At what gestation would YOU want YOUR baby saved? - page 4
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... Read More
Jun 23, '06Joined: Dec '05; Posts: 217; Likes: 45Quote from LaNICUnurseThis is exactly the case with one of my home health patients. He is missing part of his 9th chromosome, and has medical problems from head to toe. He is 20 months old, but cognitively/developmentally about 4 months. He has had multiple surgeries, and still needs 3 or 4 more. Mom says that she needs to do everyything she can for him, so that if he does pass away, she will have no guilt. What an exhausting 20 months for her, of no sleep, multiple hospitalizations, etc. Her poor kid has been through SO much. From the outside looking in, I think I would have let him go, but knowing how much I love MY son, I understand her motivesThis is the type of case I always picture when I think of a <25 weeker. However, I have seen some true miracles made. God is truly in charge of however the infant ends up. He has a reason for this child holding on for its parents, and eventually, they will be able to come to terms with the results. The reason, may be for these parents to live with the knowledge that they did everything possible for their child, even with the eventual demise.
Jun 23, '06Occupation: Nurse Educator Specialty: 13 year(s) of experience in NICU ; From: TX, US ; Joined: Nov '05; Posts: 8,750; Likes: 1,692Quote from LaNICUnurseActually I wasn't early or small, but I still had serious problems. I know this is a thread about premies, but I was just pointing out that I was disturbed by a trend I saw on the thread (I know it's an old thread) - the notion that people would not want their babies saved because their, say, 28-30 weeker might have problems. Any baby might have problems - in fact, many babies are sure to have problems. Doesn't usually mean we should withhold treatment though. There are clear instances where things go overboard (reference my previous post about the baby who got CPR 12 times) and we have to know when to let go, but I just don't think we can make blanket statements about many conditions or gestational ages.I am very glad that you did well. Especially as early and small as you were.
Jun 27, '06Joined: Oct '04; Posts: 5,969; Likes: 1,404I'm really glad someone bumped this thread up ..... because I've been thinking about stuff like this A LOT lately.
I'm new to the NICU. I'll be starting my last week of a 12-week orientation .... so I've only been in the NICU for about 3 months. BRAND new.
I haven't been in the NICU long enough to really see how all these babies turn out. I haven't really had the chance to see a 24-weeker that has done well. I asked my preceptor if they ever do well, with minimal problems and she said yeah, but that's the dilemma .... so many of them do have problems if they even survive, while occasionally some do very well with no problems.
2 chronic kids stand out in my mind, vividly. I'll never forget them. 1 of them was a previous 24-weeker, born back in November. He had bilateral grade IV IVH, hydrocephalus, etc ..... many problems. I don't know all of them because I never had him for a patient, but I was in the same pod as him a few times. Very sad. He ended up with a trach. The parents wanted everything done. Eventually they were able to talk the parents into signing a "partial DNR". It meant that they could re-intubate, but no code meds were to be given if he coded. When they changed his trach, he coded and died. He'd been on the unit for like 6 months so it was obviously a big blow to everyone. But overall everyone felt relieved, for this poor baby and thanked God that he was no longer suffering. My heart broke for those parents.
Another previous 24-weeker I did take care of ..... a couple of times. Born back in December or January. They trached him too. The first time I took care of him he was actually off the vent. The last time I took care of him though he had the trach. Just got worse and worse. He's got all kinds of fungal infections, the trach ties are already breaking his skin down ...... it just broke my heart Why are they putting him through all of this?!?!
I know there are cases in which these micropremies do well, but from what I've seen that's not how it is in the majority of the cases. I know I'm still new and haven't seen a lot. I don't know what I would do though if I had to make that decision. It just seems like the odds are not good.Last edit by RainDreamer on Jun 27, '06
Jun 27, '06Occupation: SAHM, for now. From: WI, US ; Joined: Feb '04; Posts: 2,574; Likes: 322When I was in school getting my speech path degree, we worked and talked a lot about babies in the NICU. We had this discussion about parents who wanted everything done on a 450g baby, and those who didn't want to resuscitate anything under 30 wks.
There are some parents who say, "DO EVERYTHING!" and some who take the "wait and see" approach. Parents are educated on everything that might happen because they don't expect it to happen. Everyone wants a normal pregnancy and birth, and they don't read about those who are born at 24 wks and have grade IV bleeds, ROP, NEC and everything that goes along with it. Usually, all the parents hear about is the occasional 24 weeker that made a miracle recovery and believe that's the norm.
Since I've worked in L&D, I've seen a 33 weeker who I thought had a chance. She was born at 33wks, +3 pounds. She was initially on room air, and thought to be doing great. Next time I came in I checked on her, and she had passed away 10 days later d/t viral pneumonia.
As someone said, the NICU has the most gray areas of the hospital and it's very hard to predict what can happen.
For me, personally, I wouldn't want anything done on a baby <28 weeks. I say that now, but if I were to get pregnant, it would be a miracle, and would I really stick to that knowing this would be my only chance at a baby?
Very hard decision. Very hard.
Jun 27, '06Joined: May '05; Posts: 67; Likes: 10I was a 26 weeker in 1980.All I can say is thank goodness my parents wouldn't let me go, despite some of the 'advise' they got. I will be 26 years old soon and there isn't a thing wrong with me. I think this sort of thing should really be a case by case basis, but even then.. how do you know? Nobody expected me to make it, so what if my parents had listened and let me go?
Jun 28, '06Joined: Oct '04; Posts: 5,969; Likes: 1,404Quote from Cherry2That's the thing ..... no one knows how it's going to turn out. I agree with everyone that it has to be a case by case basis, depends on the circumstances, etc. Yeah there are micropremies that turn out just fine with no problem, but there are SO many (the majority) that don't.I think this sort of thing should really be a case by case basis, but even then.. how do you know? Nobody expected me to make it, so what if my parents had listened and let me go?
If 1 in 100 micropremies turn out just fine with no lasting effects, then it is worth it to try and save all of them? Before working in NICU, I would have said "yeah, sure". But now, I'm not so sure. Seeing all those chronic kids, suffering so badly ..... really changes my perspectives and thoughts on a lot of things regarding issues like this.
You don't know how the baby will turn out .... if they'll have to suffer .... wind up trached and live off of tubes forever. There's no way to know.
Sorry if this sounds heartless, these are things I've been working through ever since I started in the NICU a few months ago.
Jun 28, '06Occupation: RN-Retired Specialty: 27 year(s) of experience in NICU ; From: US ; Joined: Jul '02; Posts: 1,400; Likes: 163We sent almost 24 week twins out (we don't keep the tiny ones). Heard they are doing well, no big bleeds, and nothing bad has happened.....yet. It's a long haul for little ones like that. If they do well, we'll get them back as growing premies in the next few weeks.
I don't like to see babies that size resuscitated, but maybe these two girls (of course) will be OK.
Jul 1, '06Joined: Feb '03; Posts: 1,717; Likes: 424I'm not a NICU nurse, but a peds floor nurse and we get a lot of kids with many chronic problems who are "NICU grads", one of whom died about a month or so ago after spending almost all his 14 months in and out of the hospital (much more in than out), and it's so hard to see all their suffering. But then there are some kids who come in with just some random illness unrelated to prematurity, seem perfectly normal and their parents mention they were born early- those kids seems like were usually never less than 30-32 wks though. Of course I guess I don't ever see the ones who go home and do fine or almost fine and never have to come back to the hospital. I agree there are many many gray areas. As a parent I think I would want to try to save my babe at first, and then see how they did after that. As a nurse I am very conflicted- I've always been raised that every life is sacred and I do believe that wholeheartedly. It's worth everything to try to save a child. But then some of the suffering these babes and their families go through is heartbreaking. It's so complicated I don't think there are any easy answers no matter whose perspective you take.
Jul 1, '06Occupation: NICU Nurse Specialty: NICU ; From: CA, US ; Joined: Oct '04; Posts: 611; Likes: 45Like some others, I think it is different when you are actually in the situation. I was in PTL with both of my pregnancies, but when I was dilated to 2, 90%, fFN+ at 23+5 with my son and hospitalized, I actually had to have "the talk" with the doctors, because they didn't think I would be pg much longer. We decided 24 weeks as our cutoff.
I'm surprised by the number of people who are saying that 28-30 weeks would be the cutoff for them personally. Yes, they typically have a shorter and easier course through the NICU, but many many 26-27 weekers now are doing incredibly well.
Jul 3, '06Joined: Sep '03; Posts: 148; Likes: 10My son was a 27weeker( 880g). membranes raptured at 26+4days and we sat in bed talking to each other. I said just make it to 27weeks and we see from there. And boy the morning at 3.59am when he was 27weeks he said im outa here. And I know the stress and the worries coz i am PICU and NICU trained. Only God worked the miracle. Its hard unless you have walked the road to say I know I will do this if it happens to me but when push comes to shove, often times one is not sure what to do.
I have seen how damaged and how much these babies go thru even with my son he was on SIMV for 48hrs then NCPAP for weeks and only came off oxygen 1day before his due date and its not easy. I do not know what i would do if I had a baby less than 27weeks though.
Jul 21, '06Occupation: Graduate Nurse From: US ; Joined: Jul '06; Posts: 172; Likes: 89Quote from NICUhopeful87I was born somewhere around 26 weeks (according to my mom) and I weighed 3lbs 2oz and that was 1984. I have had no problems whatsoever, besides staying in the hospital for 3 months. I don't know how I would ever make a decision like that.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.
Jul 21, '06Specialty: NICU ; Joined: Nov '03; Posts: 3,768; Likes: 252Quote from mindyg22That's very big for a 26 weeker. Usually a baby of that gestation weighs about 1.5 to 2 pounds at the most. A 30 weeker is often around the 3 pound mark. Maybe her dates were off?I was born somewhere around 26 weeks (according to my mom) and I weighed 3lbs 2oz and that was 1984. I have had no problems whatsoever, besides staying in the hospital for 3 months. I don't know how I would ever make a decision like that.
Either way, I'm glad you did well!!!
Jul 22, '06Joined: Jul '00; Posts: 11,351; Likes: 385I'm glad you pointed that out Gompers. I hear about a lot of 24 weekers who weighed 2-3 lbs at birth. I'm always a little suspicious, but glad they did well regardless of dates.