Premie vs. "Miscarriage"

TonyafutureRN · Dec 30, 2003

True, most babies do have permanent problems, but not all. I know a lady who had a 23 1/2 week baby and her little girl has no long term problems. When my daughter was born at 33 weeks they told me to expect her to not be able to nurse, to stay in the NICU for a while, and to have underdeveloped lungs. But she came out hollering, nursed like a champ, and the NICU team said she could go straight to the reg. nursery. We both went home 2 days later. It just goes to show you, you never can tell.

dawngloves, BSN, RN · Dec 30, 2003

I can't think of anyone off hand that I've cared for less than 25 weeks that didn't have any residual problems.

I know if I delivered a 24 weeker, I would sign a DNR form. I hate the things we do to those poor babies and only about 25% of them pull through and have some problemn or another. Sent two long term vent micros in the past two months to get trached.

Tony, where I work we'd at least keep your baby for 7 days for a sepsis rule out.I'd fall over if we sent a 33 weeker home with mom!

TonyafutureRN · Dec 31, 2003

They never said anything about sepsis when they sent us home. The dr said the baby was nursing well, eliminating well, keeping up temp and glucose, and breathing well so they had no reason to keep her. She was 4 lbs 15 oz. My cousin also had a 5 lb 33 weeker and they sent her home with mom too. The nurses said it was unusual that she didn't have any problems that 33 weekers usually have, but nobody said she should stay in the hospital. And she's a very healthy one year old now. Only one mild cold.

NicuGal, MSN, RN · Dec 31, 2003

Wow...33 weeks stay in our unit...our nursery won't touch them. And then your baby would have had at least 2-3 days of antibiotics if there were any risk factors. We wait for all cultures to come back...we have had some kids that are completely asymptomatic turn symptomatic in a few days! Some kids surprise you, but the majority of those under 24-25 weeks have some problems and if they don't they are the exception to the rule. I hate how media play up things...they rarely show you the bad side of it. We have had many, many parents say that if only they knew, they would have never agreed to treatment. It is sooo sad. Sure, we send them home at some point, but even if they seem fine, later in life something crops up. Visit your comp care floor and ask how many of them were previous 22-24 weekers. I hate to float up there and see what we created!

Tonya...there is absolutely no way an 18 1/2 weeker would ever survive (that is 4.5 months post conception).

TonyafutureRN · Jan 1, 2004

So do you think the dr shouldn't have let my baby go home? I hadn't really thought about that before I came to this board. I did have to bring the baby back to the dr the next day (fri), then early the next week so they could make sure she was doing well. I had 2 bags of IV antibiotics before she was born (my water broke 30 hours before delivery). Maybe that was why they weren't as worried about infection? just guessing. I had also had 2 rounds of steroids the week before to develop the baby's lungs (so did my cousin). I've read there's no proof that that works, but both of our babies came out screaming, maybe they did help.

The 4 1/2 month baby, I was guessing it would be around 22 weeks (21 1/2 at least), since it said after conception, and you are 4 weeks pregnant 2 weeks after conception, and also because a calendar month is a little longer than 4 weeks. That's how I took it anyway.

Another thing I'm trying to figure out is how the wife of one of my home health patients had 2 babies less than 6 months apart. She said the second baby only weighed a pound and some odd ounces. I didn't know babies that early survived before the technology we had today.

I know I'm just rambling on. I need to go to bed. LOL

Tonya

NicuGal, MSN, RN · Jan 1, 2004

That seems silly to me to go home and come back every few days...sure, save some money in the long run, but that is a lot to do! And steroids do work wonders! Many of our 32-35 weekers aren't even intubated anymore due to steroids...there is always a chance of rebound a few days later, but they all usually do well.

Do I think it was chancy sending home a 33 weekers...sure I do, but that is my opinion. The risks of the kid getting sick, rebounding off steroids, getting jaundiced, etc is still up there. I am glad she did fine though :)

Jolie, BSN · Jan 1, 2004

I think one important consideration in discharging Tonya's baby is that a hospital (especially a NICU) is no place for a healthy patient to be! The risk of a hospital-acquired infection is very real.

I'm not terribly surprised that she was discharged, given her stable condition. I'm pretty sure that is what our docs would have done. It also helped that she has an obviously responsible mom who could be relied upon to monitor her closely at home, and bring her back to the ER or ped at the first sign of trouble.

My youngest was a preemie who was discharged home with me. She later needed phototherapy, which I insisted on doing at home. No way was I going to risk an admission, unless she showed showed signs of actual illness, which thankfully, she did not.

Mimi2RN, ASN, RN · Jan 1, 2004

Originally posted by TonyafutureRN
When my daughter was born at 33 weeks they told me to expect her to not be able to nurse, to stay in the NICU for a while, and to have underdeveloped lungs. But she came out hollering, nursed like a champ, and the NICU team said she could go straight to the reg. nursery. We both went home 2 days later. It just goes to show you, you never can tell.

Tonya, your little girl behaved more like a 35 weeker, right on the border as far as feedings are concerned, but had the blessing of steroids to mature her lungs. I always figure any baby could be 2 weeks either way.

We once had twins that we swore were 2 weeks apart gestationally. One ate, did really well, the other was clueless and took two weeks to catch up!.

BRANDY LPN · Jan 1, 2004

MIMI2RN-

My thoughts exactly, prob. all of these kiddos that were "really early" were two weeks ahead.

My 2nd was born at 35 1/7 and weighed 5 lbs but I was not sure of my dates and her edc was based on an ultrasound, I always figured she was prob. a little older than that. she did great after del. (with steroids) but she just didnt look that young.

L&D_RN_OH · Jan 3, 2004

Originally posted by NicuGal
Visit your comp care floor and ask how many of them were previous 22-24 weekers.

We don't even intervene until 23 weeks. Before that, we don't consider them viable.

TonyafutureRN · Jan 5, 2004

My grandmother also said she thought the baby wasn't as early as we thought, but her reasoning was the baby had long fingernails. Of course she's also the grandmother who told me my milk had turned to water when my 3 month old baby had her growth spurt and wanted to nurse every hour. LOL. The reason I think she really was 33 weeks, is because we were trying to conceive when I got pregnant with her, and I kept very close track of my periods and my temperatures. I had a textbook ovulation chart and 2 early ultrasounds (at around 5 weeks and 7 weeks) matched my calculations right on the dot.

The hospital infection theory, I can definitely understand that. My mom had surgery last year and her recovery was greatly longer than it should have been because she got a bad infection in the hospital and had to be on several antibiotics before it cleared.

Thank you everyone for your responses to me. I hope to be a L&D nurse one day so this is all very interesting to me.

Tonya

HazeK · Jan 6, 2004

23 weeks: viable...but morbidity and mortality statistics are horrible!

definately a bioethical dilema weighing quality of life vs cost vs kinder to allow death with dignity. (before you think I am heartless, please talk to parents of 23 week babies...often end in divorce, bankrupcy, etc.)

20 weeks: offer your condolences.

Haze