Oppinions Please on 27 Weeker

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Hey everybody,

I have browsed your threads a few times, but I work in adult ICU so I'm not in the know about the teeny babies. I have a family situation though that I'd like your thoughts on. My sister in law is pregnant 27 weeks gestation. She started leaking amniotic fluid about 22-23 weeks. She's been seeing high risk OB weekly and has been hospitalized twice so far. About two weeks ago, she got put in the hospital until she delivers b/c she continued to leak amniotic fluid so she and the baby could be monitored more closely. The started her on prednisone to help the baby's lungs, his chest is growing, HR is strong and a good rate, he's active and gaining weight, so all seemed to be going well. Her leaking had also slowed down. Now, a couple of days ago she started bleeding, and the docs are talking a C-Section. I have already started trying to prepare the family for the possibility that the baby will be very sick b/c of lungs/organ/immune system not being fully developed plus the stress of coming out of the uterus so early.

My question is based on everyone's experience, how do these early ones usually do? I know it probably varies widely in respect to mom's history (healthy 1st pregnancy no medical hx on mom or family to complicate things), how delivery goes, unusual complications sometimes after birth, etc. I'm just trying to get a feel for what to expect. I've been anticipating he'll be in NICU at bare minimum for 2-3 months-is this about accurate? I also think if I remember correctly that 24 weeks is considered viable, but I know the longer she can be held off the less the risk of morbidity/mortality for the baby. I think part of the concern also is that the docs can't agree on exactly what it going on. One says possible infection-but blood work supposedly not showing any infection is what they told her, one says he thinks she's possibly abrupting her placenta-makes most sense to me since she's had lot of bleeding/abdominal pain, and the nurse says she thinks it is just plain old pre term labor.

I would really appreciate hearing any experiences you've had with these babies either good or bad. Thanks!

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Specializes in NICU.

Can't really give any medical advice, but I wanted to say I hope everything works out ok for your sister and her baby ..... they'll be in my thoughts and prayers.

It's so hard to say because each baby is so different. Some 27 weekers that come in don't even have to be on the vent, they just go straight to NCPAP. Then others are vented from the beginning and they still can't get them off the vent for months to come. Yeah, 24 weeks is "viable", but I don't think the majority of them do all that well. Of course there's the exceptions that survive with no complications, but that's not the norm. But you say your sister is 27 weeks now, that's a lot better than 24!

Expect him to be in the NICU at least until his due date.

I wish you and your family all the best, keep us updated!

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We have a baby! He was over 2 lbs, but he did have to be intubated and on "high vent settings", which they told us was not unexpected. Mom is doing great, glad it's all over. They've decided now she was abrupting, so it's a good thing they went ahead with the C section. We're just hoping now everything will turn out okay with the baby. I had a couple of other questions though. I know in the adults, we usually start talking a trach to pt/family if pt can't be extubated by 10-14 days, is the same timeframe for trachs typical with the premies? Also, if I remember right, I don't think it's that uncommon for the premies to get extubated and end up reintubated is it? Thanks for your reply.

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Yes, it was a very good thing that the c-section was done, because if she'd completely abrupted, things could have been so much worse!

As the above poster said, 27 weekers can require intubation or CPAP, it just depends on the kiddo....and some of them who start on CPAP end up getting intubated because they wear out on CPAP. The key here is, be patient and take things one day at a time. The baby has the benefit of prenatal steroids, and it sounds like mom had good prenatal care. Encourage mom to start pumping and storing breastmilk, these little tykes really need that for when they start feeding. They will start with very low amounts of feeds (like 5 cc's) and build up, but mom needs to establish her supply. Also, when the baby is stable enough, encourage her to do kangaroo care (skin to skin contact that is SO beneficial for baby's growth and development as well as bonding).

As for the trach question....in our unit, trach's are the exception, not the rule...the only kids that get trached are those that cannot be extubated with multiple trials (Usually 3 months or so old).

Congrats again, keep us updated on the progress.

Jamie

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As raindreamer already mentioned every 27 weeker is different so it is hard to predict how he will do. He does have a long road ahead of him, but survival rates for 27 weekers is very high. As far as the trach question goes it is not common for preemies to be trached these days. The preemies that do get trached these days are ones that have really bad chronic lung disease and they just can't get off the vent, or they have developed an airway anomaly. Most 27 weekers will wean from the vent successfully, although some may have to go home on home oxygen via a cannula. Some preemies are intubated for 3 to 4 months without being trached. Also regarding your question about preemies not being reintubated. Generally speaking once the preemie is extubated they usually go to cpap or a nasal cannula, but it is not uncommon for them to be reintubated because they just weren't quite ready or they had some other sort of set back such as NEC, sepsis, etc...

Good luck and keep us updated!

You can go to the march of dimes website and they will have lots of helpful info. that is family friendly or you can go to neonatology.org and get more indepth info.

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Specializes in NICU.

Congrats to you and your family on the new baby!! :)

It's not surprising that he had to be intubated at first. But they most likely put surfactant down the ETT. Surfactant is a great thing!

Congrats again!

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Sadly, the baby did pass away this morning. They told the parents his lungs were too stiff and he couldn't be ventilated well enough to get oxygen. It has been a long couple of weeks for the mom, but I just wanted to tell everyone on here thanks for your replies. The job you do really helps parents through this difficult time. They were allowed to hold the baby as he went, and all of the nursing staff were nice and very compassionate, it makes this time much easier to bear with caring faces. He was perfect and so beautiful, I guess it just wasn't enough time for him to be ready. Thanks again everyone.

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Wow! I'm speechless! I'm so sorry to hear that. I will say a prayer for you and the babies parents.

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Specializes in NICU.

Maybe he had hypoplastic lungs from the reduced amniotic fluid.

I'm so sorry.

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Maybe he had hypoplastic lungs from the reduced amniotic fluid.

I'm so sorry.

That's exactly what they said was the problem. His lungs were stiff and couldn't get ventilation. They tried two different vents but couldn't keep his sats up. At least mom is doing fine, they have offered them grief counseling and they are going to go when they get out of the hospital and things settle down. They at least got to tell him good bye and took pictures of him.

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Specializes in NICU.

Wow. I'm so so sorry to hear this :( You and your family will be in my prayers.

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Sorry to hear about your loss. I will keep you and your family in my prayers.

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