Preemie survival rate question - page 2
Am working on my lecture about premature babies. Thanks, by the way, for all your help with transcutaneous oxygen pressure monitoring, pulse oximetry, ABGs vs capillary blood gases. Now I have... Read More
Jul 31, '03Krisiti,
I could agree more with your concerns regarding viability. We recently had a 13oz kid, who now a month later is dead. I can't help wondering if we are really doing these families justice by saving these severe preemies. And my questions is, if these micro preemies do live, will they be normal neurologically. The 23-24 weekers in my unit are not making it. I am seeing more success with 25+ weekers. My hospital also has an ongoing lawsuit regarding a 23 weeker they saved that the parents didn't want saved. The kid is now 6 years old, but she can't walk or talk. They did a story about them on the news and basically they show this drooling spastic kid rolling around on the ground. The parents simply stated "this is not the kind of kife we wanted for our child." So who's right and who's wrong? Do the parents have the ultimate say? Or does the hopsital ethics committee make all the rules?
Jul 31, '03A 75% survival rate for a 23 weeker? 25% for 22 weeks? I find that hard to beleive! I have seen one 24 weeker surviv oon my unit in the past year and a half and we won't touch 22 weeks.
Jul 31, '03I just don't know if I personally agree with attempting to intervene with most 22+/-days weekers. I realize that it's a very fine line between absolute viability and being completely incompatible with life, and I will continue to do my job to the best of my ability and support the decisions of the families in whatever way I can, but IMO, it just seems that the extreme preemies like this are simply not "healthy" babies when they are being d/c'd, at least not those I've had the experience to work with. Severe ROP, BPD, multiple 4+ IVH's, NEC, spastic muscle disorders, the risk of severe learning and developmental disorders, etc.- much of which we don't even *see* because we never see these babies post-d/c. Certainly not every baby suffers from these developments, and I'd love to meet a family with a child who didn't, but in my extremely limited experience, I have yet to meet a single child like this. It's extremely disheartening to me, especially because I feel so passionate about the work that we do in the NICU. In my current facility, so often the mothers have received no PNC and have no idea of the possibility of disability or death in their children when they go into extreme pre-term labor. They do not have much of an opportunity (if any) to discuss intervention plans prior to birth, the babies come out, interventions are begun, and then the decision is made for them by the team and by state and federal law (re: withdrawing care after a certain threshold).
Jul 31, '03Ethical issues always will exist in the NICU....how far should we really go? With equipment becoming more advanced...and smaller.....how much smaller are we going to resuscitate? I mean, we all know you can't do much with a 2.0 ETT....not even a 5fr feeding tube fits in there....which all some of our smallest preemies can fit between those tiny little vocal cords. What scares me the most, is some neo's are basing resuscitation efforts on if the infant is born with "signs of life" such as gasping respirations, heart rate, etc. BUT...even 16 week fetus that are spontaneously born sometimes come out gasping and we all know that the heart is first to beat at 6-8weeks of gestation, and takes quite a long time to stop beating after a baby is born. I think in almost 10 years I have yet to see a baby born without a heart rate....completely no beat in a one minute count....unless it was still born. It may be 2 beats or one even in that one minute count, but there is a beat. I have taken kids off ventilators, given MSO4 and let their mama's hold them while they passed and some took as long as 6 hours to completely be asystolic! Where are we going to draw the line? I don't know.....ignorance is bliss in the NICU.....because like Kristi said, we don't take care of them once they leave the NICU....our job is done....and that parent's job will never be done.....this will always be an ongoing issue for NICU staff.....all we can do is be HONEST with the parents, tell them what to expect, and do the best job we can to preserve the quality of the lives of our patients.
Jul 31, '03These statistics came from our chief of Neonatology. I did not personally crunch the numbers. I know that it is not the norm for 23-24 weekers to die any more, when we first started resuscitating 23 weeks, most of them died. The survivors are not all drooling, spastic children.
You can believe these numbers or not. I certainly don't have any agenda in posting them, other than for general interest. I stand by my statement that as technology and understanding of how to manage these infants improves, we will have better outcomes. We have certainly seen this in our unit.
Jul 31, '03LANurse, the statistics you posted were from your own unit? If so, that's a wonderful outcome probability for your babies!
Jul 31, '03In our quest to find the most recent statistics, I also found these on emedicine.com. The article had been updated in October 2002.
11.6% for birth weights <500 g
50.7% for birth weights of 500-749 g
83.9% for birth weights of 750-1000 g
Jul 31, '03I'll have to find our stats, but I know that our survival rate isn't that high for 23 weeks. No, not all 24 weekers are gorked out, but the majority of them have some sort of impairment, whether it is blindness, CP, PVL, etc. We see them up on the comp peds floor....and it isn't pretty. Kids that we send out that we THINK are going to be fine end up with GT's and some nasty neurological things, but then again, some kids that we thing are going to be bad aren't. There is no exact science with preemies.
We had a severe IUGR last year...she weighed 12 oz at birth and went home perfectly fine. She was 27 weeks
There is such a fine line with those little ones....the thing that our ethics and legal say is that we just can't pull the plug on a kid...once they are stable. We do consults and the neonatologists go and speak to the parents and then they sign a consent for treatment. And they don't really paint a wonderful picture for the less than 24 week kids....they lay it on the line. People just don't know any better and they just want their baby. It is after that I have had many parents say, I wish we would have done nothing. But, you can't just pull life support when they want. And that is so sad.
I think that the media, such as magazines, paint this rosy picture about some of these kids....they only have the good ones, not the bad ones...I think it was Ladies home journal or one of those that had preemies in it. All I could think of was, well, why didn't you interview the parents that have the devastated kids?
Jul 31, '03Thank you for the information and different perspectives... who knows what technology is right around the corner and the edge of viability will be pushed back even further?
Aug 1, '03Originally posted by LANurse
These statistics came from our chief of Neonatology. I did not personally crunch the numbers.
If I've seen one 24 weeker in my level III university NICU, I've seen a dozen and I can think of two that went home, with deficeits. I have seen maybe two 23 weekers and the only reason they were resustitated was bad dates. They lived a week, tops.They don't even call us for 22 weeks.