Unhappy 22 Weeker

Mimi2RN, ASN, RN · Feb 28, 2004

It's cruelty to treat a baby like that, but it seems that some docs don't know where to stop. Where are the parents of this poor baby? Do they have any idea what kind of life this baby has?

It's amazing that he is so old, but I can't say that's a tribute to modern medicine. We don't treat 22 weekers, we are a level II, anyway, but our docs are pretty good at telling the parents "no". The transport team doesn't come for anything less than 23 weeks, and that's borderline.

So sorry you have to care for little ones like that. I don't know if I could do it. The blessing will be when he is allowed to go to heaven.

mimi

fiestynurse · Feb 28, 2004

Nationwide, most 22 week babies are given hospice care. Very few 22 week babies survive. Of course, it depends on the gender of baby (girls do better than boys), whether it was a multiple birth, or whether betamethasone was given. Even then, the chance of a 22 week baby surviving with intensive care is 10%. Most NICUs rarely succeed in sending a 22 week baby home alive. Most of these 22 week babies die after the brain is badly injured by severe bleeding and intensive care was withdrawn.

Parents of extremely premature babies must understand these things, because the law and our society in general have decided that parents have the right to choose whether or not intensive care is the best thing for their extremely premature baby. Deciding whether or not to choose intensive care for your baby is the "hardest decision." The doctor needs to be very frank about the survival rates and the expected quality of life.

Doesn't your hospital have an ethics committee that discusses these types of situations and how best to handle them?

fergus51 · Feb 28, 2004

I hate the borderline cases. We are just torturing them. I think if the parents really knew what kind of suffering we would be inflicted on their child, they would never say they wanted it.

Gompers, BSN, RN · Feb 28, 2004

I hate the borderline cases. We are just torturing them. I think if the parents really knew what kind of suffering we would be inflicted on their child, they would never say they wanted it.

Sometimes it's the parents that are demanding that everything be done. Because of religious reasons or guilt, they refuse to take the baby off support or even make a DNR order. Our ethics committees will meet with the team about kids like this, but if the parents are at the bedside day after day and know everything that is going on, including poor long term prognosis...then they rule that it is ethical because it's the parents' decision. And who wants to tell the parents, "You're torturing your baby by not letting him die!" I hate cases like this, lived through one too many already. What really bothers me is when the mom is there and you want to give more pain meds, and they try to stop you because they think they can make him feel "all better" inside. That might work with a normal kid, but with a chronically ill baby in multi-system organ failure...I get so p***ed off because I know that giving narcotics is the only thing I can do to help that baby.

:crying2:

gypsyatheart · Feb 29, 2004

undefined This past week I got the assignment from you know where. A s/p 22 weeker on DOL # 210. NO LUNGS or GUT, little vision or hearings. Blood pressures out of the roof, meds (3 pages ) like you would not belive. NPO because that morning he had had surgery #8, freshly extubated CO2 85 (Doc okay with it). This poor kid was unconsolable even with morphine, ativan and methadone. The only thing that helped was the swing and music. WHY DO WE DO THIS TO 22 WEEKERS! This kid has a misserable life! When I tried to talk to the Neo about what would happen to him he looked at me like I was nuts and said" Come on! you know hw is going to die" I still think these little kids are resus to keep the lawyers at bay. I cried all the way home. Does anybody else ever feel like this. I tried to help this kid but I failed.

(((((((((((((Hugs))))))))))))))))))))!!! I have no words of wisdom, these cases are horribbly sad for these little ones. I'm sorry you had such a rough shift!

jnette, ASN, EMT-I · Feb 29, 2004

I just don't see how you guys do it. My heart could not bear it... it would break in two. I truly don't believe I could do this on a permanent basis...

...how do you bear the constant pain?

I have the utmost respect and admiration for all of you .

fergus51 · Feb 29, 2004

I see that all too often here Gompers. Muslim families will almost never withdraw here and Jewish families are reticent as well. But, those families are also not usually in the room when we run a code on their child. I sometimes think if they saw us ripping off tape, pulling out ETTs, reintubating, doing chest compressions, etc. they would not be so eager to insist we do "everything". I do think doctors and nurses need to be frank and just say "we are only prolonging his suffering", cause that's the truth.

nurseiam · Feb 29, 2004

We have had the most chronic babies code with their parents at the bedside and they still want everything done! It is awful. We had a gut kid dihiss, he was a former 23wk twin, the guts fell out so they put it in a silo. There was nothing to keep the silo on so they used a scapel at the bedside to make a skin lip so the nurses had something to pop the silo back onto when it fell out. There was gastic content everywhere! The parents just couldn't give up. This baby suffered for weeks before sepsis was kind enough to take him!

In our unit we only save 23+ weeks. Sometimes I wonder about them. They end up soooo chronic, if they make it. But then I think who am I to choose.....But then I think, these parents are not making an informed decision. They have not been to a long term care facility that is filled with former micro preemies. They have no idea what they are in for. A Neo giving a laboring mother in crisis the statistics for a micro preemie...is that an informed decision?

prmenrs, RN · Feb 29, 2004

Anybody ever think about karma? What you do and how you do it in this life has a lot to do w/what happens to you in the subsequent lives? No, never mind, don't answer that.

It is painful to watch and participate in these fiascos--if you have ethics committees--use them. Social workers CAN help parents face reality. Parents need to be required to spend time each and every day @ the bedside. Sometimes, w/very young moms, it's kinda like, s/he's mine, I'm keeping her. A possession. Very sad.

Spend as much time as your day allows holding the baby; Music can help: lullabies, classical, new age played very softly is what they like. Volunteer cuddlers are a Godsend. A little tylenol goes a long way.

And when you're at home, get as much supportive care as you can-even if you have to provide it for yourself. Indulge yourself. Try not to get into any heavy discussions right as you walk in the door.

It is not supportive to have co-workers come up to you as you're trying to care for this baby, and have the discussion we are having here. Tell them that. If they want to help, they can hold the baby for a while, or do something for you so that you can.

((((((((HUGS)))))))))

jnette, ASN, EMT-I · Mar 1, 2004

Spend as much time as your day allows holding the baby; Music can help: lullabies, classical, new age played very softly is what they like. Volunteer cuddlers are a Godsend.

Wow, prmenrs.... you just lit a HUGE lightbulb in my head !!! :idea: When I get too old to work, that is EXACTLY what I'm going to do !!! Watch me !

Y'know, forEVER, I've wanted to work in the neonatal unit... but the way they USED to be... and I don't think those exsist anymore... where the babes all had their little bassinets and all the babies were there... while the moms all recouperated... you know... old style. Since that went out, I gave up that dream.

But if there's a possibility of still being able to "cuddle" these little ones for as long as I want or as long as they need it.... HERE I AM !!! It would be SOOOOO fulfilling for me, as well as comforting to the babies... AND a help to the nursing staff ! WOW !!! Can't wait !!! :)

fiestynurse · Mar 1, 2004

**********Oops. Didn't see that "DOL #210" -- Sorry