At what gestation would YOU want YOUR baby saved?

[StacyC417]

I have a good friend with a former 24 weeker (540g) who is doing WONDERFULLY. She is now 16 months and is developmentally normal in all areas. I was talking to her the other day, and she was saying that she couldn't imagine NOT saving her little girl. I just think that it is just SUCH a tough decision to have to make...Even though she ended up with a "happily ever after story" SO many of these little ones end up with IVH, CP, BPD, ROP, PVL, NEC and the list goes on. I don't think that I would have been prepared to deal with the *potential* consequences of saving a baby at 22,23, or 24 weeks. The statistics are just too bleak for the majority of these kids.

I would say that I would request no resuscitation before 26weeks/750g if it were my child. What are all of your opinions?

Stacy

[mommy2boys]

My DH and I had to really think about this when I was pregnant with #2. I started having contractions at just under 21 wks. I was hospitalized and treated to stop the PTL. We were prepared for another rough pregnancy (I went into labor w/ #1 at 32 wks and delivered at 35 wk) but not for me having problems so early.

After a long and difficult discussion w/ my OB, family and each other we had made the decision not to do anything if I delivered before 24 wks unless the baby was doing really great by the doctor. I had to live with the fear of delivering a baby that was less than 24 wks for almost 3 wks. From 21 wks until 24 wks I wouldn't accept that I was pregnant and going to have a healthy baby, I had already planned on what I was going to do if something happened.

Thank God I could keep him in until he was 35 wks 2 days and he didn't need any special treatments (except bili lights for jaundice). It was a very scary time for my family and I, but we got through it. If it wasn't for the wonderful nurses and doctors I think that all my worst fears would have come true, but in fact all of my greatest dreams came true.

JMO

Erin

[Mimi2RN, ASN, RN]

I hate to see 24 weekers resuscitated, chances are they will have problems. You never know, though. I had a 34 weeker as a patient, on a vent for a couple of days, extubated and doing well. The parents had 10 y/o twin girls, born at 24 weeks. I asked dad how they were doing. He told me their only problem is asthma! I suggested that he bring the girls in to see the sibling, because WE want to see how THEY are doing!

We don't keep micropremies, they all head on down the road. Some of the ones we get back as growing premies have had grade 3-4 bleeds, or NEC. They may be growing, but will have lifelong problems. Maybe 26 weeks would be a better place to start, unless the baby is vigorous. At least they have lungs, even if they need to be intubated. It would be a hard decision.

[EricJRN, MSN, RN]

In my limited NICU experience, it would be hard for me to quantify a cutoff like that. In large part, I think the expression is true: (gestational) age is just a number. We have 24 weekers who do really well and term babies who go straight down the tubes. Recently on another shift at our hospital, a 29 weeker came out with very hypoplastic lungs and was pronounced after being coded twelve times within six hours. In addition, being a couple of weeks off on your dates one way or the other can make a huge difference in the viability of a premie. As one poster above stated, I think I'd have to be in the specific situation to know.

I'm perhaps not the most objective source on the subject though. I was term, but I was a medical problem child from the start and required numerous surgeries, especially over the first six years. My parents were told that I was guaranteed to have some issues, but the extent of them was not going to be known for a while. I'm glad they didn't switch to palliative care mode simply because they knew there would be issues. Twenty-seven years later, I consider myself to be almost (medically :) ) normal.

[LaNICUnurse]

NICUhopeful87 said:

I was born at 24-25 weeks at 1.10 lbs, in 1987 in Baltimore, MD; and I turned out perfectly normal and healthy. And the fact that I was born so early is one of the reasons I'd like to work in NICU.

You are one of the lucky ones. I see babies everyday that shouldn't have been resuscitated. I believe that the individual baby tells us how to treat him/her by their responses. But, we have to be willing to see what they need even if it is to be removed from support.

So, many times we'll see infants that will remain infants for years, and that is not fair to them. God has given us the power to intervene, but I do not think that gives us the right to, in every case.

Each set of parents has to decide for themselves what is right for their family. But, I think we have a responsibility to give them an acurate picture of what may result.

[LaNICUnurse]

Mimi2RN said:

I hate to see 24 weekers resuscitated, chances are they will have problems. You never know, though. I had a 34 weeker as a patient, on a vent for a couple of days, extubated and doing well. The parents had 10 y/o twin girls, born at 24 weeks. I asked dad how they were doing. He told me their only problem is asthma! I suggested that he bring the girls in to see the sibling, because WE want to see how THEY are doing!

We don't keep micropremies, they all head on down the road. Some of the ones we get back as growing premies have had grade 3-4 bleeds, or NEC. They may be growing, but will have lifelong problems. Maybe 26 weeks would be a better place to start, unless the baby is vigorous. At least they have lungs, even if they need to be intubated. It would be a hard decision.

I agree, the vigorousness of the infant should help to rule the decision. I have seen micro-premies that do very well. They ususally exhibit spunk from the beginning.

[LaNICUnurse]

EricEnfermero said:

In my limited NICU experience, it would be hard for me to quantify a cutoff like that. In large part, I think the expression is true: (gestational) age is just a number. We have 24 weekers who do really well and term babies who go straight down the tubes. Recently on another shift at our hospital, a 29 weeker came out with very hypoplastic lungs and was pronounced after being coded twelve times within six hours. In addition, being a couple of weeks off on your dates one way or the other can make a huge difference in the viability of a premie. As one poster above stated, I think I'd have to be in the specific situation to know.

I'm perhaps not the most objective source on the subject though. I was term, but I was a medical problem child from the start and required numerous surgeries, especially over the first six years. My parents were told that I was guaranteed to have some issues, but the extent of them was not going to be known for a while. I'm glad they didn't switch to palliative care mode simply because they knew there would be issues. Twenty-seven years later, I consider myself to be almost (medically ? ) normal.

What kind of medical issues did you have?

[2curlygirls]

I am saying 26 weeks NOW because I'm NOT pregnant and have 2 healthy daughters. I can't say for sure if the cirsumstances were different.

[smk1, LPN]

My only slightly educated opinion (just a student) is probably 28 weeks if everything has been well to that point. If not maybe 30.

[EricJRN, MSN, RN]

LaNICUnurse said:

What kind of medical issues did you have?

Myelomeningocele. Fortunately it was low on the spine. Had my share of shunt surgeries and other hospitalizations. They couldn't predict whether I'd be a walker or non-walker until I actually walked.

[hica19]

During my NICU preceptorship, I have seen one baby born at around 34 weeks or so that came out almost dead. Cause was a placenta previa and I think the surgeons had cut a little bit of the placenta during the c-section to get to the baby. Apgars were 3 and 2. Took a long time to recuscitate the baby in the OR before the baby was stable enough to move to the NICU. What seemed really bad immdiately after birth turned into a very stable case the next day. Was ventilated but the nurse assigned to the baby said it was doing well. Then about a week and a half later, I got assigned to care for the baby. By then, the baby was off everything. No vents, no lines...just a regular grower and feeder.

[danissa, LPN, LVN]

Saw a programme on TV about practice in Holland where they don't actively resucitate less than 25 weeks. Makes you think. Have just done two long days looking after a tiny babe born at 24weeks. so precious to her parents after a totally awful obstetric history. she was 16 days old today, finally tried on oscillation from yesterday, but it's just not working. She's so sick and you can see she's just so tired. Needs 100% FiO2, just to achieve sats of 80%! had 6 infusions going, her skin is breaking down when you touch her, she must be in such pain even with the extra morphine.

shes paralysed with vercuronium, needs dopamine, her BP is so bad, everything is closing down on her. We called the parents in today, have a fab consultant who is so humane in his approach and he discussed( tried to recommend for her sake!) letting her go. Her poor wee mam is so opposed to withdrawing any treatment, she keeps saying that she has fought this far, she will make it. This wee babe has whiteout lungs, H+ of 100.4, and pCO2 of 10+. She also has grade 3&4 bleeds. I find this so sad, I'm home tonight and thank God I don't have to go in tomorrow, this is selfish I know, but I think another day of this babes suffering would floor me. The question is why did we start treatment in the first place for one so young, her parents have this thread of hope, she's fought this far therefore she will make it! It's so sad, I will need to phone in to work tomorrow to find out what has happened with her. You cant help but be attatched can you? I know we sometimes see the miracles, but at 24 weeks, with all this suffering who are we keeping going for?

[LaNICUnurse]

EricEnfermero said:

Myelomeningocele. Fortunately it was low on the spine. Had my share of shunt surgeries and other hospitalizations. They couldn't predict whether I'd be a walker or non-walker until I actually walked.

I am very glad that you did well. Especially as early and small as you were.