23 wkrs suffering?

umcRN, BSN, RN · May 13, 2011

Agreed...and then the ones that do "survive" that no one wants to let the parents in on the fact that the baby has no intestines, gr 4ivh, probably rop and a host of other issues that won't turn up for a while

On the other side of the spectrum of things that get me going...parents who do agree to a dnr and then stop visiting...ugh

dawngloves, BSN, RN · May 20, 2011

Nothing makes me angrier than a pt dying while on osc because no one has the balls to say, "Enough!". Can you imagine dying that way??! How horrific! :crying2:

RainDreamer, BSN, RN · May 25, 2011

Yeah, it's cruel and unusual punishment.

We have one neo that is blunt and to the point, but he's good in these situations becuase he'll basically tell the parents "Your baby is going to die. He/she can die hooked up to tubes and wires and flat on a hard bed .... or he/she can die in mom and dad's loving arms".

NicuGal, MSN, RN · May 25, 2011

Although, sometimes even when the docs say something, the parents want to go on. It's a rock and a hard place and I hate it. All I hope is that they are drugged enough to not feel anything we do to them We have a kid that was no way even 23 weeks and one of the fellows brought it back...then you are obligated to go on until the parents say stop or the baby dies. Bad bleed, big PDA, the whole works. The docs are too leery of getting sued (not that it would win, but there was one case years ago that set the tone).

Somedays, our job stinks.

Elvish, BSN, DNP, RN, NP · May 25, 2011

Yeah, it's cruel and unusual punishment.
We have one neo that is blunt and to the point, but he's good in these situations becuase he'll basically tell the parents "Your baby is going to die. He/she can die hooked up to tubes and wires and flat on a hard bed .... or he/she can die in mom and dad's loving arms".

We have a couple that are really good like that too and I love them for it. One of them went so far as to stay over his call shift and hold the baby himself until he (baby) died because the parents wouldn't or couldn't, I'm not sure which.

umcRN, BSN, RN · May 26, 2011

we have some docs that can't seem to let it go though...had a baby once with NO kidneys, full term, they let that torture go on about 3 days, he was finally let go and I remember, hours later as another RN and I are shrouding him, the doc runs in to "just listen one more time"...really???

Blindsided · May 26, 2011

Poster, some of the terms you use are really foreign to those of us that haven't stepped foot in NICU for decades. Can you enlighten? Aside from this, it sure sounds like an awful position to be in when the docs aren't upfront with the families. We experienced this lots on oncology, so frustrating! But, the nurses with the guts would begin to educate the families, have little conversations. Almost always, they thanked you and they could focus their love and care toward their dying family member's last days or hours of living, instead of focusing on keeping them alive, no matter what, and to what end?

umcRN, BSN, RN · May 26, 2011

Figure I could help a little:

Just wanted to vent. I don't understand why we let dying babies....yes actively dying, lay there on HFOV high frequency oscillating ventilator, highest vent support available, very loud, hundreds of breaths a minute, makes the whole body jiggle violently sometimes and the docs don't have the guts to tell the parents to just hold and love their babies while they can. Seriously.... gasses in the 6.88 or less range very bad acid/base imbalance in the blood/body, can cause multiple organ damage. in 100%, maxed out settings, 100 percent oxygen to maintain o2 sats, no where to escalate respiratory support gut about ready to perf.when subject to low blood oxygen levels for a period of time, in preemies the gut is usually the first to go whether theyve been fed or not, aka necrotizing entercolitis not to mention the other signs of death that is OBVIOUS. WHY? It went on for over 8 hours and the mom didn't have the guts to make the decision and also couldn't sit at the bedside for longer than a few minutes. Since when did we give the parent so much power that they cannot make an informed decision? They can't stay long enough because they don't want to watch their child suffer and we can't get away from the bedside long enough to do anything else. Is it because of Vermont Oxford? yea, we save 23 wkrs. Yes SOME of them do go home minus bleeds brain, interventricular hemmorrhage, nippling all taking all feeds by mouth, etc. but many just do not. Even seen it where iNOinhaled nitric oxide, typically saved for full termers in PPHN but more and more docs are using it on preemies now w/o adequate evidence to back it up was used. Really? It's hard for the parents, but it is morally distressing to many RN's as well.

Hope that helps, feel free to add in anywhere

Blindsided · May 26, 2011

Helps a lot! Thanks much! :):):)

SJerseygrle · Jun 1, 2011

I WOULD like to point out that in 1991, when 27 weeks was touch-and-go, the smallest baby at that time ever to survive was revived by a nurse after the mother had agreed to let the baby go. Reading this mom's story of the heartbreak, divroce, and over 400 operations she and her baby suffered through in the next four years was excrutiating. And it was the NURSES decision - and she was PROUD of it.

Since then, society has joined in the chorus, with any and all doctor shows having "miracle" babies born at 23 weeks grow into perfect newborns. But it's all of our faults, not just mom and dad. People take their cues from the people around them, including the people in the NICU - doctors that say it straight are doing the parents a favor.

And let us not forget that keeping 23 weekers alive is also part of an agenda about abortion that makes the situation that much more difficult.

I mean, just go onto a website and try to explain why you are having an abortion at 23 weeks for a fatal disease or congenital abnormality and watch the fur fly. So why would you expect parents to ever agree to let their child go... it always turns out fine on Gray's Anatomy.

And honestly, no matter what, you don't feel like a good parent when you agree to let your child die. Even when it's the right thing to do.