NICU filling with miscarriages

Nurses Safety

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I am an RN on a general pediatric floor and have seen many children on the floor that are very acutely ill. Just in two months working there I have seen three cases of infants born with agenesis of the corpus collasum! One of my co workers responded by saying that as the years go by, more and more medically dependant children are going to fill the floor. I myself am a very conservative, however, what kind of quality of life does a infant born at 21 weeks have? These innocent babies are being born blind, deaf, missing parts of their brain, will have chronic seizures for their entire life, and most likely end up vent dependant. They will never grow to be productive members of society. If I myself gave birth to a child with disabilities I would love him/her just as I would love my son and daughter now. I realize children are born with these health issues at full term as well. It makes me wonder how many come into the ER having miscarriages and the baby is placed in the NICU. This is a very difficult subject matter, where do you draw the line? I sure can't call it. On top of all this, a recent article I read also states that the maternal mortality rate is increasing in the U.S. The article attributed it to the increasing c-section rate and advanced maternal age(women delivering after 35 y/o). I guess the c-section rate and advanced maternal age mothers go hand in hand though. In the end, who ends up the victim. The poor babies, I welcome any comments. Thank you.

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Specializes in MS, ICU, Peds, L&D, Camp, HH.

Holly,

I'm seeing this as well, working pediatric homecare. Let me tell you... there is a lot of stress on the families. Unless of course, they get 24/7 in-home skilled nursing care (not usually) - many become dependent upon the nurses then stress out when "their" nurse isn't available for whatever reason (sick, vacation... transferred to another case). Just not a great all-around scene unless multiple family members stay engaged and involved in the care of the child. And yes, lots of vents in pedi home-care these days.

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Specializes in NICU.

Wow!!

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Specializes in CICU.

Infants born under 22 weeks gestation cannot survive. It is not anatomically and therefore not physiologically possible. There are stories in the press of infants younger than this surviving but the gestational age must have be falsely calculated and in fact they were older. Infants born at 22 weeks or under simply do not have the anatomic capability for gas exchange at the cellular level which is necessary for life. That being said VLBW/ELBW infants born at 23-26 weeks have roughly, give or take, a 50/50 chance of "making it". Their stay in the NICU is hazardous and long. If they manage to bypass the sequelae associated with extreme prematurity then developmental problems usually become evident as they get older. You can't say with certainty that every preemie is going to have such and such a developmental problem. Most parents in our NICU love their children regardless of the state of their health. As a nurse I work to the best of my ability to provide the most excellent care I can for any infant. I certainly am not going to judge whether or not they deserve to live, that is not my job as a nurse. Also...a miscarriage is a miscarriage, labor is labor and an emergency c-section is an emergency c-section. Preterm labor is a completely different thing from a miscarriage.

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Specializes in NICU, Telephone Triage.
Infants born under 22 weeks gestation cannot survive. It is not anatomically and therefore not physiologically possible. There are stories in the press of infants younger than this surviving but the gestational age must have be falsely calculated and in fact they were older. Infants born at 22 weeks or under simply do not have the anatomic capability for gas exchange at the cellular level which is necessary for life. That being said VLBW/ELBW infants born at 23-26 weeks have roughly, give or take, a 50/50 chance of "making it". Their stay in the NICU is hazardous and long. If they manage to bypass the sequelae associated with extreme prematurity then developmental problems usually become evident as they get older. You can't say with certainty that every preemie is going to have such and such a developmental problem. Most parents in our NICU love their children regardless of the state of their health. As a nurse I work to the best of my ability to provide the most excellent care I can for any infant. I certainly am not going to judge whether or not they deserve to live, that is not my job as a nurse. Also...a miscarriage is a miscarriage, labor is labor and an emergency c-section is an emergency c-section. Preterm labor is a completely different thing from a miscarriage.

i totally agree. In my 17 years in NICU, I've never seen a 22 weeker. Only 23 weeks or more. Also, I don't believe that csections and advanced maternal age go hand in hand. I gave birth at 38 and it wasn't a csection! Csections are required for a lot of reasons, and i don't think age has much to do with it!

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Specializes in NICU, Telephone Triage.

And not all premies have all those abnormalities you mentioned. I took care of 27 week twins who have no problems now at all. They go to a regular school and just wear glasses, that's it!

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My children were in the NICU for two months and there was a little baby there born at 21 weeks. The mother and I chatted each evening and she asked me one day if I would like to walk over and see her baby, and I agreed. I just about couldn't even see the little infant in the midst of all the tubes, wires, etc.

The baby was still there when I took mine home, and I never found out what happened to it. When we left it was there for four months.

The mother was having a miscarrriage and was told the baby would not survive...there was no Neonatologist, no heated isolette, even a lady partsl delivery was done. The issue was, the baby didn't die after it was born, and after over an hour, the decision was made to transport the infant...and the mother explained that the child almost had to be treated like a burn victim because of the outer layer of skin was highly suseptable to infection.

Everyone is right. As technology progresses, it's going to get to the point where where more of these babies (and elderly people) are going to have to have more difficult time letting nature take it's course. However, having experienced myself the horror of not knowing if your children are going to make it or not, or if they do...what are you going to be left with? I don't know if I could make that decision.

I'm in nursing school now, and the NICU is my career goal, so this subject greatly interests me. I agree with all of the stats and the outcomes...but it's just hard, so very hard, to decide what to do when a decision has to be made.

On a side note, I think that more women are dying in childbirth because insurance companies are forcing hospitals to kick women out before they are ready and some OB/GYN's are taking chances that they shouldn't. I had a close friend that lost a FULL TERM infant about two years ago...it was her first baby...what she described to me was a clear-cut sign of pre-eclampsia, and instead of doing the right thing and getting that baby out of there (it was full-term!), her doctor sent her home and told her to wait...three days later she came back, woke up sweating, BP through the roof...what did he do? A C-Section...nope...he induced labor. The baby died during delivery. She really and truly believes that "these things happen" and the doctor has convinced her that the outcome would not have changed. I kept my mouth shut...b/c nothing would have brought that baby back...she had closure, but it made my physically ill that the chances of that baby surviving probably could have been very good if she had a doctor that didn't live on the edge.

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Specializes in High Risk In Patient OB/GYN.

Calling a living, breathing baby a "miscarriage" doesn't seem right to me. Regardless of whether or not you agree with the measures taken, it's a person and I think that's disrespectful to the families of these children and to the children themselves.

If you want to be specific, even if no interventions were initiated, and the baby died an hour after birth (or a minute, or a day), it would have been a neonatal loss, not a miscarriage. Because technically, if it's "alive" in the NICU, it's at the age of viability whether it "should" be or not.

I work antepartum and many of our mothers have 1st, 2nd or 3rd trimester losses. Some women want everything done at 19weeks (despite having spoken with NICU who assured them that nothing could be done), some are comfortable letting nature take her course with a 25/26 weeker.

The mother of the 19weeker...this was her 8th pregnancy. 1st baby hit by a car age 18mos, 6 (six!) losses, 4 of those being 2nd trimester losses. She had never made it past 16 weeks (aside from 1st baby).

It's such a personal decision, and really I can't imagine that any of us can cluck our tongues until we've actually had to make it.

And c-sections have little to do with maternal age. Look at doctor's fear of being sued in the event of a bad outcome, use of continuous EFM (which has been shown to increase c/s rates without improving fetal outcomes), the medicalization of a normal pregnancy, the refusal of many doctors to perform or attempt a VBAC, miseducation of patients, and over use of interventions/restrictions and you'll get a hint as to why the c/s rate is as insane as it is.

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Specializes in CICU.

I'm sorry but 21 weekers cannot live. Look it up in a perinatal anatomy textbook if you don't believe me, it simply is impossible. They do not have the lung structure present to live. Gestational ages are variable and the infant had to have been older in order to live. It would be like saying "I know this baby that survived four months etc without any lungs." Can't happen.

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You can see unethical practices on both ends of the spectrum, why are great lengths taken to keep alive a 22wk baby with no fighting chance at a quality of life and a 97 y/o with the same? My husband is into ham radio and he recently heard on the waves that a 70+ y/o is about to receive a heart transplant. I don't necessarily agree with the practice of most transplants anyway, but aren't there young people waiting on the list who would have a better prognosis? I don't work with babies so I can't vouch for what goes on there but I see all the waste on the very elderly and when I see an 80 something year old being rolled into the endoscopy lab while the 40 y/o who can't afford the care rots it just makes me sick.

Or are these some sort of Dr. Mengele experiments going on?

Yes, where do you draw the line?

The wonders of medicine...

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Specializes in Maternal - Child Health.
Calling a living, breathing baby a "miscarriage" doesn't seem right to me. Regardless of whether or not you agree with the measures taken, it's a person and I think that's disrespectful to the families of these children and to the children themselves.

If you want to be specific, even if no interventions were initiated, and the baby died an hour after birth (or a minute, or a day), it would have been a neonatal loss, not a miscarriage. Because technically, if it's "alive" in the NICU, it's at the age of viability whether it "should" be or not.

I work antepartum and many of our mothers have 1st, 2nd or 3rd trimester losses. Some women want everything done at 19weeks (despite having spoken with NICU who assured them that nothing could be done), some are comfortable letting nature take her course with a 25/26 weeker.

The mother of the 19weeker...this was her 8th pregnancy. 1st baby hit by a car age 18mos, 6 (six!) losses, 4 of those being 2nd trimester losses. She had never made it past 16 weeks (aside from 1st baby).

It's such a personal decision, and really I can't imagine that any of us can cluck our tongues until we've actually had to make it.

And c-sections have little to do with maternal age. Look at doctor's fear of being sued in the event of a bad outcome, use of continuous EFM (which has been shown to increase c/s rates without improving fetal outcomes), the medicalization of a normal pregnancy, the refusal of many doctors to perform or attempt a VBAC, miseducation of patients, and over use of interventions/restrictions and you'll get a hint as to why the c/s rate is as insane as it is.

KellNY,

You and I have debated some of these issues in the past with very different opinions. I was touched by this post. Thank you for your well-stated contribution to this discussion!

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Specializes in OB, Telephone Triage, Chart Review/Code.

Are parents given false hope by all the television programs promoting some good outcomes for preterm births?

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