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How many 37, 38-weekers wind up in NICU?

Posted

I was just wondering how many 37,38-weekers do you encounter in the NICU due to organ immaturity (RDS, etc).

**I am adding my subsequent question further down in the thread here, so that it will be seen:

The reason I ask is that there is a bit of controversy regarding early (pre-38 weeks) self-induction inquiries. We are concerned that these mothers do not truly comprehend the gravity of the possible implications for their babies. Are we over-reacting? My point is that in contradiction to the popular belief that early induction won't work unless and until your body and baby are ready, is that if you are unknowingly at risk for preterm labor, this could provoke a pre"mature" birth. Is this a valid concern?

Thanks~

Wen

Jolie, BSN

Specializes in Maternal - Child Health. Has 35 years experience.

It's not an everyday occurence, but not unheard of, either.

37-38 weekers (especially IDMs) occasionally have respiratory distress severe enough to require CPAP or short-term ventilation. Caring for them is a challenge because they are big and strong enough to fight, putting them at risk for complications such as pneumothorax. They require sedation, pain management, and minimal stimulation.

Meconium aspiration syndrome, which can lead to persistent pulmonary hypertension in the newborn, is a complication which occurs almost exclusively in near-term or full-term infants. The incidence has dropped significantly over the last few decades, mostly due to better delivery room management of at-risk infants. The care of these infants is also quite a challenge, as they are among the sickest of the sick.

Occasionally, full-term infants are admitted for treatment of birth defects such as cardiac anomolies, abdominal wall defects, neural tube defects, etc. These babies usually require surgery and possibly other specialty consults.

The majority of term and near-term NICU babies require management of relatively minor problems such as transcient tachypnea of the newborn, glucose instability (possibly due to maternal diabetes), and rule-out sepsis. Most of these babies are in and out in a matter of a few days, with some being able to go home with their moms.

The most unusual full-termer I ever cared for was an apparently healthy baby boy who developed NEC and perforated his intestine while in the well-baby nursery. Thank Goodness, his mom was a C-section and had a 4 day stay. If this had happened at home, I don't think he would have survived.

prmenrs, RN

Specializes in NICU, Infection Control. Has 42 years experience.

Thank You for that very nice response. Good job!

The reason I ask is that there is a bit of controversy regarding early (pre-38 weeks) self-induction inquiries. We are concerned that these mothers do not truly comprehend the gravity of the possible implications for their babies. Are we over-reacting? My point is that in contradiction to the popular belief that early induction won't work unless and until your body and baby are ready, is that if you are unknowingly at risk for preterm labor, this could provoke a pre"mature" birth.

Can I just ask how many of the 37-38 weekers who end up in NICU were anticipated to need assistance prior to delivery?

Many public hospitals here will not schedule inductions for prior to 38 weeks in the absence of a compelling medical reason (precisely because even "reliable" dating methods still have a margin of error which can make a crucial difference to outcome), so I was a little surprised by the extent to which "self-induction" methods were condoned without warnings during antenatal classes. Granted, many of those methods are probably of more psychological than physical benefit and are going to have no effect at all on a body which isn't ready to labor and deliver, but I do wonder whether treating preterm "self-induction" as something which is fairly routine might lead to women for whom the fairly innocuous methods fail might feeling over-confident about trying more risky methods of "bring on baby". Are the generally good outcomes for >34 weekers now so well publicised that people feel a false sense of security?

I think the majority of >37 weekers I see are TTN or PPHN babies.

I 'll tell you one thing from personal experience, not professional, about self inductions. I know a few women that have self induced and have had meconium present at their deliveries. One friend, who took castor oil, her baby aspirated meconium and was transferred to another hospital and put on a ventilator.

You are right mermom. Dates can be off and if you think you are 37 weeks, you may be 35 and a whole new kettle of fish. I've seen that a few times.

And reprise is also right. You hear all the happy "I had a 22 weeker and she's fine." stories and people thing, "Well hey! Then what's wrong with 32 weeks?"

I could go on and on about the OB's that induce at 36 weeks because the mom is tired of being pregnant or the woman taking black cohosh at 37 weeks because she's afraid of having a big baby. Let nature do what it's supposed to! There's a reason you are supposed to be pregnant 40 weeks and you don't know what you are doing to your body when you force it against itself!

A dear friend of mine was induced at just under 37 weeks for suspected chorioamnitis (spelling? I'm an adult MICU nurse, sorry!). Babe went to NICU for a few days to r/o sepsis, then spent another few days in newborn nursery getting bili lights. Everything's fine except the baby does have the preemie reflux/vomiting problem.

A dear friend of mine was induced at just under 37 weeks for suspected chorioamnitis (spelling? I'm an adult MICU nurse, sorry!). Babe went to NICU for a few days to r/o sepsis, then spent another few days in newborn nursery getting bili lights. Everything's fine except the baby does have the preemie reflux/vomiting problem.

My own son (#4) was term and during labor had problems with decreased fetal heart rate .... was stimulated several times to no avail. When he was finally born, he was extremely cyanotic and not responding. They worked on him for a bit in the room and then took him away. Ended up in the NICU. He had aparently aspirated amniotic fluid during birth. I am not a NICU nurse (work oncology) but have requested records several time (out of interest mainly)... but apparently they "misplaced" the 115 page birth record. Anyway, he is fine now, but, as an earlier poster stated, resp. distress happens to those full term 8lb babes too. Interesting thread....

My own son (#4) was term and during labor had problems with decreased fetal heart rate .... was stimulated several times to no avail. When he was finally born, he was extremely cyanotic and not responding. They worked on him for a bit in the room and then took him away. Ended up in the NICU. He had aparently aspirated amniotic fluid during birth. I am not a NICU nurse (work oncology) but have requested records several time (out of interest mainly)... but apparently they "misplaced" the 115 page birth record. Anyway, he is fine now, but, as an earlier poster stated, resp. distress happens to those full term 8lb babes too. Interesting thread....

KRVRN, BSN, RN

Specializes in NICU.

Full term respiratory distress is almost always different from premature respiratory distress. Preemies usually have problems from having immature lungs and surfactant deficiency. Full term respiratory distress is usually due to meconium aspiration or pneumonia or a cardiac defect. Of course, preemies can have pneumonia and cardiac defects as well, but it's very rare to see mec aspiration.

37-38 week babies can still have immature lungs and need surfactant, but it is quite uncommon. And if it does happen, you always think in the back of your mind that it might have actually been a 35-36 week baby with a wrong due date.

Our hospital does not allow for inductions before 38.5 weeks for this very reason. We had one doctor in particular who would induce 37 weekers and they usually were earlier than that.

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