Ok, so one of our neos tells us our unit is 2 years behind "the rest of the world" because we are not enforcing the AAP's standards for "Back to Sleep" in our unit. As in she doesn't want feeder growers, even those still in isolettes swaddled and doesn't want rolls placed in the bed (the ones I'm talking about are blanket rolls covered by a "bottom sheet" blanket that is tightly tucked around the mattress). She wants these babies placed like the pictures on the "Back to Sleep" pamphlet which I am trying to attach. First off, I can't imagine trying to keep some of our smaller open crib kids warm without swaddling much less keeping any kinds of OG/NG tubes in.
Now I'm all about teaching the parents about back to sleep and starting to put them on their backs as they move to nipple all feeds, but no swaddling or boundaries when I have 4 kids to keep happy?
So, are we really 2 years behind the rest of the world? If my fellow NICU nurses out there wouldn't mind responding and providing location (even as vague as "South", "East Coast") I would really appreciate it.
I swaddle-it's developmentally appropriate until @ least 36 wks, off O2, tolerating (and nippling) all feeds, no reflux. And, I believe it's "evidence-based".
I do tell parents that the baby will be supine closer to discharge. I also tell them "we cheat", i.e., the babies are on monitors, thus limiting their ability to have a SIDS.
As for d/c'ing pts "soon after 32 weeks"? I trust them even less than 35 weekers. (see below) They don't even know how to eat. And they're not supposed to, either.
Trends come and go in health care. And I've seen LOTs of changes in nearly 40yrs, 25 in NICU. IMO, you can't change your practice every time a new study comes out. Ask your neo for all data indicating a change in care practices.
Southeast here. One of our neo's has done some research that says that HOB up doesnt help with reflux. SO, combining that with back to sleep and they are marching around every morning putting all od the HOBs down, throwing a fit if a kid is on his belly. We can place prone if the kid is on O2. Rolls are removed when the babe is a few dyas from dc. We do swaddle but it has to be shoulder level to prevent rebreathing. I can not imagine a child staying warm unwrapped..... even nursery babies get cold when you unwrap them and leave them with just a blanket laying over them.
Personally, I can understand placing "back to sleep" when the kid is preparing for DC. I can not understand placing a severe refluxer, CHF, or preemie (LBW, ELBW) on his back just so the parents can see us doing what they should do at home. Keeping the HOB up in a kid less than 1kgmakes a huge difference in IVH risk. I cant see us doing harm to the baby (CHFer SHOULD be with HOB up..... babes are no different than adults, they just cant verbally express their discomfort.) A refluxer should also be placed with the HOB up. I had reflux when I was in HS. I slept with my head up because I had less reflux in that position, why is this any different? I cant tell you how many preemies sat better on their bellies. Some CAN NOT tolerated being on their back. It is proven that prone positioning can improve oxygenation. I see it all of the time.
I really wonder to what degree "back to sleep" has made a differencce. I was told by a LC that the research done on back to sleep was done in scotland where the kids were being placed on wool blakets and thick bedding. I wonder how much of a difference removing heavy blankets and avoiding smoking and exclusively breastfeeding changes the stats/risks not including the supine positioning. Not sure if that made much sense.... having trouble articulating tonight!! Just a thought.
The parents might copy what they see to an extent, but I'd be interested in hearing from some of the ex-NICU moms in this forum and get their take on it.
I would think the parents would understand the difference between having their baby swaddled and/or on their bellies in the hosptal while on a monitor and being closely watched by the nurses versus being home without all the close monitoring.
When they are nippling all feeds and in a bassinet we will swaddle them, but the blanket ends under the armpit, not up around the neck. We put them all on their backs to sleep then, esp for their sleep studies. I just went to a conference and the doc presenting said that research has shown that putting kids in corificeats, or on their belly really doesn't help with reflux. Parents, not all, but some, will mimic what they see us do.
Our policy (I'm in Cincinnati, now) is that once babies are nippling 25% of their feeds (2x a day), then all developmental tools (snuggle ups, froggies, snoedels) need to be removed from the bed and unless a kid is experiencing reflux that is symptomatic the HOB lowered. We are supposed to give the kids 'tummy time' once a shift (2x a day), but the goal is to have them on their belly's while awake to strengthen their neck muscles. We send kids home at 34-35 weeks generally, so this can happen fast.
(to set examples, we also do not let parents sleep while they are kangarooing, and do not encourage co-bedding multiples, even though we do cobed them in the unit.)
prmenrs, RN
4,565 Posts
I swaddle-it's developmentally appropriate until @ least 36 wks, off O2, tolerating (and nippling) all feeds, no reflux. And, I believe it's "evidence-based".
I do tell parents that the baby will be supine closer to discharge. I also tell them "we cheat", i.e., the babies are on monitors, thus limiting their ability to have a SIDS.
As for d/c'ing pts "soon after 32 weeks"? I trust them even less than 35 weekers. (see below) They don't even know how to eat. And they're not supposed to, either.
Trends come and go in health care. And I've seen LOTs of changes in nearly 40yrs, 25 in NICU. IMO, you can't change your practice every time a new study comes out. Ask your neo for all data indicating a change in care practices.