ISAM Baby question

[SamRNmedic]

I have worked in a NICU for 2.5 years as an LPN.. and the majority of my time is in the subintensive NICU with the feeders/growers...and ISAM babies. These babies tear at my heart. I feel sooooo bad for some of them. But, in the last couple weeks, we have had one particular baby who has been such a challenge for me personally. Her mother did cocaine, methadone, and who knows what else. This baby was full term and has been with us 2 months now. Often times, I feel our doctors try to wean them too much too soon and the last 2 shifts I had with her were torture. I start the day out feeling good and by the end of the day I am ready to cry.

In 2 days, the physicians dropped her morphine,phenobarb, and clonidine all by 50% of the doses she was on. And She literally cried all day long with 20 minute naps. I did EVERYTHING I could for this little innocent sweetheart. From bundling her tight, to putting her in a swing, to holding her in my arms or up on my shoulder, to walking around the NICU with her. At times I left her alone to see if she'd put herself back to sleep but that just made her more inconsolable. She feeds anywhere from 2-4 hours.. she had been on 4 hours until they cut her doses now she wants fed little snack every 2 hours and it is a vicious cycle. The charge nurse finally called the physician who increased her clonidine only..and only by 100mcg.

I guess my question is this... what do you do?? You have 2 other children to take care of.. and you have a screaming baby who you can't make feel better no matter what you do. She had Finnegan scores up in the mid-teens! Sometimes other nurses give me a break but they all have had shifts with her and welcome the shifts they don't have to take care of her. All I want is to help her but I get to a point where I don't know what to do. I left the other day and cried in my car on the way home. A sweet coworker left me a voicemail telling me I did a great job.. that she would've literally ripped her hair out if she had been with that baby that day.. and I was glad she thought I was good, but inside I felt like I had no idea what I was doing!!

How do you all deal with this?

Any tips for coping? Any words of advice from veteran nurses.

[umcRN, BSN, RN]

Cut all three by 50%??!! That's way too much, I would have called the docs and told them so and that her withdrawals scores were super high, our kiddos usually have something for breakthrough to give PRN if scores are above a certain number, also if a baby was withdrawing that bad our docs would typically be alright with going back up and waiting a day. Also we usually wean by 10% the original dose when we wean. For the severe withdraw-ers or the babies who spent weeks on serious narcotics we often have the hospital based pain team get involved and come up with a long term weaning schedule. We almost never wean more than one thing per day and sometimes we wait two to three days between weaning

[SamRNmedic]

Honestly, the more experienced nurses did mention it's usually just 10%. They were really upset about this and when the charge nurse called the doctor and she only increased the clonidine, we were all in disbelief. It was heartbreaking. I was so frustrated! And obviously the baby was too!