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.

[SteveNNP, MSN, NP]

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

Don't be surprised if you're positive for CMV. I read somewhere that up to 90% of adults have had CMV by adolescence and developed antibodies. (which is why it's hard to find CMV neg blood for our tiny ones)

Non-immune related hydrops is typically caused by a condition such as CCAM, or genetic issues, not usually infectious.

Has the baby been tested for CMV/parvo, etc?

[juliachloe]

Don't be surprised if you're positive for CMV. I read somewhere that up to 90% of adults have had CMV by adolescence and developed antibodies. (which is why it's hard to find CMV neg blood for our tiny ones)

Non-immune related hydrops is typically caused by a condition such as CCAM, or genetic issues, not usually infectious.

Has the baby been tested for CMV/parvo, etc?

They did do CMV & parvo cultures among others & they came back negative which at first put my mind at ease but then the doctors ordered more CMV & parvo cultures since they couldn't determine the cause.

[juliachloe]

I appreciate everyone's replies regarding this matter. It has helped. Granted I didn't find out about any other NICU's that had that one policy but it has lit a fire:idea: that maybe the unit shouldn't put pregnant nurses with these babies until we get the cultures back - we'll see what happens. Thanks again.