, finally tried on oscillation from yesterday, but it's just not working. She's so sick and you can see she's just so tired. Needs 100% FiO2, just to achieve sats of 80%! had 6 infusions going, her skin is breaking down when you touch her, she must be in such pain even with the extra morphine.

shes paralysed with vercuronium, needs dopamine, her BP is so bad, everything is closing down on her. We called the parents in today, have a fab consultant who is so humane in his approach and he discussed( tried to recommend for her sake!) letting her go. Her poor wee mam is so opposed to withdrawing any treatment, she keeps saying that she has fought this far, she will make it. This wee babe has whiteout lungs, H+ of 100.4, and pCO2 of 10+. She also has grade 3&4 bleeds. I find this so sad, I'm home tonight and thank God I don't have to go in tomorrow, this is selfish I know, but I think another day of this babes suffering would floor me. The question is why did we start treatment in the first place for one so young, her parents have this thread of hope, she's fought this far therefore she will make it! It's so sad, I will need to phone in to work tomorrow to find out what has happened with her. You can't help but be attached can you? I know we sometimes see the miracles, but at 24 weeks, with all this suffering who are we keeping going for?

This is the type of case I always picture when I think of a

[nursemelani]

This is exactly the case with one of my home health patients. He is missing part of his 9th chromosome, and has medical problems from head to toe. He is 20 months old, but cognitively/developmentally about 4 months. He has had multiple surgeries, and still needs 3 or 4 more. Mom says that she needs to do everyything she can for him, so that if he does pass away, she will have no guilt. What an exhausting 20 months for her, of no sleep, multiple hospitalizations, etc. Her poor kid has been through SO much. From the outside looking in, I think I would have let him go, but knowing how much I love MY son, I understand her motives

[EricJRN, MSN, RN]

LaNICUnurse said:

I am very glad that you did well. Especially as early and small as you were.

Actually I wasn't early or small, but I still had serious problems. I know this is a thread about premies, but I was just pointing out that I was disturbed by a trend I saw on the thread (I know it's an old thread) - the notion that people would not want their babies saved because their, say, 28-30 weeker might have problems. Any baby might have problems - in fact, many babies are sure to have problems. Doesn't usually mean we should withhold treatment though. There are clear instances where things go overboard (reference my previous post about the baby who got CPR 12 times) and we have to know when to let go, but I just don't think we can make blanket statements about many conditions or gestational ages.

[RainDreamer, BSN, RN]

I'm really glad someone bumped this thread up ..... because I've been thinking about stuff like this A LOT lately.

I'm new to the NICU. I'll be starting my last week of a 12-week orientation .... so I've only been in the NICU for about 3 months. BRAND new.

I haven't been in the NICU long enough to really see how all these babies turn out. I haven't really had the chance to see a 24-weeker that has done well. I asked my preceptor if they ever do well, with minimal problems and she said yeah, but that's the dilemma .... so many of them do have problems if they even survive, while occasionally some do very well with no problems.

2 chronic kids stand out in my mind, vividly. I'll never forget them. 1 of them was a previous 24-weeker, born back in November. He had bilateral grade IV IVH, hydrocephalus, etc ..... many problems. I don't know all of them because I never had him for a patient, but I was in the same pod as him a few times. Very sad. He ended up with a trach. The parents wanted everything done. Eventually they were able to talk the parents into signing a "partial DNR". It meant that they could re-intubate, but no code meds were to be given if he coded. When they changed his trach, he coded and died. He'd been on the unit for like 6 months so it was obviously a big blow to everyone. But overall everyone felt relieved, for this poor baby and thanked God that he was no longer suffering. My heart broke for those parents.

Another previous 24-weeker I did take care of ..... a couple of times. Born back in December or January. They trached him too. The first time I took care of him he was actually off the vent. The last time I took care of him though he had the trach. Just got worse and worse. He's got all kinds of fungal infections, the trach ties are already breaking his skin down ...... it just broke my heart Why are they putting him through all of this?!?!

I know there are cases in which these micropremies do well, but from what I've seen that's not how it is in the majority of the cases. I know I'm still new and haven't seen a lot. I don't know what I would do though if I had to make that decision. It just seems like the odds are not good.

[BabyRN2Be]

When I was in school getting my speech path degree, we worked and talked a lot about babies in the NICU. We had this discussion about parents who wanted everything done on a 450g baby, and those who didn't want to resuscitate anything under 30 wks.

There are some parents who say, "DO EVERYTHING!" and some who take the "wait and see" approach. Parents are educated on everything that might happen because they don't expect it to happen. Everyone wants a normal pregnancy and birth, and they don't read about those who are born at 24 wks and have grade IV bleeds, ROP, NEC and everything that goes along with it. Usually, all the parents hear about is the occasional 24 weeker that made a miracle recovery and believe that's the norm.

Since I've worked in L&D, I've seen a 33 weeker who I thought had a chance. She was born at 33wks, +3 pounds. She was initially on room air, and thought to be doing great. Next time I came in I checked on her, and she had passed away 10 days later d/t viral pneumonia.

As someone said, the NICU has the most gray areas of the hospital and it's very hard to predict what can happen.

For me, personally, I wouldn't want anything done on a baby

Very hard decision. Very hard.

[Cherry2]

I was a 26 weeker in 1980.All I can say is thank goodness my parents wouldn't let me go, despite some of the 'advise' they got. I will be 26 years old soon and there isn't a thing wrong with me. I think this sort of thing should really be a case by case basis, but even then.. how do you know? Nobody expected me to make it, so what if my parents had listened and let me go?

[RainDreamer, BSN, RN]

Cherry2 said:

I think this sort of thing should really be a case by case basis, but even then.. how do you know? Nobody expected me to make it, so what if my parents had listened and let me go?

That's the thing ..... no one knows how it's going to turn out. I agree with everyone that it has to be a case by case basis, depends on the circumstances, etc. Yeah there are micropremies that turn out just fine with no problem, but there are SO many (the majority) that don't.

If 1 in 100 micropremies turn out just fine with no lasting effects, then it is worth it to try and save all of them? Before working in NICU, I would have said "yeah, sure". But now, I'm not so sure. Seeing all those chronic kids, suffering so badly ..... really changes my perspectives and thoughts on a lot of things regarding issues like this.

You don't know how the baby will turn out .... if they'll have to suffer .... wind up trached and live off of tubes forever. There's no way to know.

Sorry if this sounds heartless, these are things I've been working through ever since I started in the NICU a few months ago.

[Mimi2RN, ASN, RN]

We sent almost 24 week twins out (we don't keep the tiny ones). Heard they are doing well, no big bleeds, and nothing bad has happened.....yet. It's a long haul for little ones like that. If they do well, we'll get them back as growing premies in the next few weeks.

I don't like to see babies that size resuscitated, but maybe these two girls (of course) will be OK.

[perfectbluebuildings, BSN, RN]

I'm not a NICU nurse, but a peds floor nurse and we get a lot of kids with many chronic problems who are "NICU grads", one of whom died about a month or so ago after spending almost all his 14 months in and out of the hospital (much more in than out), and it's so hard to see all their suffering. But then there are some kids who come in with just some random illness unrelated to prematurity, seem perfectly normal and their parents mention they were born early- those kids seems like were usually never less than 30-32 wks though. Of course I guess I don't ever see the ones who go home and do fine or almost fine and never have to come back to the hospital. I agree there are many many gray areas. As a parent I think I would want to try to save my babe at first, and then see how they did after that. As a nurse I am very conflicted- I've always been raised that every life is sacred and I do believe that wholeheartedly. It's worth everything to try to save a child. But then some of the suffering these babes and their families go through is heartbreaking. It's so complicated I don't think there are any easy answers no matter whose perspective you take.

[LilPeanut, MSN, RN, NP]

Like some others, I think it is different when you are actually in the situation. I was in PTL with both of my pregnancies, but when I was dilated to 2, 90%, fFN+ at 23+5 with my son and hospitalized, I actually had to have "the talk" with the doctors, because they didn't think I would be pg much longer. We decided 24 weeks as our cutoff.

I'm surprised by the number of people who are saying that 28-30 weeks would be the cutoff for them personally. Yes, they typically have a shorter and easier course through the NICU, but many many 26-27 weekers now are doing incredibly well.