I need help/information from those of you who work in NICUs.
I am a Certifed Nurse Midwife in Milwaukee, WI. One of the hospitals I
work in has made great strides towards being mother & baby-friendly, but
recently I have encountered some instances of (from my point of view)
quite conservative management of newborns.
We recently had a woman deliver at 34 6/7 weeks after being ruptured for
about 8-9 hours. The baby weighed 5 lbs. 3 ounces, was OK at birth with
Apgars of 7 and 8, and was pronounced "totally fine" by the Neonatal nurse
practitioner present at the birth. He went to the nursery largely because
of his gestational age, not because of any problems. The next day my
partner went in and found the baby in the nursery with "breathing
problems" per the Mom, on oxygen, but no ventilator.
I was in today. Baby is now almost 48 hours old, with normal BP, heart
and resp. rates, O2 sats of 94-97% with a nasal canula. He also has an IV
for antibiotics. Mom is upset because she has not been allowed to hold
him since birth. When I tried to find out why, the nurse said that he was
unstable yesterday, and that if they did much of anything to him that he
desaturated. He is apparently better today, but they are still reluctant
to let her hold him.
I my previous life I was involved as a LC with 30-32 week (occasionally
younger) babies whose parents were encouraged to hold them skin-to-skin.
Occasionally, even a stable baby on a vent did Kangaroo care, and we had
at least one 31-32 weeker that sucessfully BF. I am having a hard time
understanding this situation in light of my past experiences. I called
and spoke with a nurse in the NICU at the other hospital where I practice,
and she confirmed that they also do Kangaroo care on much smaller, much
younger babies, even some on vents. What might I not understand that
explains their reluctance? Or is this, as I suspect, just very
conservative management?
I also need to know what others use as their standard for hypoglycemia in
term infants, not LGA, not babies of diabetic Moms. They are
supplementing quite a bit for blood sugars under 50. This led one of my
Moms last week to worry a lot about her baby, and to beleive she still
needed to supplement on the third day. It took some major convincing on
my part to get her to understand she did not need to continue
supplementing at home. I suspect she may actually be giving some
formula "just in case" to her now ten day old baby.
When I asked about the blood sugar policy, the same nurse told me their is
new literature out that says that the goal is to keep the blood sugars
above 50. Is that so, and I just don't know about it? Has anyone else
heard this?
I plan to go up the chain of command to the NNPs and possible the
neonatologists. I would appreciate hearing from you NICU folks about
these issues. If you could email or fax (414-444-5661) any policies or
practice guidelines, I would be quite grateful. To prevent clogging the
list, please feel free to respond to me directly.
Hello to all my friends and proteges in Michigan and Delaware. I miss you
all.
Thank you.
Janet DeCoopman MS, CNM
3554 N. Prospect #3
Shorewood, WI 53211
(414) 315-4083
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