Preemie resuscitation in regards to gestational age

fergus51 · Oct 29, 2005

Our hospital seems to go as far as they can. If the baby is big enough to be intubated, they'll try. Usually under 22-23 weeks is their official cutoff. Those kids generally have extremely poor outcomes. I generally think aggressive resucitation before 24 weeks isn't a good standard policy. There are always exceptions, but most of those babies seem to just suffer incredibly.

prmenrs, RN · Oct 29, 2005

I agree w/Fergus. The 22-23 wk range is when the babies lung start developing alveoli. Before those are present, there's not much point in trying to ventilate--no way to get the good air in and the bad air out. 23-24 is too hard to make a strict rule. Lots of variables. Prenatal care, life style (substance abuse, nutrition), infections, whether Mom got tocolytics, steroids to help stop labor and promote lung development.

Gompers, BSN, RN · Oct 29, 2005

I believe our current "cut-off" is 23 weeks or 400 grams. We've had a couple that might have only been 22 weeks but were 500 grams, and others that were 300 grams but like 26 weeks or so...

Of course, you'll always have the doctor that thinks he/she can save ANYTHING and the parents who want EVERYTHING done, even if a baby is clearly not viable. On the other hand, there are some docs who are very humane and parents that are very realistic, and I've seen some small babies allowed to just be held by their parents instead.

sunnysideup09 · Oct 29, 2005

We make it a standard 24 weeks. We don't get into the weights because who can honestly tell at the resuscitation how much the baby weighs? We have great success with 24 weeks with low mortality and morbidity. We have yet had one survive at 23 weeks....we use to try but without success we decided it would be best not to. Having the standard of 24 weeks puts everyone on the same page...if a parent insists that we resuscitate for a 23 weeker, our MD will tell the mom she will need to be transferred to a children's hospital. The closest is 1 1/2 hours driving time.

Christine, RNC, BSN

Finallyat40 · Oct 29, 2005

We recusitate at 24 weeks, and if they're 23 weeks and try to breathe at birth, we sometimes will, however, we haven't had any successful outcomes with 23 weekers that I can remember. 24 Weekers are still a crap shoot, but we have fairly good outcomes with these. I think there's a weight requirement, but we tend to go by the gestational age.

Jamie

SteveNNP, MSN, NP · Oct 29, 2005

We will resuscitate to 23 weeks/450 grams. If we know a 23-24weeker is inevitable, our neonatologist will usually do a consult with the parents to discuss outcomes and viability. Most parents will want to resuscitate a 23 weeker, but they always usually have very poor outcomes, and end up dying after a week on the vent. It's really hard on the staff, to perform all those procedures, only to prolong the baby's suffering. Sometimes we just pray that the baby will go to the only place he can be well: heaven........

scampi710 · Oct 29, 2005

to all of you in nicu.....i don't know how you do it...your specialty is so intense and incredible! god bless you all.

rainbows4me · Oct 29, 2005

We use 23 weeks and 400 grams as a cut off. Our outcomes with 23 weekers (23 and change) have not all been bad, but certainly the majority of them do not survive without major problems along the way, if they survive at all. We did recently have a 23 weeker who was on cpap at 1 week - crazy. The jury is still out on this baby's final outcome, but for now it looks good.

iceNICUnurse · Oct 29, 2005

We have a 24 week policy but it has happend that we tried to resuscitate a 23+some days with mostly bad results.

But it all comes down to the neo on call this is not really a written policy.

tiggerlover · Oct 29, 2005

Technically we are suppose to resuscitate 24 weekers plus, however if the baby is less than 24 weeks and has a heart rate at all then it will to intubated etc regardless of either gestational age or weight. In my experience the poor baby doesn't survive but like previous posts it depends on the Doctor at the time. Some are unable to let the baby go although clearly it is in the baby's best interest. Somes Doctors feel by keeping the baby alive for a while it gives the parents time to come to terms with it. I personally feel a baby with a very poor outcome and quality of life should be allowed to go, cuddled by the parents or nurses if the parents don't want to hold them.

sparkyRN · Oct 31, 2005

No set-in-stone protocol--usually any 23+ weeker with a HR will get intubated. It may not always be the best thing to do, but it's hard not to give them a chance, esp. if they are active, with decent HR and trying to breathe. Those of you that have been around awhile like me have seen more than a few babies that were supposed to be 22 weekers but were really SGA 24 or 25 weekers that ended up doing really well.