What do NICU nurses consider "viability"?

babyNP., APRN · May 21, 2014

The problem is that it may be hard to pinpoint an exact gestational days due to maternal differences in menstrual cycles; IVF is probably the most accurate for dates.

That being said, there are 23 weekers that make it out (neurodevelopmentally, overwhelming majority have deficits). But there are many 24 weekers that do well.

This is a calculator where you can input the gestational age, weight, etc and it will give you the odds on death and disability--> NICHD Neonatal Research Network (NRN): Extremely Preterm Birth Outcome Data

zeus&lincoln · May 21, 2014

We go as low as 23 weeks in our unit but our neos and NNPs are pretty good at explaining to parents what the neurological deficits will be and chances of survival. The neuro deficits will be devastating in most if not all cases if we attempt to intervene at that gestational age.

The problem is that when the baby is born it could be plus or minus a couple weeks so that 23 weeker could be 25 weeks or 21 weeks. The OBs in our hospital know that we won't attempt to save a neonate under 23 weeks so they say every baby that is 22 weeks and some change is 23 weeks. There are tons of ethical issues in the NICU.

Everyone thinks a pound baby is cute. What happens when that pound baby grows and becomes 180 lbs and can't feed themselves, walk, speak, etc. It isn't the parents fault for wanting to try every life saving measure... They are just doing what they think is best for their child. However, as the professionals, it is our duty to explain what their reality WILL look like if we try everything we've got.

TiffyRN, BSN, PhD · May 21, 2014

I think I was taught in nursing school that 26 weeks was viability; but that was the early '90s. Now the official number is 23 weeks.

One of our neos did a talk on morbidity/mortality of ELBW infants and her estimate was that at 25 weeks the infant had a 50% chance of surviving without major morbidities.

Most nurses I work with would probably think long and hard about resuscitating their

NicuGal, MSN, RN · May 22, 2014

Depends on which attending is on. We have 2 that bring back 22 weekers. We have had a few survive but they ended up trached and g-tubed and sent to long care facilities. So sad

TiffyRN, BSN, PhD · May 22, 2014

Depends on which attending is on. We have 2 that bring back 22 weekers. So sad

This! Absolutely! The last time we had a 22.6 deliver the team came back saying "thank God Dr. XXXX was on, he isn't the kind to be a hero." We used to have 2.0 tubes around & one doc notorious for using them. Official story is that the packaging said they expired, in reality, I'm pretty sure they just got tossed by nurses who never saw them put to good use.

zeus&lincoln · May 22, 2014

22 weeks?!?!? Those neos should have to foot part of that family's long-term health bill! They are not G-d! Why must we do this? It pains me to care for micro premies at times...The babies that have been poked some many times and are so neurologically devastated that they don't even wince at painful stimuli. I know I've become hardened or desensitized is the better word by working in NICU but really what is the point of spending millions of dollars and taking away nurses and machines from other babies to save a neonate that isn't "viable." What is life going to look like for that family once we send this kiddo home or to a long-term care facility? Quality of life is so much more valuable than days lived. I swear in NICU we want to save everything because we don't have to "deal" with the aftermath of those choices. After the baby is of age and is trached and tubed we send them to peds or long-term care facilities. Sometimes this job is mind boggling. ...end rant!

Elvish, BSN, DNP, RN, NP · May 22, 2014

I know NRP says 23 weeks, but after seeing a 23-weeker be coded, I think my personal cutoff would be more like 26. Obviously a lot would depend on what happens at delivery, but if I'm honest I'd much rather be able to hold and love my baby while he lives for a couple hours than have him be resused spend a whole life trached and on tube feeds. 'Breathing and has a pulse' technically does mean 'alive', I guess, but at what price?

Other parents would do differently and I understand that people want to feel like they gave their baby every chance possible.....it's just not what I'd choose.

HyperSaurus, RN, BSN · May 22, 2014

I don't think our NICU has a hard and fast rule. From what I've gathered, we resuss 24 weekers and/or 500 gms.

katierobin23 · May 23, 2014

Our limit is 23 weeks as well. There are some ethical questions raised because the dates do sometimes get fudged to make a 22+change weeker "be" a 23 weeker...those usually don't end well.

We don't have a weight limit...if they can intubate with a 2.5, they do and we go for it. The smallest I have taken care of was 310 grams. That baby did not live.

I've had a few 360-380 gram babies that did live and two of them had really good outcomes (so far!), so you just never know. The one who was a total rock star was 370 grams and not quite 23 weeks (22+4-5 ish days). She went home before 40 weeks without oxygen, never had an IVH or belly problems. The only typical micro preemie thing she had was ROP that needed laser treatment.

rnkaytee · May 24, 2014

After our first baby was born at 28 weeks we had to do a lot of thinking when I got pregnant a second time. After seeing these babies and what they go through, we wouldn't have resuscitated less than 25 weeks and even 26 weeks if there were complications (our first had a grade 4 bleed). Luckily I went to 35 weeks the second time but I held my breath the whole time!

Bortaz, MSN, RN · May 25, 2014

Depends on which attending is on. We have 2 that bring back 22 weekers. We have had a few survive but they ended up trached and g-tubed and sent to long care facilities. So sad

I ran to an emergency delivery one night. One of those where you answer the phone and the person on the other end screams WE NEED HELP IN 14! THE BABY IS OUT! and slams down the phone.

When i ran in, the baby was lying in a puddle between moms legs. I snatched him up and put him on the warmer just as my charge and the neo walked in. This kid was between 21-22 weeks, 348 grams, I later discovered. I nearly swallowed my tongue when the doc said "give me an ett". I said the f-word a few times while he intubated this kid. Spent the next 8 hours coding him before the fool finally told us to stop.