Labile babies

[Deidre Shiobhan]

Nursing labile babies are stressful++. I don't know whether you'll agree with me or not. Their slighest movement will cause them to desaturates and may even go brady. Most of the time these babies do self response even without intervention but the alarms just can't stop ALARMING!

I've got this particular baby who'll desaturate down to 50s or even 40s upon movement or handling but not accompanied with bradycardia. It's self responding most of the time but may need some intervention on & off.

This situation is norm to us but the parents are taking it very hard. They demand full attention and became quite nasty lately. We try our best to reassure them and get them to realise that this also happen in other babies too.

Pls share with me how do you handle these extremely labile babies in your units and perhaps the parents too. :smackingf

[fergus51]

I try to touch them as little as possible. I do silence the alarms before touching them when I have to and preoxygenate them as well. That usually minimizes the desats and prevents the parents from freaking out over alarms.

[BlueYYsRN]

For some babies there really isnt anything that will help. Its just part of being immature. When I care for kids with very labile sats I try to get them comfortable and contained using snugglies and positioning devices like gel pillows or even beanie babies if they have them. Sometimes I will use the beanie babies on top of the babies head or for ETT support.

I think labile sats are a sign of pain in some kids. In the absence of an order for pain medication sucrose is great. A few drops before and after hands on can help with desats. It can help with anxious parents also. Let them see the baby respond to a few drops of sucrose by sucking on ETT and curling up. That action is very normal for a newborn and one of the few "normal" things these parents will see for a while which helps to elevate parental comfort levels.

My first approach to these parents is to explain that not every sound coming from the monitor warrants intervention. I try to get them to focus on the baby and not the monitor. We all know that doesnt always work. I have been known to do an impromtu thorough monitor inservice to some parents followed by a pop quiz. Dont forget to keep reinforcing the fact that babies can feel and will react to parental stress.

[Deidre Shiobhan]

Thanks for all the reply Pls share with me if anyone has anymore information about nursing labile babies. It's true that we can't do very much for labile babies except to keep them as comfortable as possible and to give parents lots of reassurrance.

We try not to manipulate the use of oxygen too much for fear of complication such as ROP, I have suggested getting devices to promote comfort or even developmental care but it's not possible as these devices are pretty expensive and I come from a very big unit - 24 beds NICU and sometimes even rise till 29 on very bad days.

I feel that the approach on developmental care is a touchy topic here as not many will agree and believe. Not many nurses are very much aware of it, we are trying to create awareness through inservice and presentation but progressing slowly.

Maybe this is the culture here, sigh!

[prmenrs, RN]

You don't need a lot of expensive positioning devices to nestle a baby. Take 2 blankets, put them together, fold in 1/2. Lay it down on a table, and roll the edges under and in. Both sides should be even. Then take one of the unrolled edges, gather it together and tape that end closed--that's where the feet go. Put the baby in it, prone, tuck in the sides to fit, get binky in mouth. If there's an ET tube, cut a V in the edge of the binky to fit around it. You may want the foot part taped a little higher so the baby's head is above the roll, or you may want to unroll the blanket where the tube is.

If the kid is on an open warmer, you can use a Saran Wrap "blanket" (ask dietary for one of their big, industrial size rolls) to keep drafts out. Tear off a good size piece, "edge" it w/tape, and make an X across it--that makes it easier to handle. You can place it over the rolls of the blanket and tuck it in.

Find a way to shade the eyes--just a washcloth across the forehead works great. It also protects their ears a little. You can tape a cotton ball across the ears, too. Try to reduce the noise level in the nursery. Good luck w/that if there's no support from admin for it. Point out that every time someone tells a particularly good joke, the kid takes a dive. Also, see if you can establish a "quiet zone" in the nursery. Sensitive kids can be moved there.

The most important thing of all to do is to convert a few key RNs and MDs on the value of this. There is more than enough literature/studies published--post some.

[prmenrs, RN]

http://www.contemporaryforums.com/m695/main.asp

This conference is in November. Might be a good thing for the Unit Manager and some other key people to attend?

NOW I read you're in Singapore. Maybe you can order the CD-ROMs.