Late crumpers

[LilPeanut, MSN, RN, NP]

Does anyone else seem to notice a trend with late crumpers?

It seems like once our chronics get past that first acute stage, then the next major time they crump is around 8ish months. It's hard because somewhere in your mind you think that they've made it this long, and so have other kids, why do some of them just lose it?

ie: We have had 3 kids recently go home on mist collars & trachs, past a year old, another one home on NC...obviously all BPDers. But the ones who have hung on and done about as well as those who went home just seem to falter when they hit that 8-9m mark and collapse.

Have other NICUs noticed this trend or is it just unfortunate luck for us?

[BittyBabyGrower, MSN, RN]

We see that from about 6-8 months too...and all of them have had severe PPHN. I seems like they hit that growth spurt for that age and their lungs and hearts can't keep up. We have only had a few make it out of that, despite electively intubated, paralyzed or heavily sedated and sometimes put on nitric and other cardiac meds. And they all start with that PPHN cough...and at first we think it is a reflux cough but then they head down hill.

It is awful to have gotten them this far for them to die

[2curlygirls]

We had a kiddo recently on NC iNO for 5 months post ECMO for CDH. Poor kid ended up dying the day before they were taking him home. Another was a transfer from another facility-ex 25 weeker, had every complication of prematurity. Ended up back on HFOV for two weeks after being on NCPAP post surgery to repair some adhesions.

Our kids go to PICU after 6 months (usually) so if they crump late, they usually do it there. I'm sure it's a pretty frequent occurrance.

[lovemyjob]

We see that from about 6-8 months too...and all of them have had severe PPHN. I seems like they hit that growth spurt for that age and their lungs and hearts can't keep up. We have only had a few make it out of that, despite electively intubated, paralyzed or heavily sedated and sometimes put on nitric and other cardiac meds. And they all start with that PPHN cough...and at first we think it is a reflux cough but then they head down hill.

It is awful to have gotten them this far for them to die

I have a twin (ex 23 weeker, now 6 mo, somehow didnt get nec, but has a grade IV IVH) who has that cough....makes me nervous. I havent been a NICU nurse for long enough to notice trends, but I will def be more attuned to them after reading some of the comments on this forum.