When a Baby dies....

elizabells, BSN, RN · Jan 7, 2008

I just had my first on-duty death after 18 mo in the NICU the other night -I was present when my primary died, but not working. The situation was two 23 +1 day twins who we'd been working on for appx 10 hours. The fellow paged the attending, who came in at 0200, went to PP to talk to mom, and she then came up with her husband. We put the babies on conventional vents (had been on oscillators), then gave them morphine and versed, took out the ET tubes, swaddled and handed them to mom. Mom and dad handed them back and forth, prayed and cried, and the babies went. We let the parents spend as much time as they wanted there, took pictures of them holding the babies, and then the attending accompanied mom back to PP. I did footprints/handprints and filled out the bereavement card in the memory box, removed the umbilical lines (with the OK from my charge nurse, as there was not going to be an autopsy), washed the babies (there was some blood, etc from the tape removal), placed ID bands, swaddled them, and the morgue tech came and picked them up.

Each death is a different situation; I had no prior relationship with the parents, so I was a little more reserved than I might have been with parents I knew well. I got water for them, and stayed in their eyeline so they could ask if they needed anything but tried to be unobtrusive - it was their time with their children. Thankfully my charge nurse stayed with me almost the whole time, since it was my first and I really, really didn't want to do anything wrong. You do kind of have a sense of what to do - even though I'd never really done it before, I did okay. The compassion that makes you a good nurse will see you through.

littlepeach · Jan 7, 2008

I don't think you can ever be emotionally prepared for it. One of the biggest parts of bereavement care is conserving memories. handprints, footprints, lip prints, hand/foot molds, lock of hair, bracelets, tape measure, crib cards, and most importantly, some really good and tasteful pictures. remove lines if able to. We help the families contact any funeral homes or set up whatever arrangements they desire. And offer the mother some bereavement support. And know it is okay to cry with the family.

RainDreamer, BSN, RN · Jan 8, 2008

I had been a NICU nurse for about a year and a half when I had my first demise. Here's what I wrote in my journal about that night:

So I've been a NICU nurse for about a year and a half now. I've had some incredible experiences. Certain babies stand out and I'll remember them and their families, but for the most part I go in and take care of my kids for the night, do my part, and that's that. But there's some nights that I have a kid and parents that I won't ever forget, and they'll stay with me forever.

Forever.

How incredible is that? To go in for a 12 hour shift, and leave with a lasting memory that will stay with you always.

Last Monday was one of those unforgettable nights. A baby and family that I won't ever forget, as it was my first demise on my own. I'd dealt with a demise on orientation, and I've helped with some, but I've never had one on my own. It's something that I'm sure every nurse, unfortunately, has to go through, and something that'll last forever.

Once I got in to get report I knew it was going to be a hard/busy night, as the kiddo was already circling the drain. A precious little 25-weeker. Already on an oscillator and nitric, yet still satting in the low 70's. Not just an extremely early preemie, but a very septic one, with severe PIE and PPHN.

I was terrified. I mean this is the sickest kid I've ever had on my own. Drawing labs constantly, giving PRBCs, platelets, FFP, boluses ..... constantly all night. From the time I got there he just continued to get worse. Sats started out in the low 70's .... now we were lucky if we got sats any higher than 50. On 20 mcg of dopamine and 20 mcg of dobutamine, giving hydrocortisone ..... and still only getting mean BPs of 20. Wow. What else could we do for this kid?

The neo stayed at the bed throughout the night. All I can say is thank God for good doctors .... ones that are compassionate and understanding. He explained a ton of things to me and was extremely patient throughout the night.

The poor little guy just continued to get worse. Got a head ultrasound and it showed a grade IV on one side, a grade III on the other. Doc explained everything to dad and went over the options. Mom was still at the other hospital that the baby was transferred from. We were able to get her to our unit on a pass from her hospital, so she could be with her baby.

Mom, dad, and family spent a bit of time with the baby. I told mom she could hold the baby, and then the doctor explained the options. He told them they could hold the baby with the ETT in, or we could take him off if they're ready. She said she didn't want to hold him if it would hurt him. The doctor explained we would give him pain meds so he'd be comfortable. I gave the pain meds. Mom said she wanted as few tubes in as possible. So we turned off all the fluids. I wrapped the baby up and got him ready to be held by his parents. Then the doc pulled the ETT out. I handed him to mom. We took them to a parent room so they could spend time with him. He died about 15 minutes later.

:scrying:

While we gave the parents time with him, we made the memory book. When the parents were ready, we took him and finished the feet/hand prints. The parents kept thanking me for taking such good care of their baby and thanking me for being so gentle when I wrapped him up.

It was so incredibly heartbreaking. Yet it was just so incredible to be a part of this, for this family.

I will never forget this sweet little boy and his family :redbeathe

mybabies · Jan 15, 2008

I can tell you that I have been doing NICU for a little over two years. I have worked only in surgical NICU's and have had to deal with many deaths. 2 of my primary's have actually passed away. One of them was 4 months old and the other was 9 months old. Both of them had spent there entire life in the NICU. I can tell you it is not easy to handle. Once you are attatched to the babies and the families it becomes harder and yet easier all in the same. You learn to grieve with the family. I still think about both of my primary's all the time but you have to remember that you did the best you could. I still keep in touch with the families to this day. It is a bond you share with them. Noone else knew there precious baby but you and them. No matter if the baby was alive for just a few hours or several months you still have that bond with the family. I agree with everyone that the most important role you can play at the time of a death is to collect everything that touched the baby, provide a lock of hair if possible, take pictures and never be afraid to cry in front of the family. My personel advice to you is if you ever have a baby that you are close to die...please go to the funeral...it helps with closure. If you are ever in a situation and need more advice please ask.

RainDreamer, BSN, RN · Jan 17, 2008

I agree with everyone that the most important role you can play at the time of a death is to collect everything that touched the baby, provide a lock of hair if possible, take pictures and never be afraid to cry in front of the family.

That brings up a really good point. Even things that you wouldn't think that would matter, keep them anyway and ask the parents if they want any of it.

prmenrs, RN · Jan 17, 2008

If, for some reason, the family cannot be there, you can hold the baby @ the end. Go somewhere quiet, and just hold and rock them.

RainDreamer, BSN, RN · Jan 17, 2008

If, for some reason, the family cannot be there, you can hold the baby @ the end. Go somewhere quiet, and just hold and rock them.

Another great point. Never ever ever let a baby die alone.

elizabells, BSN, RN · Jan 17, 2008

We had a Trisomy 18 baby who was comfort care only, and no one in the family could bear to come to the unit. We spent the shift passing him up and down the hall, and whoever had a free minute would hold him. He didn't pass on our shift, so I don't know what days did, but I hope someone was cuddling him when he died.

mybabies · Jan 17, 2008

Last March one of my primary's passed away. The parents were there and held the baby for a little while. The Dad was having a very hard time and Mom thought it best that they leave. They also had 3 other little ones waiting in the waiting room. I held that baby for a long time after they left. It made the mom feel so much better that I was going to stay with him. I still keep in touch with her to this day. It is a horrible but wonderful bond you can form with these families.

prmenrs, RN · Jan 17, 2008

I had a horrible shift once, near code to code to take off everything and hold till s/he was gone, post-mortem care. While I was sitting waiting for Security to accompany me to the morgue, sort of in shell shock, the charge nurse grabbed the [dead] baby and told me we had to go pick up premie twins @ another hospital.

I'm telling you, I was useless. Fortunately, there was another nurse who was running circles around me, starting the IV's, hanging fluids; she would just tell me, "mix the abx" how many mgs, "get that one in the transporter", etc. Fortunately, I did most of the charting so she could be supernurse.

preemieRNkate, RN · Jan 17, 2008

If staffing allows (which is usually rare) and the nurse wants to, we usually let him/her go home once all the work is done. I usually wind up with the end of shift code though. And sometimes, I feel better staying and being around other people who "get it."