NICU Changes

Gompers, BSN, RN · Jul 18, 2005

This is just what's new at MY particular hospital - different units make changes at much different paces...

1. Tropic feeds (aka "gut stim")

2. Starting feeds with UAC lines still in place

3. Curosurf instead of Survanta - more concentrated, less volume, and the babies seem to tolerate it much better, absorb it faster, and keep more of it in the lungs instead of flying up the tube

4. Safety conscious everything - needles, IV caths, butterflies, etc.

5. Using higher humidity than ever before (85%) to decrease insensible water loss in micropreemies in an effort to limit IV fluids (to prevent PDAs)

6. Benefiber in feedings for babies with short gut syndrome

7. Aquaphor to treat the skin of micropreemies - what a debate!

8. Gel-filled pillows and memory foam matresses for babies who are immobile for long periods of time

9. Instead of Amphoteracin B all the time to treat yeast - now we also use Caspofungin and Fluconazole

10. Prevacid and Prilosec to treat reflux

11. Neocate formula working for babies whose guts didn't tolerate ANYTHING

12. Getting all preemies into isolettes ASAP, instead of just leaving them on radiant warmers

13. I know this is an equiptment one, but I must mention Vapotherm - it has revolutionized our NICU at this point!!!!!! We have kids that would never have tolerated extubation in the past actually thriving on it. So much better than regular CPAP, as the babies can move their heads around, parents can hold them, and most importantly, the babies seem much more comfortable on it! Plus there is MINIMAL care, which not only saves time but also saves their noses from constant suctioning.

Again, this is just MY hospital...

RN4BABES · Jul 25, 2005

I'd love to hear more about Vapotherm. You sound excited about it and I have never heard of it! I checked out the website but would like a brief explanation as to what it is/does for your babies. And what is "gut stim"??

dawngloves, BSN, RN · Jul 25, 2005

Trophic feeds. We give 1ml of preferably breast milk, Q6 for about 3 days to get the gut ready to advance. Then we do a slow advance, up to Q3 then 2 mls Q3, ect.

We wait about 48 hours after birth and if the UA/UV is out.

Vapotherm is not FDA approved for infants, so you may not find much online info on it. It is a basically a high flow nasal cannula with high humidification. Great alternative to CPAP!

Hey! Has anyone using cooling caps for asphixia babies? I just heard about this today and we are getting one later this year.

fergus51 · Jul 25, 2005

I'd love to hear more about Vapotherm. You sound excited about it and I have never heard of it! I checked out the website but would like a brief explanation as to what it is/does for your babies. And what is "gut stim"??

You may call vapotherm "High flow" (that's what we called it when I worked in Ontario). Basically it's just a system that humidifies the flow through the nasal canula so you can give up to 7 or 8 LPM. It's almost thougt of as an equivalent to traditional CPAP without all the problems (septal damage, caps, restricted mobility, etc).

Gut stim is just the practice of giving a small amount of feeding to the babies as soon as possible rather than keeping them NPO for extended periods of time. I've seen some kids getting 1cc Q6H or even Q12H just to keep the gut healthy.

Gompers, BSN, RN · Jul 25, 2005

Hey! Has anyone using cooling caps for asphixia babies? I just heard about this today and we are getting one later this year.

I saw a special on the BBC a few years back about that. They used either a hat or a cooling blanket to lower the baby's body temperature, thus decreasing oxygen needs. It was used for full term kids in PFC/PPHN and it was working pretty well for them. I haven't heard anything about using it in the USA or Canada though, and it's exciting to hear it's being discussed some places! European NICUs are so different, it's not surpise they came up with this stuff before us!

Let us know what happens if and when you guys get one!

RN4BABES · Jul 26, 2005

Okay, we call that "induction feeds"...same thing/different lingo. We use "high flow" with humidification but rarely does it seem to replace the CPAP (unfortunately) We have made some advances in the prevention of septal damage however...using Duoderm on the end of the nose seems to help as does alternating prongs with the mask on the "Aladdin's". The "bubble CPAP" (hate it as the prongs are so large and difficult to position) continue to be a bother. Do you use this wherever you are? If so, what do you think of it?

Funny you should mention "Aquafor" for prems...we stopped using it quite a few years back due to infections.

mac23 · Jul 27, 2005

We are using the cooling blanket. I've only personally seen it used twice and but we've been trialing it for the last 6 months. Now that the trial is over they are planning on using it more often.

RN4BABES · Jul 27, 2005

Anyone involved in HELLP (heat loss prevention.....) aka: baby in a baggie (on admission/birth) ?

dawngloves, BSN, RN · Jul 27, 2005

We do and I loath it! You have to cut holes in the bag anyway to have access to the extremities. Then you have to cut the bag off the kid because the lines are in anf the monitors hooked up and cutting things off ababy makes me nervous. :uhoh21:

The docs are always hell bent on this bag and I have yet to see it make a difference, Maybe because no one ever puts a hat on the baby until 15 minutes after delivery. :rolleyes:

iwantedtobestressed · Jul 30, 2005

Vapotherm is a great way to give high flow 02, but I have problems with alot of water up my babies nares. I hate that! They don't like it either.....lol

Gompers, BSN, RN · Jul 31, 2005

Vapotherm is a great way to give high flow 02, but I have problems with alot of water up my babies nares. I hate that! They don't like it either.....lol

How high are you putting the temperature on the Vapotherm? We were doing 37 degrees, and the rep told us to lower it to 33-35 degrees instead. It's still very warm, but there is less of a temperature difference between the tubing and the outside air, so it really helps decrease condensation.