Length of Nicu Admission

SteveNNP, MSN, NP · May 14, 2009

He would be screened for a G-tube and sent home with intermittent bolus feeds here.

prmenrs, RN · May 14, 2009

Time for a Mic-Key button.

If you have OT support, or if you have a pediatric unit that has a "Child Life" program, you could ask for a consult for "developmental support". They can see the baby for "play time" and "tummy time". Otherwise, he'll fall further behind his milestones.

Good Luck!!

helicoptergal, BSN, RN · May 15, 2009

Thanks so much for responding. Parents do not want him to get a g-tube. I think that they are in severe denial over accepting his diagnosis, and see a g-tube as to final. That is only my opinion..... I am new to the NICU but am trying to understand why a pt who is not an ICU pt has been allowed to stay so long without someone asking why besides me?? I approached the md about discharge with NG tube after parents and immediate family learn how NG tube care, and that is the new plan. I just wonder if other NICU's have these similar situations and how they are managed. Thanks so much!!!!

RNin2007 · May 15, 2009

How intermittent are the feedings given via gavage? We sometimes send kids home on gavage feedings (after parents are taught how to do so). We also had parents not long ago that were very adamant on not having a G tube and the baby went home on NG feedings (he would probably eventually need one because he had severe HIE, and no suck/gag reflex). But it wasn't something that we could force upon the parents at that point.

TiffyRN, BSN, PhD · May 15, 2009

For parents that are not agreeable to a GB, and the infant has been given a reasonable chance to learn to nipple (at 48wks adjusted age that would qualify in the unit where I work), then a care conference is called. This is comprised of MD's, NNP's, case workers and usually a bedside nurse that knows the infant with of course the parents. They usually come up with a plan, a compromise if you will, 1 more week of attempts, wait until due date, resolve any unanswered issues that haven't yet been addressed (i.e. diagnosing and treating GERD). Often parents who feel the staff are not trying hard enough to nipple their child are given the opportunity to day room in on monitors and allow the parents to do all the feeds, with minimums set.

Usually, the parents agree to a GB after a while, especially with continuous reinforcement from the staff that their infant could be home with them, leading a much more normal life and with increased chance of meeting their developmental goals. Very rarely we will train a family to do NG feeds. The last family I remember us doing this with, both parents were MD's.

To me it is very sad to hear of an infant that far past their due date not being home with their families. Our unit does not have child life specialists and though we do our best, I know the kids do not get the best developmental care once they get too far past newborn stage.

prmenrs, RN · May 15, 2009

Unless you can "sell" it to them as a temporary measure, go w/the NG tube plan.

How did the developmental issue go?

littleneoRN · May 15, 2009

It is extremely unusual for us to send an infant home with an NG tube, and most families who have taken one home have eventually come back to tell us it was more stressful than it was worth. This would especially not happen at our facility if it was clearly just a temporary avoidance of the inevitable. At this point, it is likely that we would have been encouraging GT placement. But it also depends on how long this infant has been working on oral feedings and how long since other reasons for hospitalization have been resolved. If he's mainly feeding orally, maybe a GT isn't necessarily warranted. Feeding is the last thing that keeps many preemies in the hospital. Not every NICU baby actually requires true intensive care, but that doesn't mean they're ready to be home either. If he's mainly taking oral feedings, we would probably do a trial of ad lib feeding and if the infant continues to gain weight, home he goes...spared of a surgical procedure he didn't need. :) Now some of them don't continue to thrive as their caloric needs increase, but that bridge can be crossed when it comes.

babyNP., APRN · May 16, 2009

We kept a kid for 6 months at one point...he was another one of those kids' mom that didn't want anything in her kid. Unfortunately, he was a severe BPDer and ended up with a trach AND a g-tube. It basically ended up as something that we talked with Mom every few days or so until she warmed up to the idea.

I think the point to press is that (depending on the case of the kid, obviously), this could be a very temporary thing! That the kid could have it out in a year or two. And wouldn't it be better for him to be able to go home?

helicoptergal, BSN, RN · May 16, 2009

Thanks to all who have replied. This particular family is completely against a g-tube. And child life is now working with the baby. Thanks a lot!

SteveNNP, MSN, NP · May 16, 2009

If a baby was still having only feeding issues at that age, the parents would be given 2 options. GT or discharge to a LTC facility until the baby can feed.

Unfortunately, the high acuity and high-volume unit I work in is unable to justify keeping a baby simply for the occasional NG feeds. We "hold" 58, but run around 68-70. We even send our postop cardiacs home after teaching the parents to NG feed once all other issues are resolved... and the infant is still working on feeds.

ECUPirateRN · May 17, 2009

I work in pediatrics and these are the types of babies we often get from NICU and Convalescent Newborn. We often get the babies who still need feeding help but are no longer deemed critical. They still need aggressive management and therapy to encourage and evaluate feeding and are not ready to go home, but it is a waste of precious beds and resources to keep them in the NICU. I had a little one a few weeks ago actually who was in ths exact situation. He was a term baby who had a mec aspiration. Had Apgars of 1, 1, and 5. He was in NICU for a while and came to us when the only thing he still needed was nutrition assistance. When I got report from the NICU RN, she told me she couldn't tell me what mom looed liked b/c she had never seen her. He also had a dim neuro prognosis. He has absolutely no muscle tone. When working with the feeding team he made 0% effort to PO feed even when using the Vital Stim. We were NGing all his feeds. MDs wanted a G-tube but mom refused. They had a family conference and made her stay for several nights in a row to see just how much it takes to care for this baby. She stayed and then consented to a g-tube. He had one, he is doing great, and I think he has even gone home.

I can't imagine holding a baby in the NICU where 1 night costs thousands just for feeding issues when there are other choices available.