mweaverrn

Hi there! I haven't been on here in ages...been busy! Anyways I wanted to pose this question to you. Does your hospital require the use of a filter during Albumin transfusion? Our hospital policy is vague when it comes to Albumin. In general it states all blood products should be filtered, but it doesn't list Albumin when discussing the specific blood products. From my understanding the policy of whether to use a filter differs by hospital. The drug company recommendations also differ. I get so many mixed responses on this issue on my unit. I just wondered what your hospitals require. mweaverrn

LOL those were great. Have you ever said that if your baby didn't hurry up and it he/she was going to be wallpaper. LOL, sometimes it's just frustrating. Thanks for a good laugh! Michelle

Sadly the baby did not make it. The parents were hysterical and cussing at people on our unit saying we killed her. Hopefully the will come to their senses. They seemed a bit irrational from the get go. She is still pregnant with the other twin though and that twin is over 500 g. I know what you mean about the hypoxia, but she wasn't expected to live that long. When she was born they couldn't intubate her so the docs left her with the parents, but she kept on going. Not much we could do for her at that point. A nasal cannula was put on her by the parents insistance that we do something. Had we not done that she probably would have went sooner. I know it's a huge ethical dilemma. I just got home from work a little while ago. Business is booming once again. Our census is 29 and strong with lots of potentials. Just today on our L&D board we got warned about a ruptured and bleeding 24 weeker, 30 weeker in active labor, hyperbilirubinemia from another hospital, and a 30 weeker with a diaphragmatic hernia. I'm sure I'll go in tomorrow and we'll have at least 2 of those. UGH!! And of course we had a influx of big hypoglycemic kids....gotta love em! Good Night, Michelle

Thanks for the links. I'm going to show this to my neos at work, but even still small is one thing...gestational age is another. This baby is a twin and 360 g and 23 wks. Remember that she had been ruptured since 22 wks. as well. All these things factor into the equation. Prolonged rupture increases her risk of infection. I did take the time to look at some of those cases and most of them do have long term problems such as BPD, eye problems, rickets, etc. This is the unfortunate thing that comes with having an extremely premature infant. I agree that the parents only hear that survival is possible!! WE don't even have anything small enough to intubate her with. When the honeymoon is over...well those of you have been there know. Her electrolytes are already out of whack. And then there is the risk of IVH with being so extremely premature. When our neos talked to her at 22 wks. they wanted everything done then. I just can't believe this mom almost left AMA the day she delivered the baby. Hopefully she can keep the other twin in there a bit longer. The other twin is bigger and the sac isn't ruptured. When I was talking about steroids I was talking about steroids for the baby. Apparently there were some studies suggesting that high steroid usage increased ADHD and neurological problems later in life. However, I find that it would be very difficult to find correlational studies. And of course, they would never deprive any infant what they need for the sake of a study. And what is to say that the babies wouldn't have had those problems anyhow. And I would take ADHD anyday over Chronic lung disease, wouldn't you? Our NICU used to use higher doses over longer periods and the babies were able to wean from the vent alot sooner and came off oxygen or were on low settings. Nowadays it's taking forever to wean them from the vent and some don't. In the past 2 mos. we have sent 2 to get tracheostomies ...we haven't seen a trach in almost 5 yrs. I guess we're lucky, huh?

I agree..I bet she won't make it. Obviously she has had some will to survive to make it this far though. Her skin doesn't look that bad either, but she's so small. The parents are totally unrealistic and trying to throw statistics at the neos. I guess when you're not around it on a daily basis you have no clue. Not to mention the long term problems she will have if she survives. I have seen babies less than 600 g survive, but we'll see how they fair when they hit 1 yr. We had a set of 23 2/7 wk twins born last October...400 and 600 g. They had a lot of problems. Both have had eye surgery and in time we will find out how much they will be able to see. I don't think either one of them is on oxygen any longer. It just seems that since I started working in the NICU in 1998 that they keep getting smaller and smaller. We are keeping them longer and longer. We have cut our steroid use down since I started and I think that is contributing to a lot of our chronic cases of BPD. We have this little girl on my unit that has been there since the beginning of September and she isn't even close to going home. As soon as we get her oxygen down to 1/2 L she stays for awhile then back up we go. I feel so sorry for the parents.

We have taken over our census as well. We're a 30 bed Level 3 and we have been as high as 40. Sometimes it looks very cramped up. Technically speaking I don't think the bed space is as large as it should be for 30 beds. WE have 4 other Level 3's around here besides us. And we have NEVER closed our unit to deliveries or transports.

Pretty much the same here. It all depends on acuity. The most I've ever had was 4 feeders and growers. On occasion I have seen as many as 5 feeders and growers to one nurse, but that isn't typical. Generally we have 2-3 babies a piece. Our L&D admission assignments are generally 2 baby assignments.

Well just when you thought you've seen it all!!! I've seen some small babies, but this has to be the smallest. She is a twin, but her sister is still happily in utero. She is now 33 hrs old and still alive an kicking! She was born at 23 wks, ruptured since 22 wks., at was 360 g. The neos were unable to intubate at delivery so they left her with her parents. We received a call 3 hrs. later and she was still ALIVE!! Our neo decided to put her on a nasal cannula. She is still on a nasal cannula...1 liter and 70%. And of course she has lines, has received a transfusion, insulin drip, and the usual NICU hoopla!! I'm just amazed. The other twin is apparently over 1 lb. and hopefully she can keep her in utero a bit longer. I will be even more amazed if she's still there when I go back to work on Friday. I'll keep you posted. I asked our Neo what the smallest surviving baby was and he said 25 wks around 400 something grams. The smallest before this baby I think that I saw was 420g, but that baby didn't make it. I did take care of a 26 wk. IUGR that was 480g and she did great. She self-extubated 1 wk after birth and was on a nasal cannula. Age does make a difference!!