Monday, March 5, 2007

Have NICU's Changed?

In doing some recent research on the technology (both equipment and medicines) used in today's NICU's, I was surprised a few times.

First, it's hard to actually find information on current NICU practices. I realize, as a non-medical person, I do not have the same access as medical staff to research publications but it was next to impossible to find much of anything in the way of usable information.

Second, as I was googling I noticed that my blog has been mentioned in a few preemie groups that I do not belong to (and never knew they existed).

It is the latter of these 2 surprises that caused me to want to discuss it further with all of you here.

See, when my blog was mentioned, it was because other preemie parents were saying that their outcomes would be better than my daughter's life because so much has changed in the NICU since my daughter was born, 8 years ago. One mom went as far as discussing my blog with her pediatrician, who told her not to worry because so much has changed and she has a better chance of a better outcome. Her child was a 24 weeker home on oxygen.

After reading many posts from parents of early preemies, who are still under a year old, I am finding that many of them seem to have more issues, early on, than those preemies born around the time when my daughter was born. More of them are coming home on oxygen. More seem to have ROP. Many more of them seen to have brain bleeds. By far, many more of them have hearing loss.

My daughter did not have any of the above.

So, has the NICU really changed in 8 years? For the better? Worse? I need the help of medical staff and researchers to make that determination.

*Our* NICU (Level 3) experience in 1998 (for our 25.5 week preemie)...

*Vent for less than 24 hours - no postnal steroids used to ween
*CPAP then nasal cannula
*Postnatal steroids used for kidney issue or possible CAH
*Antibiotics
*Theophylline
*Caffeine
*TPN
*NG
*Daily heel sticks
*3 Transfusions
*Closed incubator (except 3 days prior to going home)
*VERY loud environment-phone at bedside, helicopter landing above NICU, loud speakers
*Bright environment-quilts were used over incubators for some hours of the day

I'm sure there were some things that I was not aware of but the above is listed on various papers from her chart.

Anyone else care to weigh in on the differences from their NICU experience?

Nurses, neo's, etc... any thoughts on how the NICU has changed?

25 comments:

Lori said...

Good topic. I think *some* are changing. Our son's NICU has private room care. Closed door with only my son in an isolette inside. Dim lights if any at all. Signs on the doors reminding the staff to whisper once inside the room. Vented babies have 1 to 1 care. One nurse to one baby. She carries a pager linked to the monitors and if something falls outside the parameters, her pager goes off and she can enter the room and deal with it. There were parent beds and a bathroom with shower in the room...encouraging us to be there as much as we wanted to. It was very private and nice and quiet for my son. Kangaroo care was AWESOME....dark, private, quiet...he always did so well during KC.

After hearing that NICUs still operate with 25 babies in one room...I am shocked. Do we not know that we are *trying* to protect their brains?

Lori

Chris and Vic said...

You may be surprised that I don't have too much to say on this . . .
*Theophylline changed to caffeine.
*The equipment changes rapidly--better, more hi-tech vents--jet vents and oscillators as opposed to conventional vents.
*Hopefully many more are believing in the value of "developmental care," decreased noise, low light, fewer interruptions in the infant's sleep, not weighing a baby daily in the first 2 weeks (for the smallest babies), etc.
*STEROIDS used much less frequently (should be at the top of the list).
*We have lowered our oxygen use, to keep sats at 88%-95% approx, rather than 92%-100%--in keeping with what we know the intra-uterine environment to be. (Hopefully, less ROP will be a result.)
*Our use of Indocin has changed, for closing a PDA.
*Epogen IM for anemia.
*More and more use of central lines for extended TPN. Fewer peripheral lines/IVs. Which decreases sepsis.
*Laser surgery for ROP in the NICU.
*We use an i-Stat for monitoring labs--immediate feedback on gases, chemistry panels, creatinine, etc.
*In the last 18 mos or so, we have different bili lights. Some places don't use overhead lights at all any more--only "blankets" or lighted trays.
*As in other areas of the hospital, the IV pumps have more failsafes built into them to prevent over- or under-doses of meds (med errors).
*High alert meds are not kept on the unit in a "stock" drawer. The pharmacy must prepare these meds and send them up in unit-doses--to prevent med errors. Ex. potassium, insulin drips, pressors.
*Respiratory therapists and neonatologists now attend many of the c-sections, on stand-by, so to speak. Those deliveries are watched more closely for distress of the infant (usually related to the reason for the c-section, not necessarily related to prematurity). When I read the notes after the fact, I frequently see "blow-by" oxygen, suctioning, etc. It used to be that an NICU RN and an RT went back--now the RT goes back with a doc. This happened more than 8 years ago where I work.
*RTs intubate at delivery routinely. This practice is older than 8 years, as well.
*Neonatal Nurse Practitioners (NNPs) often stand in for docs, for some routine issues. (See Ex Utero's Toby story.)
Chris and Vic

Jennifer said...

When I was in the NICU in 1978 my mother was told essentially 'we'll call you when she's ready to go home'. She didn't get to really hold me until I was home.

She worked at the hospital so she did see me every day but she didn't get to hold me very much.

They also had breastmilk banks and she pumped enough milk for the entire nursery.

The nurses in my daughters NICU said that was customary for their unit in the late 70s also.

The thing I didn't like about our NICU experience was having to leave during medical rounds. I remember arriving just prior to rounds and not be allowed in - I had to sit in the waiting room with another family as they talked about the preemie who was having lots of problems that day. Turns out that was my daughter - she was back on CPAP after 4 days off. Turns out a nurse forgot her caffeine for 2 days! The nurse who was on was very upfront with the mistake - but I was pissed. I was also not told of my daughters Grade II IVH because it was in her 'medical book' which the nurses don't have access to. I found out at her first peds appointment.

The lack of privacy was awful - having to take of your shirt to breastfeed in front of other people is awful. There were never enough chairs - we'd end up standing around her isolette for hours until another mom and dad left and we could grab their chairs. It got so bad that I would make a beeline to the chairs as soon as I got in and grab one for each of us.

Thankfully they are building a new NICU with private rooms. Would have been nice for us...

Chris and Vic said...

Privacy--yes. I have been to two newer units lately---they have private, or at least curtained spaces for each infant. Where I work, there are 4-6 infants per room. One of the NICUs has floor-to-ceiling curtains that can be drawn around the beds.

*I think that MRSA affects NICU care in the last 8 years, with isolation procedures in effect a lot more than ever before. Not to mention the primary issue of infants exposed to the methicillin-resistant staph aureus--and the meds used to try to eradicate the MRSA from the infants' systems. I believe MRSA to be an invisible epidemic in the community as well as in the hospital. (Sixty percent found in skin and wound cultures in 15 cities' EDs in Oct. 2006 qualifies as an epidemic to my way of thinking.)
*At many NICUs there is a push for breastmilk as the infant's first and best food. There are lactation consultants on the "team".
*Speaking of teams, there are now "interdisciplinary teams" caring for patients--not just a doc, not just a primary nurse.

*Docs and nurses are supposed to work with respiratory therapists (always a big part of the team with an excellent working relationship among us where I work, but not so everywhere, I guess) and occupational or physical therapists and pharmacists, and lactation consultants, as well as the neuro consultants and eye docs. As in teamwork.

*There are "recreational drugs" out there--I see a lot of this where I work. Cocaine. Heroin. Alcohol, always. Recently there was an infant who was positive for benzodiazepenes, the worst is the Methadone-withdrawal scourge
. . . but I am concerned about all the infants who are exposed to their mom's anti-depressant meds, as well. Nothing illegal going on, but I cannot believe that there is no effect on the child. And then, the further question about the presence of those drugs in breast milk.
*Hepatitis B is now given before discharge after only a 24-hour stay in most places. For NICU infants, there are other vaccines given close to discharge--that is not so new, but there seem to be more and more vaccines . . .
*The metabolic screen or the "state screen" now looks for about 20 inborn errors of metabolism---used to be only PKU and Maple sugar urine disease and one or two others. There are now designer formulas for kids who test positive for these rare inborn errors of metabolism, to prevent cognitive disability.
*Formula companies are copying breastmilk, that is, finding more and more elements to copy (AHA, DHA? I don't even know what these symbolize at the moment) from breastmilk. So the formulas have changed. I mixed a 26-calorie formula the other day! That is a hefty increase in calories (the traditional formulas and breastmilk being 20-cal). There used to be a limited number of ways of mixing formulas--now there are many techniques and formulas for mixing. Our formula-mixing area is now a sterile-technique area. There is a scale to weigh powders, for more exactitude, etc.
Chris and Vic

Anonymous said...

My NICU experiences were in 1990-91 (as a nursing student) and ten years later in 2001 with my surviving twin, who died after several days.

In both cases, we had the warehouse experience, although in '01 they made much more attempts to make things much quieter.

What was bad was the inability to visit our daughter for long periods of time. There was only one "parent room" which we had to sign up for by the hour. I was recovering from weeks of bedrest followed by a crash section with a surgical wound that was literally falling open as fluid continually poured out of it. I couldn't stand that long, or even sit on one of the little chairs for any length of time without feeling like I was going to pass out, and we lived 1/2 hr away from the hospital. Having been in their PICU, I can tell you, treatment for the older kids' parents is so much better - everyone has a private room and their is a place for the parents to sleep at bedside 24/7. Also the NICU makes you leave from 7-8 both am and pm for shift report.

When we went back to have our youngest child, I told them in no uncertain terms that if he needed the NICU, we were not leaving for any reason. Not for shift report. They could just get a gurney and wheel me in from the OR after the section. If they wanted to get me away from the baby, they were going to have to call the police. Literally. The hospital was not happy about this, but they agreed if we needed the NICU, they would give us an isolation room, which is private. So glad we had a healthy, term son, and it was not an issue.

Neonatal nurse practitioners were definitely a new addition - and we had NO IDEA that random NNP were showing up at our daughter's bedside, writing orders and performing procedures until one ended our daughter's life performing a non-emergent procedure without our knowledge DURING HER TWIN SISTER'S FUNERAL! (I think they didn't want us underfoot while it was going on.) Let me tell you, having the NNP's was NOT helpful. The neonatologist sure did not take responsibility for the botched procedure (which she had ordered and supervised) and her associate just said "well, that wasn't our nurse"

Well, I'm ranting at this point. so I'll stop.

Anonymous said...

ps, whoever suggested central lines decrease sepsis may want to rethink that -- infection is one of THE MAJOR complications of any central line (a little 26 weeker a few graves down from our twins died from it) as well as peripherally inserted central lines are inserted frequently by these NNPs, let me tell you first hand with varying degrees of skill. They are, unfortunately, very necessary for TPN, however, if the baby needs TPN, or a drug like dopamine, it really needs to go through a central line.

terri w/2 said...

My girls were born at 25 weeks nearly 21 years ago - the NICU we were in was baaaad. Phones ringing constantly at the nurses' station (our girls isolettes were parked up against the nurses' station). On Sundays, football games were blasting from a radio in the nurses' station. Back then (1986) ALL of the baby's cardiac monitors were audible.

We also were kicked out during shift changes, and we were NOT allowed to talk to any other parent while visiting our babies.

Have there been changes to this NICU from way back then - absolutely. It's from what I've heard much, much quieter. And, I'm sure the spiffy new gadgetry looks all impressive and everything, but. . does this mean that NICU's of today no longer are seeing IVH's, ROP, severe hypoxia, NEC, etc? No, it doesn't.

So. .even with the developmental friendly changes in the physical environment, and a few tweaks to the equipment, have things REALLY changed for the babies born after my girls? I doubt it. But boy, there are neos and pediatricians who sure do want everyone to think so. Until IVH's, ROP, BPD, NEC are no longer buzz words in the NICU, really - these changes are pretty much meaningless to outcomes.

Helen Harrison said...

One change is the advent of MRI imaging, making it now possible to begin to figure out why so many preemies (75%) currently leave the NICU with significant brain damage and/or abnormalities.

It seems that premature delivery *in and of itself* (even without prenatal problems) is a major culprit.

Then there is the ventilator.

Steroids are a significant cause of brain damage,as well, although some hospitals are now cutting back on their use.

Infections are also important villains and more investigations are underway.

Stay tuned for news on nitric oxide.

Otherwise, outcomes have not changed -- except for a rise in handicap during the 1990s (probably due, in part, to steroid use) and a reduction in the last two years or so, bringing us back to the severe handicap levels of the 1980s.

Anonymous said...

QUOTE:o. ."even with the developmental friendly changes in the physical environment, and a few tweaks to the equipment, have things REALLY changed for the babies born after my girls? I doubt it. But boy, there are neos and pediatricians who sure do want everyone to think so. Until IVH's, ROP, BPD, NEC are no longer buzz words in the NICU, really - these changes are pretty much meaningless to outcomes."
No, things like decreasing the noise level may not decrease the amount of NEC, BPD, ROP, etc, but it probably does impact other aspects of the outcomes. Read on........

HEALTH RISKS
Premature babies are very fragile and must cope with their
environment with immature organ systems. Their auditory,
visual, and central nervous systems are the last systems to mature. These last stages of development occur,
in part, during the time the premature baby is in the incubator or NICU. It has been recognized that high
noise levels exist in the NICUs and the incubator. There are four types of adverse noise-induced health
effects on the premature baby to consider:
Hearing Impairment:
The American Academy of Pediatrics, Committee on Environmental Health has conducted numerous studies
and documented that continuous noise exposure of premature babies cared for in a NICU can result in
noise-induced hearing loss. Premature babies exposed to constant high levels of background noise have
shown abnormal development of sound frequency discrimination. The bandwidth for the reception of sound
in the ear actually increases or widens (in a noisy environment) so that the infant, as a child and as an adult,
will be less able to discriminate between frequencies.
Sleep Disturbance:
Loud or sharp sounds can cause physiological changes during sleep such as high heart rate, fast breathing,
apnea, and a drop in blood oxygen levels. These changes affect sleep, either by awakening the infant or by
changing the sleep state, which causes the infant to experience unnecessary stress and lose needed sleep
time.
Somatic Effects:
The increased number of awakenings and resultant crying effect due to noise levels in the incubator and the
NICU, are a potential cause of hypoxemia and source of neonatal morbidity. Fluctuations in arterial oxygen
tension, blood pressure, and intracranial pressure may contribute to hypoxic brain damage. The decrease in
oxygen saturation of blood can affect the development of vital organs. The infant residing in a NICU or
incubator can experience acute effects many times in the period of rapid brain growth. Potential conse-
quences include increased risk of weakened vessel walls in the cerebral vasculate.
Auditory Perception and Emotional Development:
Current knowledge strongly suggests that stimulation provided by the auditory environment plays a role in
the emotional development and in the development of auditory perception of the baby. The sound quality in
an NICU and incubator is reduced, since speech and other relevant sounds are masked by different noise
levels. The premature infant may have difficulty in making fine discrimination with respect to (the intonation
of) the voice of the mother and caretakers, which may result in hindering the infant’s emotional development

Sammie said...

My twins were born at 24 weeks in June 2004... they were put in and open bed with an oxyhood on it after intubation and stayed there until 8stable* enough for an isolette, the NICu was bright and blankets were used also for the babies... one of my twin spassed away from complications. Our surviving twin had a 77 day NICU stay with no brain bleeds, no surgeries while in the NICU... he did have laser eye surgery for ROP after coming home. h ehad daily heel sticks and has the scars to prove it,lol. You can see a *timeline* of all his NICU procedures here:
http://www.n8andnoah.com/TABLE/timeline.html

Chris and Vic said...

Anonymous, can you give the reference for your quote, please?
Thanks

Some of you may know that Neo Doc has had a discussion re:Village over at his blogspot. Towards the end of his responses, there begins to be a good discussion on suffering . . .

I think the way we have acknowledged pain has improved in the NICU, tremendously, in the last 8 years. It is a nursing thing, mostly. We have 2 pain scales that we use to assess a baby at least once a shift.
There is an abstinence scoring form too, for kids who are withdrawing from cocaine or methadone--or who are extremely irritable and who we think may be withdrawing from some substance.
I think these are some of the most to-the-point changes there are---in respecting an infant's pain.
Chris and Vic

Elizabeth said...

I just ran across you blog today while checking the stats on mine - someone googled us!

My son was in the NICUs at 3 different hospitals. They all tried to keep the rooms quiet and dimly lit when possible.

At NICU #1 there was a phone next to each baby. The babies where in a cirlce, divided in the 4 "rooms" with 2 walls for each baby. They kept the lights off unless in the "rooms" except for the "room" the nurse or dr was in. There where about 4 of the circles in a big room and there where 2 big rooms. This helped with noise and privacy. Each nurse had 2 babies. There where also a couple of parents rooms.

NICU #2, was at an old hospital. There where halls of babies - about 5 babies in each hall with a curtain to seperate. At the end of each hall was a private room for the very sick babies. There was also semi-private room and "swing" rooms for babies that barely needed ICU. This was the brightest of the 3 NICUs. This was also my favorite NICU. The nurses and doctors seemed truly concerned about how my husband and I where doing. They encourage us to hold our son and kangaroo him. They also let us help with everything - tube feeding him, changing his ostomy bag, everything. 2 babies per nurse.

This hospital had another NICU for the babies that were about to go home. In that part, each baby had a private room and parents were encouraged to be there 24 hours a day. There was nurses station at the end of the hall.

NICU #3, was about 10 years old. It was just 3 big rooms full of babies along the outside. Each room held aobut 10 babies. There where 2 private rooms and 2 parent rooms. This NICU was the loudest. Again, 2 babies per nurse. We spend the most time at this NICU, it was our sons birthing hospital - he went to the other 2 for his surgeries.

There was a difference in equipment at each hospital. At one point, he didn't need a CPAP, but wasn't ready for a nasal cannula. 1 of the hospitals had a high-flow nasal cannula. It was perfect for him, but then he tranferred hospitals.

My son spent 6 months in the NICU (and 2 weeks in the PICU). He was born October 10, 2005. He died April 24, 2006 from overwhelming sepsis due to NEC (round 2 for NEC).

I thought I was the preemie experiment. ;)

Sarah said...

"After reading many posts from parents of early preemies, who are still under a year old, I am finding that many of them seem to have more issues, early on, than those preemies born around the time when my daughter was born. More of them are coming home on oxygen. More seem to have ROP. Many more of them seen to have brain bleeds. By far, many more of them have hearing loss."

I am sure its been mentioned before but maybe the higher rate of complications is due to the higher rate of surviving elbw preemies? There must be a relation in the numbers somewhere.

In answer to your larger question. Our NICU experience sucked. 70 days in a loud room with 8 sometimes 10 babies at a time. No primary nurses and in fact, quite a noticable nurse shortage. No high-flow cannula, no high frequency ventilator and I had to ask the nurses *often* to be quiet around Jack's isollette. This NICU does not have a developmental clinic so I am left trolling the internet for local resources...This was at a major NYC hospital, known for its birthing center and the NICU is a level III.

The Preemie Experiment said...

Thank you everyone for adding to this discussion!

One change I am noticing is the care and concern over sensory stimulation (sound, lights, etc). I am so thrilled to see this taking place!! Dr. Heidelise Als has done so much work in this area.
http://www.childrenshospital.org/cfapps/research/data_admin/Site2265/mainpageS2265P0.html

Our NICU was horrible with respect to sound. It was a 40 bed NICU, separated into sections of 8 babies. There were 2 - 3 nurses in every section. The nurses would yell over to each other (I think this was due to understaffing at times), there were phones at every incubator that would ring off the hook, and the helicopter landing was above the NICU!

Lori, Wow! A NICU with private room care! That's wonderful.

Chris, Thank you so much for such a detailed comment! I was really hoping you would lend your expertise. Thank you.

Jennifer, I hear on the frustration of not being present during shift changes! So many times hubby and I would get to the hospital, after driving 90 minutes to get there, only to be shut out for 30 minutes. One time we were waiting in the hall and I overheard parents talking about OUR daughter. They also made a comment about how sad it was that her parents weren't there for her! I was devasated. Also, our NICU had a hallway that you could go down and peek through windows to see the babies. Once, when I arrived during shift change, I was watching through the windows only to be horrified because they were working on our daughter because she had crashed. Since it was shift change I had to stand by and watch, without being able to even go in there after they stabalized her (still 10 more minutes of shift change).

Anonymous (11:43 am), It's amazing how strong willed we become when we have a second child. You wrote: "I told them in no uncertain terms that if he needed the NICU, we were not leaving for any reason. " When my son was born (7 1/2 years later) nothing was going to stop me from being with him. I threatened to walk myself down, 6 hours after my csection, if the nurses wouldn't help me.

Terri wrote: "Until IVH's, ROP, BPD, NEC are no longer buzz words in the NICU, really - these changes are pretty much meaningless to outcomes." AMEN!! This is what I was trying to get to the bottom of, by asking about NICU's. Not only are those buzz words still around, the babies seem to be worse. Now, admittedly, this is just MY observation. But, when I read all of the posts on the preemie lists, those babies are coming home with more equipment than they did when my daughter was born.

Helen said, "One change is the advent of MRI imaging, making it now possible to begin to figure out why so many preemies (75%) currently leave the NICU with significant brain damage and/or abnormalities." I had forgotten all about that Helen, thank you. It will be interesting to see if anyone will be following the kids that had early MRI's, as they get older (beyond age 2 please!).

To those who have experienced loss.. I am so sorry. I appreciate your comments. A woman who has been very present on my blog, started her own blog to discuss the passing of her twin preemies. Her blog can be viewed at www.lossesandgains.blogspot.com

Chris and Vic said...

Another important change is related to HIPPA--confidentiality.
You, as a relative or the father of the baby (if you are unmarried), cannot receive any information until a mother clears it.

Some NICUs have video visits--you can see/visit your baby via a TV cam.

Nitric oxide treatment. I have only seen this used very rarely. In our hospitals, there is disagreement still about the protocols.

Some NICUs do ECMO. Mine does not.
A child needing ECMO is transported, when stable enough, to Children's Hospital.
Chris and Vic

Chris and Vic said...

Just a bit off-topic but well worth noting, I believe--Jodi Reimer, at Reimer Reason blogspot, is presenting her "top 10 tips for parent advocacy". She began yesterday, 3/6/07, and it looks as if she is doing one per day. She is a professional. I really like what she is writing.

http://jodireimer.blogspot.com:80/

Chris and Vic

Anonymous said...

My sons NICU was one big room with 50+ beds on the level 3 side. It was loud and bright. Sounds arcane eh, except that he is only 2. They used covers on the isolettes but that only does so much. I didnt know how different things could be until I heard from others here.

Anonymous said...

Our daughter was at Brigham & Women's (Boston) NICU and it was 10-20 babies in a room in isolettes. Lots of noise and light. No privacy. I think we should start naming the hospitals. These are verifiable facts, not opinions. If exposing the poor physical plants that need updating helps to make them better, then we've accomplished something!

I also have an opinion that we had great nurses who expertly and deeply cared for all of us. I will be forever indebted to our daughter's dedicated nurses.

Chris and Vic said...

Thank you for your tribute to nurses. I wrote recently to another blogspot to ask a doctor to write about suffering/pain in children. But the truth is, the docs may not know about suffering and pain in neonates, except indirectly through nurses' reports and nurses' insistence. Likewise, it is the nurse who "inflicts" some or much of this pain and suffering on the baby---it is the nurse who weighs the baby; starts the IVs, and where I work, puts in the central lines. It is the nurse who handles, bathes, changes diapers,feeds--with developmental standards (containment, slow moves, etc) or abruptly and sometimes even a bit roughly.

A lot is riding on the nurse. For better and for worse.
Chris and Vic

Lori said...

Chris,

I have not contributed to this discussion having no experience with NICU's, but I have followed along with interest.

I just wanted to add my shout out to nurses!! Though it is a different area of expertise than you spoke of, I wanted to say that the L & D nurses who tended to me during my labor and then delivery of my 23 week old twins were nothing short of angels. It was a horribly traumatic time and they were my touchstone of calmness and compassion during those days. I hardly saw my OB during that time, and the OB that attended the delivery hightailed it out of there as soon as the babies were born. It was the nurses who tended to our babies, held our hands and shared our tears.

terri w/2 said...

Yesterday in nursing school, I heard a reference to "ICU psychosis" in adults. Apparently, adults who spend time in the ICU show signs of confusion, hallucinations, etc - some of it due to meds (of course) and their condition (of course.)

However, it has been observed that some ICU psychosis is due to the ICU environment itself - the lack of windows eliminating the day/night orientation, the constant activity, noise, equipment. .my first thought was our preemies who spent months in the NICU. How on earth are ANY of these kids coming out of these environments intact when their immature nervous systems are being assaulted for months?

Anonymous said...

Someone above wrote about the NP's doing a lot of care on the babies in the NICU. I am here to tell you that if I would have known that the NP's were in charge of my triplets that I would have never ever left them at the hospital that they were at. The docs came in during the morning to round and were around for a while but after 4pm, unless there was a big problem, they were no where to be found. One of my boys was re-entubated without letting us know and we were on our way to the hospital for a visit. It was an awful scene and lots of angry words were spoken but apparently the NP didnt think she had to let us know that something terrible was going on all day before we got there. I really have nothing nice to say about them. One of the boys had to go to another NICU for an ossilator and I should have moved them all there. The docs were always around to answer questions and it was so different. Hind sight is 20/20, I suppose.

Although I do have wonderful things to say about the nurses that my boys had. I am still in touch with them and update them on how the boys are doing. If it werent for them my boys wouldnt be turning one next month. Not only did they advocate for my boys but they took care of DH and me. I miss talking to them and think of them often. We are definetly making a visit after RSV season to celebrate birthday with a cake and a thank you.

Lynne said...

In 2001 my little Ian was put in the NICU after an emergency C-section. He had tied knots in his cord, and was not getting oxygen. The first nurse I met when I got there would only let me touch his hand. It was so hard to see him with oxygen tubes and iv lines. They didnt use central lines, and while the NICU was dim, there was a great amount of noise. They housed all infants in the same place. Our 36 weeker was housed right next to micro preemies. (24weeks gestation.) The nurses were so busy that talking to one was impossible. There was one nurse to every four to five preemies. (This was in a major city.) Even the micro preemies had one nurse to every two.I was only lucky enough to see the doctor twice. Once at birth and once during the 4th week in. My son recieved surfactin for his lungs, and several antibiotics that I cant even pronounce. Things were so busy that it was the day of his release before anyone noticed that he wasnt gaining weight and couldnt suckle properly. They released him with a nasty infection that almost killed him. He was one of less then 1 percent that are readmitted to the NICU within the first 72 hours of of release. He was home less then a day before I rushed him back. I know that the standard is improving, but it seemed so hopeless back then. He had an emlarged liver and cardio problems that they didn't even catch. The oral(yes, I said oral) antibiotics gave him an ulcer that caused infant gerd, and caused him to constantly vomit and not maintain his weight. It was touch and go for the first 2 yrs of his little life. I know that different hospitals have different procedures and staffing, but I wouldnt go back there if you paid me. Perhaps some places are not changing as quickly as they need to.

The Preemie Experiment said...

Wow, I sure learned a lot from these discussions!

I guess I thought that NICU's (the actual hospital set up-not docs and nurses) have come along farther than they actually have.

How about some uniformity amoung NICU's??

The Preemie Experiment said...

NICU nurses...

I will be devoting a post to this soon but let me just say...

I sure wish we had Chris (Chris and Vic) as our daughter's nurse when she was in the NICU!!