Changes In Premie Baby Care Since The Mid 1980's

EricJRN, MSN, RN · May 7, 2006

I wasn't a nurse back then, but I just wanted to suggest that most of those answers could probably be located by Googling 'advances in premie care.' When I Googled it, it turned up several good links.

Gompers, BSN, RN · May 7, 2006

Neonatology is a constantly changing field. The answers to all of your questions is YES.

I've only been the NICU for 8 years. In that short amount of time, I've already seen huge differences in technology and the care of these babies. It's an ever-changing field. So is all medicine, I suppose, but you really see huge differences in the NICU as the years go by.

BittyBabyGrower, MSN, RN · May 8, 2006

I have been in NICU for 20 years...

1)Has the survival rate changed?

By leaps and bounds. When I first started many kids under 30 weeks didn't survive and the ones under 35 weeks had many respiratory and neuro problems. You'd have to do a search for survival rates now, but most kids 24 weeks and up do survive...some with no problems and some with many. It is kind of a crap shoot with the smaller ones. We are also more astute in infection control which has made a big difference in outcome. Also, better prenatal care and treatments have improved our survival rates.

2) How has the technology changed?

When I started, we had only one type of vent, now we have many, including high frequency/oscillator. One of the first prototypes of the high frequency, the Jet Ventilator, was recalled by the FDA due to the many deaths that occured when using it. Keep in mind, we didn't have surfactant, so we had kids with lungs like leather and when we put these kids on these vents they could blow a pneumo rather quickly. We now use long term PICC lines, where as before we used only umbilical lines and stuck kids over and over for IV's. Med use has also changed drastically as they now know more of how they affect neonates. We have pumps that figure drips for us, we have monitors that we don't have to rig up to do pressures, etc anymore.

3) How have the medications changes?

We are more conscious of antibiotic use, steroid use and we now medicate for comfort. For many years it was the belief that neonates didn't register pain. I can remember getting kids from OR that weren't sedated, just paralyzed and we didn't provided good pain management as we didn't want to drop pressures on these post op kids or "addict" them. We didn't use drips, everything was bolus. We also use vasopressors much less since now we know that they can contribute to bleeds in the brain. We don't use the steroids as much since there has been a link of CP and we know that it gives them cardiomyopathy. We also use Epogen now instead of transfusing kids that have low crits...it is pretty rare for us to use blood now. Surfactant was a huge change in how we manage lung kids.

4) How have the handeling techniques changed?

When I first started, you did hands on vitals, changed diapers, suctioned these kids every two hours whether they needed it or not. Now we do minimal stim and only suction as needed. Some kids don't get touched for 12 hours. We also keep it more quiet and use nesting much more. We put washclothes over heads on the ventilated kids to muffle sound and light.

5) How has teh environment of teh NICU changed (EX: Light, sound, etc)?

We used to be in one huge room where we had monitors and pulseox's alarming constantly. We never turned the lights down and we didn't cover the isolettes . We also stored stuff under the isolettes. We now have pods that have 5-6 kids, we are more conscious about noise and minimal stim. We don't store things under beds and we silence alarms as we can. We have dimmer lights and use gel pads to keep them comfy.

6) Anything else you can add.

We involve the parents much more. We encourage kangaroo care. Back 20 years ago, we didn't like parents to bother the kids, we rarely let them bottle feed. We also push for breastfeeding much more. We are more aware of eye problems and now laser them in the unit. We follow our kids for 2 years in our Preemie clinic and have OT/PT there and other services. We have also involved Hospice/pallative care more with many of our babies with a poor prognosis.

I hope this helps!

LilPeanut, MSN, RN, NP · May 9, 2006

One thing that always struck me was that Jackie Kennedy's son, Patrick, was born at the same gestation as my son, but passed away two days after birth. Two days after my son was born, they were extubating him and he was on his way to recovery. It just is amazing what is possible.

dawngloves, BSN, RN · May 9, 2006

A co worker told me 20 years ago they wouldn't even wake the doctor for anything less than 28 weeks.

rph3664 · Feb 1, 2008

I had a friend in high school who at the time of her birth in 1965 was considered at the borderline of survival. I don't know what her gestation age was but her birth weight was 3 pounds 7 ounces. She was totally normal.

Her mother was a recovering alcoholic who drank throughout 7 pregnancies and lost 3 of them at 6 or 7 months.

Jolie, BSN · Feb 1, 2008

Thanks, BittyBaby Grower! That was a nice summary of the last 20+ years, and quite a trip down memory lane.