Hydrops

[juliachloe]

In my short 3 years in the NICU, I've been to 3 hospitals and the only time I've ever seen hydrops is at my current location and it seems to be pretty common in this area. So when I received a hydrops assignment I honestly couldn't remember the small piece of knowledge that we got in my NICU orientation about hydrops. Especially considering I hadn't ever seen it in 2 years. Anyway I'm pregnant and as usual "pertinent" culture information didn't come through in report so I took care of this kid for 4 days in a row. The following week another nurse freaked out when she heard I was assigned to it since I'm pregnant. This is when I found out about all the pending cultures to determine etiology - we know it's not rH factor. He's 45 days old now and we still don't know what caused it and I know that often we never find out. I have spoken with a traveler since then that mentioned she had been to a NICU where it was policy that pregnant nurses were not allowed to take care of hydrops kids. Has anyone worked in a NICU with this policy??? Now I know "if you use standard precautions" you shouldn't have anything to worry about but this was a tough kid that should have been a 1 to 1 assignment, meaning no other kids should have been paired with it just because of how busy and how sick he was. BUT there was a CPAP kid with it & I was running my tail off with 2 nurses already helping me out those 4 days so needless to say when the kid crumped I ran over there to save him without gloves, there just was no time. And this happened frequently with him. To this day he's still on the jet and paired with another kid. This past week I had CMV & parvo titers and I have a doctor's note from my OB that I'm not to take care of kids like this (or CMV) but I'm freaking out that my baby has now been exposed. Yesterday they tried to give me the kid again (still paired with another kid & still on the jet trying to die) and I refused. I told them about my doctor's note and thankfully they found someone to trade. But they don't care about the note, they want me to find research about hydrops & pregnant nurses. I can't find anything but I'm guessing if there's a NICU out there with the policy they based the decision on some kind of research or an incident. I just don't understand why in a unit with 22+ other nurses on staff at one time, it is so difficult to assign kids like this to someone not pregnant. It's not like I've got all kinds of great experience to contribute. AND how come the care of all these kids is more important than MY BABY. How dare you ask me to jeopardize my baby. Someone please help.

[prmenrs, RN]

http://www.healthsystem.virginia.edu/uvahealth/peds_hrnewborn/hydrops.cfm

Not sure if this will help you or not, just states that one cause of Non-immune Hydrops is Congenital Infections.

This article's abstract lists "Congenital Viral Infections" as responsible for "6.7%" cases of non-immune Hydrops: http://pediatrics.aappublications.org/cgi/content/abstract/120/1/84

I googled "Hydrops fetalis" and then "Hydrops fetalis + congenital infections".

[dawngloves, BSN, RN]

If you use universal precautions any pt should be OK for you to care for. But if you don't feel comfortable, refuse. I'd understand if a pg nurse didn't want to take a CMV kid.

[EricJRN, MSN, RN]

It will be interesting to see the results of your titers. Most adults are seropositive for CMV anyway.

Another link, although a few years old:

http://www.med.ucla.edu/modules/wfsection/download.php%3ffileid=197

ETA: I can't get this link to work, but if you go to Yahoo Search and enter CMV pregnant nurses, it should be #8.

[LilPeanut, MSN, RN, NP]

We have a hydrops kid right now, she has Pulmonary lymphangiectasia and there's no clear cut cause to it.

I've never heard that pg women shouldn't work with hydrops kids.

[Sweeper933]

I've never heard of pregnant nurses not being able to take care of hydrops kids either... I guess it depends on the original etiology of the hydrops in the first place. One of our docs was pregnant a while back and she was doing all sorts of hands-on care with the hydrops baby all the time...

[BittyBabyGrower, MSN, RN]

I've never heard of that either. If you think about it, any kid we have could walk in with something and we wouldn't know it. That is why you use universal precautions. If we have a confirmed diagnosis, then we do not assign cmv kids to pg nurses.

[juliachloe]

I totally understand about "that's why we have universal precautions". However, this was an inappropriate assignment. This child never should have been paired with another baby. Either one, I do not believe, got appropriate nursing care because there was just me. And really that should be the issue: staffing the unit with appropriate assignments. However, I don't know a single nurse that hasn't been in a situation where a kid went to hell in a hand-basket FAST and the priority was on the baby not the box of gloves on the other side of the bed. Unfortunately things like that happen. And a good nurse knows that things like this happen. So as a team lead or nurse manager, knowing that there is a risk involved (in this case being hydrops with no known etiology and pending cultures), why risk it? There's 22 other nurses in the unit, 4 of which have the qualifications to take high frequency. BUT they're not pregnant. Why the hell do they even have a list of pregnant nurses posted in their office if they're not going to look out for us and the health of our babies. That's my point. I'm already going to see if I can help the unit create a policy to prevent this from happening again. But in the meantime I would like to find a unit that does this already to bring evidence to the table that it really is worth the change.

[TiffyRN, BSN, PhD]

It sounds like you and everyone who cared for this infant got shafted due to the heavy assignment. The unit I work in does not have such a policy for hydrops kids without a known cause. Certainly once a kid has cultures or other titers or something that prove they have CMV or parvo or whatever then no pregnant caregivers are assigned.

My husband works in another NICU and there is no such policy there.

We had such a baby a while ago that everyone was convinced had parvo, but it was negative, everything they tested for was negative, they never figured it out, unfortunately the child passed away and we never knew. They did order no pregnant caregivers at some point in the infant's first week of life but I didn't have this infant so I don't know the details of what prompted the decision.

[juliachloe]

Good news about titer: i'm immune to parvo. They didn't have the CMV yet though.

[BittyBabyGrower, MSN, RN]

Well, I have to say, if they don't know what is up with a kid, yeah we are pretty careful about getting gloves on. My point is that any kid that comes in could have something and you don't know it. On the other hand, you could argue that any IUGR or SGA kid shouldn't be given to a pg person because TORCH's are usually a rule out on those kids. I am speaking from a charge nurse point of view. If someone is uncomfortable with what they have, I will change it, but you better have a darn good excuse. I've had pg people not comfortable with a kid that is rule out, that is fine, but I can't have people refusing every assignment because they are pg.

I don't know of any NICU that has the policy you are looking for. Have you spoken to your ID department? That is how we set up our policies for certain things.

[ScammRNC]

CMV is the only type of patient not assigned to a pregnant nurse in our unit. Again, it's universal precautions at work here. The other issue you run into is discrimination if assignments are handed out solely based on pregnancy. We had that happen here.