tiniest micropreemie

dawngloves, BSN, RN · Feb 2, 2004

I think after the honeymoon is over that poor little thing is going to get very, very sick and not recover.

We had a 25 week IUGR that was 480 ish and we could not tube, so she was on CPAP and a DNR. She did great for a few weeks, then gor NEC and expired. Such a sweetie! Broke our hearts.

I have yet to see any preemie less than 600g survive or not have SERIOUS issues (CP, hydrocepalus, blindness, deafness)

mweaverrn · Feb 2, 2004

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.

mermom · Feb 2, 2004

Hi from a preemie mom. =)

I have seen several micro's smaller on my preemie support groups. One, Jessyka, is on the Tiniest Babies registry. She was a 10.9 ounce (310 gram) 26-weeker and is doing well now at 2 yrs old. Here's a link to The Tiniest Babies Registry:

http://www.medicine.uiowa.edu/tiniestbabies/index.htm

If you'll notice, the second-tiniest was a 34-weeker at 283 grams!

There's also Nisa an 11-ouncer who is featured on preemie.com's Watch Me Grow page. Here's the link:

http://www.preemie.com/niboju2020at.html

Just thought you might be interested. =)

Wen

ps~ love you guys!

dawngloves, BSN, RN · Feb 2, 2004

Originally posted by mweaverrn
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.

I forgot about the kids we can't get off the vents. We must send at least 6 of these little guys to get trached a year!

Now when you mention steroid use. do you mean in utero or after delivery?

fergus51 · Feb 2, 2004

I really have trouble with these kids. I think sometimes the parents hear "well, its possible that she'll be ok" and that's all they hear. Then when the baby dies or winds up with severe health issues they are completely shocked. I feel terrible for them.

mweaverrn · Feb 3, 2004

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?

mermom · Feb 3, 2004

Oh, I know painfully well the implications of gestational age/prematurity and pprom. I have many online and off preemie-parent friends, several very dear ones, who've been in just about every situation you can imagine, including several with 22-23-weekers. I was just posting the links to show size only. =)

Wen

preemie parent and NICU nurse fan :kiss

dawngloves, BSN, RN · Feb 3, 2004

Originally posted by mweaverrn
And I would take ADHD anyday over Chronic lung disease, wouldn't you?

Funny, our arguement is, "Do you want the baby to be blind or have crappy lungs?" The peds want us to keep the micros on vents sating between 85-95%! Always yelling at us about ROP if they see a sat >98. :rolleyes: And no we don't use steroids. And we have all those long term vent kids.......

PSA, RN · Feb 3, 2004

Enjoyed reading this thread. I would really like to know how the preemie is doing. I am a preemie mom who gave birth to twins at 24 weeks. My daughter had nec and passed at 9 days. My son is now 5 will be 6 in April. He is doing so well. Not the typical 24 weeker thats for sure. Got to run for now but will visit back later tonight.

:)

Gompers, BSN, RN · Feb 3, 2004

I really love message boards like this, where you can find out what everyone else is up to on their units!

We've had a bunch between 400-500 grams survive, but most of them are very chronic, some trached. My personal success story is a little 25 weeker (wimpy white boy to boot) who was 490 grams. Extubated at 5 weeks, home on nasal cannula and NG/PO transition at 10 weeks, off oxygen and NG totally 2 months after that. Now he's a pretty normal 3 year old, doing well in preschool, even though he does wear glasses and seems to have a touch of ADHD. But you know, his parents lost a 24 weeker in our unit 2 years before he was born, so the fact that he survived and is running around the house singing Beatles songs...they know they're extremely lucky.

My hospital has a bad rep because we tend to use a lot of Decadron. Though we have our share of traches, most are for anatomical problems (TEF, syndromes, etc.) so it's pretty rare we have a preemie get one. But we only use Decadron when it's a last ditch effort. Then you have a choice - brain damage from constant desaturations or from the steroids? It's a total catch-22, you know? But darn does it ever work. Last week my little primary was on 100%, maxed out on vent settings, desaturating, etc. So they started him on Dex and last night we extubated him to a nasal cannula. I agree with using the steroids - if he was my child, I'd chance damage from the meds rather than sitting there watching him turn blue every half hour, killing his brain cells.

We also put a lot of our really bad chronics (the kind who are on oxygen for 2-3 years) on Prednisolone, but I don't think that has the same kind of nasty reputation as Decadron...

kc ccurn · Feb 4, 2004

What an intesting thread. I am an ICU nurse for peds and grown ups, have thought about moving to NICU. I understand that premies have such a high incidence of IVH, is that because their little vessels are so fragile and can rupture at any time? do you worry about blood pressure control for these guys? Hope the questions don't sound too stupid but your corner of the world is such a wonderful speciality. I'd love to know more of the pathophys behind these complications.

Thank you for all you do NICU RN's, what a blessing you are!