"Never trust a 35 weeker"

Specialties NICU

Published

Specializes in NICU, Infection Control.

What in the world does she mean????

I get asked that a lot.

35 week gestation premies (either newly born, or finally after 4-5 weeks of nicu stay) frequently act like they know what they're doing. They stay warm in an open crib, they've learned how to eat, they've even learned to breathe on a regular basis. They're gaining wt., and they're cuter than just about anything on the planet. Mom and dad are bonded, providing care, breastfeeding. (Well, maybe not dad.)

Don't trust them! and try not to let anyone send them home!

In a heartbeat, they can remember that they're only 35 wks, and, by rights, they don't have to know how to do any of the above. They can get cold, have residuals and have apnea of prematurity, get septic, even die.

As long as you remember they're not trustworthy, you won't completely relax around them.

Gompers, dawngloves, krvrn, and all the other experienced nicu nurses--what do you think?

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Specializes in NICU.
Gompers, Dawngloves, KRVRN, and all the other experienced NICU nurses--what do you think?

I agree! It's such a weird gestation - they can either act premature or full-term, yet underneath it all, they DO have premature lungs, guts, brains, and immune systems...

I've seen quite a few 35-week gestation babies do some horrible things...

Getting NEC in step-down and dying in 12 hours.

Suddenly getting so septic in step-down that before we can physically put the baby on a radiant warmer and move him/her to the ICU, there is a code situation.

Room air, taking all PO, in step-down, getting ready to go home...and then deciding to stop breathing, then aspirate during a feeding, requireing a full code.

Doing extremely well, getting ready to go home, then going to OR for a "routine" hernia operation - and ending up coding in the OR, then being on the vent in the NICU for another week, on pressors and steroids.

The other side of the coin - a newborn 35-weeker in RDS who should be cured with a dose of surfactant, but ends up acting full-term and goes into full-blown PPHN. You never know what to expect with that gestation!!!

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Specializes in Nurse Scientist-Research.

First off, I agree with prmenrs though I'm not the an experienced NICU nurse like some here. However, our unit regularly sends home infants whose adjusted ages are 33-34 weeks (usually they've been there several weeks to get there). Now, I'm not sure the gestational age is accurate (whose really sure about those anyway except IVF babies?) but according to the MD's documentation that's their age.

We are supposed to admit all infants

Once more, though I agree with the 35 week thing, I feel better when we keep them a little longer, but those poor kids get pushed right out the door.

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Specializes in Neonatal ICU (Cardiothoracic).

OMG, you are so right....I didn't know what you meant until I started off orientation in NICU. Can't tell you how many times we get called to L&D for a blue, limp 35 and "change" weeker. Personally, I don't relax until I put that baby in his corificeat and shut the car door. We recently had a feeder go ragingly septic with positive fungal B/C and die within a few days. NICU is so unpredictable. That's what makes it exciting and absolutely terrifying at diffent times.

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Specializes in Retired NICU.

Ditto! I'd rather admit a 34 wkr than a 35 wkr any day. Those 35 wk babies can be the sickest in the unit...

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Specializes in ER, NICU, NSY and some other stuff.

I have always said they are really good babies or really bad ones. There just never seems to be an inbetween for them.

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Caring for the Near-Term Infant is an AWHONN Initiative that is addressing the issues and needs of babies born between 34-37 weeks. There are some good articles about this in Lifelines publication aug/sept 2005 and dec2005/jan2006 issues. It addresses many of the problems already stated and more.

:yelclap:

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Specializes in NICU.

We had a little one born at 33 weeks, mom was PROM at 26 weeks, had steroids, bedrest. As soon as he was eating and warm in a 72 degree nursery, he was sent out the door, barely 35 weeks. Came back to Peds 3 days later as a popsicle child, with a rectal temp 95.3F in the doctors office. Silly parents treated him like a normal newborn and took him shopping!

We tell them to keep them home, but the parents just don't listen. It's RSV season, too!

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Specializes in NICU.

And you have to beware of those IDM 35 weekers that LOOK like a big term baby... they are NEVER trustworthy.

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Lifelines is also indexed in International Nursing Index, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and MEDLINE.

I hope this information helps.

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Specializes in NICU, Infection Control.

It's nice to know that the motto I've been using for >10 years has actually been now validated by someone w/"credentials". It'll be interesting to see what they wrote.

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Thanks for the explanation prmenrs. I've seen that in your sig and wondered about it. I kind of had the idea of what you were talking about, but it helps to know in detail what you meant by "never trust a 35 weeker." :)

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