I’ve written previous blogs about evidence based practice and the need for further research in the care of neonates. While there is so much to be learned in the field of neonatology and neonatal nursing, it is worthwhile to take a look at what we have learned. In other words, a trip down memory lane.
I began working in NICU in 1980 and did a 3-week student rotation before that. At the time, we had one type of ventilator – the Baby Bird. It was a ventilator modeled after the adult ventilator and vent management was modeled after adult respiratory management. Pneumothoraces were an expectation on vented babies so the needle aspiration kit was taped to the bedside of every baby on a ventilator. I specifically remember one baby in our unit who had 6 chest tubes – and at least survived to discharge. Now, we find it difficult to maintain competency on needle aspiration and chest tube management because they are so seldom needed!
We suctioned every hour? And, before suctioning, put a moderate amount of saline down the endotracheal tube, turned the baby’s head from side to side and suctioned down each side as though we were suctioning down the mainstem bronchi!
We used 27 gauge IV needles with a metal crosspiece instead of “wings”? Most IV’s were placed in the scalp and initially we only had butterfly needles small enough for infants. Gradually, over-the-needle catheters became available in the appropriate size.
Bubble CPAP was the ONLY CPAP we had?
Criteria for resuscitation and “limits of viability” was 1000 grams. This, of course, has changed to at least 500 grams and in some cases, 400 grams, more dependent on gestational age rather than weight. I do remember one baby just under 1000 grams that we placed on hood oxygen and kept warm, thinking that the baby was not likely to survive. But she was pink and active on the low percentage of oxygen we provided and after an hour, we continued care and she survived to discharge with minimal sequelae.
We hadn’t heard of “fortifying” breast milk or any manufactured formula with more than 20 calories per ounce!
The QRS volume on the cardiac monitors was turned on so that you could hear a baby begin to go bradycardic before the alarm went off (and you would often go home with the beeps still in your head!).
We worked an 8-hour shift! But, there were no mandated nurse/patient ratios or breaks. Depending on the unit where you worked, actually getting a 30-minute sit-down lunch was rare! But, we did what we did to support each other and make sure the babies had the best care we could provide.
It’s important to remember from time to time that the field of neonatology is a relatively young one. In addition, research is not easy in such a vulnerable population. Simply reviewing our experience, whether in a single unit or across the country, is important. Therefore, monitoring outcomes and practice becomes important. As you can see and many of you have experienced, things that once were done for lack of equipment or resources, turn out to the best for the patient such as bubble CPAP.
I’m sure many of you have similar memories and many more of things we tried that may have worked or did not work but was the best we knew at the time. It is only through knowledgeable inquiry that we discover the best for each patient, not even necessarily the best for every patient. After all, what matters to every parent is not what the odds are in general but what the outcome is for their baby!
Looking for additional reading on this subject?
View Sandy Beauman’s related blog entry, Neonatal History.