The Prenatal Consult (part III)

This is part III of a series of posts which also currently includes part I, and part II
Picking up where I left off in this string of posts on prenatal consults. The next topic that I discuss with parents is the NICU admission. I explain that after seeing their baby briefly, the baby will be taken to the NICU. Once there, we get a weight and vital signs and start an IV. If the baby is extremely premature, then we place special IV's called umbilical catheters. The umbilical venous catheter is inserted into the umbilical vein and gives us central IV access in order to administer medications and the highest amount of IV nutrition possible. The umbilical arterial catheter is inserted into one of the umbilical arteries and allows us to monitor frequent labs and central blood pressure.


During that first hour or two, we monitor vital signs and indicators of respiratory condition very frequently. I explain to parents that sometimes even if there is no evidence of respiratory distress in the delivery room it may develop following admission. If this occurs, then we usually place an endotracheal tube and administer artificial surfactant. The baby may then require mechanical ventilation for some period of time or may be quickly extubated and placed on nasal CPAP.


I explain to the parents that the admission process usually takes about an hour. I tell them that once the baby is settled in they will be able to come and visit. Visitation in our unit for parents is virtually 24/7, though there is one hour from 6:30-7:30 am/pm that we ask them to step out in order to let the nurses do a change of shift. We also ask that they provide us with a list of people that they would like to be able to come and visit and that they stick to this list (this is to cut down on the amount of traffic in and out of the unit, a place where many immunodeficient preemies live). All visitors are required to be accompanied by one of the parents when visiting.


The next part of the consult involves a head to toe discussion of common complications and their likelihood at this particular gestational age. I'll save that for next time. Stay tuned!