the oldest baby in your level 3 nicu

littleneoRN · Jul 29, 2009

Our "policy" is 12 months. However, if we're short bedspace, the older chronics 5+ months are often moved to PICU or a peds floor as appropriate to make space. Or sometimes we just feel those areas can better their developmental needs as they get older. I haven't been around all that long, but I've seen some kids discharged home about 10 or 11 months old that never got moved to peds.

babyNP., APRN · Jul 30, 2009

9 months and two 6 months old. It's pretty ridiculous, IMO...

TiffyRN, BSN, PhD · Jul 30, 2009

I remember an 8-9 month old that expired in our unit after too many close calls to count. The oldest child I remember personally was a 23-24 weeker who was around 9 months old. He was huge at well over 20 pounds which would have been large for a 9 month old born at term much less 16-17 weeks early.

The 25+ year nurses tell us that pre-surfactant they used to keep infants past their 2 year birthday d/t horrible lungs. They would be trached and spent much of the day toddling around the unit in those questionable infant walkers. I guess back then they didn't send kids home with trach's whereas it is done today.

We have a children's hospital across the street but are told we cannot transfer infants there unless there are physician services there we cannot provide at our hospital. Which means we only routinely transfer over diaphragmatic hernias or complex heart defects requiring surgery soon. Both are d/t extensive surgical needs and all pedi surgeries are done across the street.

We get speech & occupational therapy involved with the "older" kids but we don't have the play & child life specialists that the children's hospital has. We try to get those kids up during the day and in an area that has sunshine so they can establish a more "normal" day & night schedule.

NeoNurseTX, RN · Jul 30, 2009

We've had a few over 1 year.

BittyBabyGrower, MSN, RN · Aug 4, 2009

We've had first birthday parties in our unit. Once they hit that year mark, they need to go to peds....we tend to treat their ailments like they are neonates, not the peds patients they are! Esp the PPHN kids....they need to go to PICU and be managed there.

dawngloves, BSN, RN · Aug 4, 2009

We don't have a peds unit. Sometimes our parents refused to have the baby transferred out when they get older. This was the case with a mom of a 24 weeker. That kid was with us for 11 months. Couldn't get her off the Vapotherm until then.

dawnebeth · Aug 14, 2009

We now tend to have them out by 6 months or maybe 9 months (although we recently readmitted one of our old chronics and I don't even want to know how old he is. Surely his birthday is coming soon.)

However, in years past we kept them, as one poster mentioned, until their second birthday, for a variety of reasons, not just trachs. When I started in our unit in '88, we had an 18 month old boy who was transferred to the floors at age two and stayed there until he was four.

In '95, I had a primary who stayed until he was 23 months old and then did go home with lots of nursing care. In the mid '90s, we had lots of babies over a year, because there was no care facility to send them to at the time, but there is now.

Dawn

premienurse · Aug 18, 2009

Our kids very rarely get transferred to PICU. They usually discharge to a LT Care facility if they are unable to go home. I think 15 months was the oldest.

littleneoRN · Aug 18, 2009

Hmmm...interesting. I don't think we ever discharge to a long-term care facility. We keep them until they can go home with home care if necessary. So our chronic trach-vent kind of kiddos go home with round the clock home care. I don't think we have that kind of facility anywhere near here. What kind of babies are ready for that type of facility but aren't ready for home care? Just curious.

dawnebeth · Aug 18, 2009

We frequently can't get round the clock care for most of our babies, so some go to a full care facility. Babies with doubtful viability--like some severe brain damaged babies, as well as babies whose parents aren't quite as trustworthy to care for them as we'd hoped. In several cases, the babies did eventually go home to their parents after more training. Some died, but one was still alive and doing amazingly well three years later. It's always incredible to work with these babies!

Dawn

littleneoRN · Aug 18, 2009

Interesting. We have a unit dedicated to longer-term, chronic care kind of kids in our hospital. And there they stay until insurance and the home care agency have worked out getting nurses hired and trained. For babies with doubtful outcomes, we have a neonatal hospice program that will transition them home with home care. And the less than trustworthy parents, their babies eventually go to medical foster care. I don't know that we would have success with insurance paying for LTC in that situation. It's so interesting hearing how things are different other places.