24 week preemie

Pediatric Critical Care Columnist · Jan 8, 2009

I'm sorry this has happened to your sister and her baby. We're unable to offer you any advice at allnurses but we can tell you about our experiences. Many 24 weekers do very well in the long term, after having some rough patches on the way to discharge. Apnea (forgetting to breathe) is very common in premature babies and they usually eventually grow out of it. CPAP helps with that. It's a positive that he's not needing ventilation and that he was "big" at birth. The doctor's comment about every day being a new day means just that... every day the baby is a day older and his body is a day more mature. Each day will bring new challenges and new rewards. Jaundice and PDA are also part of the package. IVH can be much more serious and can leave the baby with disabilities later, but many babies with a Grade I do really well. As for those who don't survive, they usually have sepsis (bloodstream infection) and don't respond to treatment. Please try not to focus on the what-ifs. Focus on supporting your sister and loving your nephew. That's what you'll all remember when he's 10 years old and spraying you with his super soaker.

SweetRN007 · Jan 8, 2009

Thank you for the heart warming reply... you are right... .. thats all im doing is supporting my sister and loving my nephew... i havent been down for the last few days, cuz ive run down with flu.. and i dont want to bring any germs to the hospital.. my sis still hasnt been discharged.. since she keeps getting unexplained fevers..

please keep the baby and her in your prayers :)

Pediatric Critical Care Columnist · Jan 8, 2009

Of course I'll keep them (and you) in my prayers. And you're doing the right thing staying away with your germs. I wish people would understand that they need to protect babies (even healthy ones) from all those nasty bugs out there. I cringe when I see or hear a newborn in the mall with people crowding around kootchie-kooing. We have 9 infants in our PICU with RSV right now and they all could have been home and well if they'd just been kept out of contact with the public. I hope your sister feels better soon so she can start bonding with her son.

MA Nurse · Jan 9, 2009

I describe 24 weekers as being on a rollercoaster. There's a lot of ups and downs. More than likely, he will end up on a ventilator because 24 wk. babies tire out easily, they have a hard time breathing on their own at this age. The docs will try feeding him very slowly...there are risks with feeding babies this small.

Just remember, the things I've described are normal for his age. He's still very young and the road is a long one. Docs can't predict what his outcome will be, and 50/50 is an accurate prediction.

Keep us updated on his progress!

It is also a possibility the PDA will not close with medication, then he would require surgery, which is also a very common procedure called a PDA ligation.

UTVOL3 · Jan 9, 2009

I describe 24 weekers as being on a rollercoaster. There's a lot of ups and downs. More than likely, he will end up on a ventilator because 24 wk. babies tire out easily, they have a hard time breathing on their own at this age. The docs will try feeding him very slowly...there are risks with feeding babies this small.
Just remember, the things I've described are normal for his age. He's still very young and the road is a long one. Docs can't predict what his outcome will be, and 50/50 is an accurate prediction.

I would try to emphasize this roller coaster concept to the parents as gently as possible. I mean I wouldn't say try not to get your hopes up, but the roller coaster thing is a great way of putting it. What Kimbalou said esp about the CPAP and the feeds, got me thinking. It truly is 2 steps forward and one, or maybe even 3 or 4 steps back with these LOs. Your little guy may, ok, most likely will wind up on a vent at some point again. Just because he does, or has his feedings stopped, or has to have antibiotics again, it doesn't neccessarily mean he has had a bad day, or week or whatever. It just means that is what he needs for now. I say this because so many parents, nurses even, base their assesment of how their babe is doing on quantitative things like this. Had a bowel movement today-check. Temp within normal limits-check. You get what I mean. When baby has one of these "setbacks" it helps to have someone close to the parents that can emphasize the positive and look at the big picture. Yes, he is back on the ventilator but look how much more comfortable he is. KWIM?

I really hope he does ok. Please keep us posted, I will be praying for the LO as well.:redpinkhe

Humbled_Nurse · Jan 10, 2009

Be sure to check out http://www.marchofdimes.com You will find a wealth of information!!! I will say a prayer for the little guy!

SweetRN007 · Jan 10, 2009

Thank you guys, so far, so good, he is now 10 days old... and is fighting everyday.. he still has the photo therapy lights, and is doing good. They have started giving him very small amounts of breast milk and are monitoring him for any signs of infection , but things are looking great so far... everyone's prayers are really helping... i will keep you all posted :)

lunglover · Jan 11, 2009

I just wanted to throw my own 2 cents into the discussion.

I was born at exactly 24 weeks, back in 1981. I had an identical twin sister that didn't survive, but I did. I had to have open heart surgery at 3 days old because of a mitral valve problem. I survived, and I am not developmentally slow, blind, or deaf. The doctors that cared for me told my parents that I had less than a 3% chance of survival, and I made it. At birth, I weighed 1lb 13oz. I have been in perfect health ever since (never even needed routine cardio care).

I pray that your family has the same outcome.

SweetRN007 · Jan 13, 2009

Thank you for sharing your personal story with me... its always great to hear about success stories from preemies themselves that know it better than us all.... my sis's baby needs blood transfusions.. im not exactly sure why... she was saying that its because of the apnea spells?.. and he is going to be put on the ventilator again.. cuz he keeps forgetting to breath... but how does that have a connection with a blood transfusion... his pda is 75 %closed... so hopefully the med (indomecin... if thats how you spell it) might do that trick... he was off photo therapy lights, but bilirubbin started to go up again.. so hes back on the lights... other than that, he is stable.. i guess all this is part of the "roller coaster"

Pediatric Critical Care Columnist · Jan 13, 2009

It's more likely that your nephew needs a transfusion because of the number of labs drawn and his immature bone marrow than for the apneas. Babies have a very tiny circulating blood volume and when they're sick they have lots and lots of lab tests done on their blood. At the same time their bone marrow, which makes new blood cells, just isn't up to speed yet and can't keep up. Premature babies have apneas because thier brains are immature too. The part of the brain that monitor oxygen and carbon dioxide levels and control breathing in response to those levels isn't up to speed either. So sometimes the brain just doen't tell the lungs to breathe. That is something they grow out of, and it can be treated with drugs such as aminophylline, theophylline, caffeine or doxapram (I don't know if that one is still in use, it's been along time since I did NICU). Your little guy is doing the things that most premature babies do.

lunglover · Jan 13, 2009

I'm glad to see that the baby is still hanging in there. He seems to have quite a healthy spirit and will to live. I wish your family all the best...