Twenty-Two Week Preemies, Should We Save Them?

Are you a neonatal intensive care nurse? Do you believe we should save premature babies born at twenty-two weeks? What kinds of treatments does it take to save a fetus whose viability is uncertain?

The New England Journal of Medicine recently published the results of a study showing the outcomes for five-thousand babies, born between twenty-two and twenty-seven weeks, at twenty-four different hospitals. The purpose of the study was to see if differences in hospital practices regarding initiation of treatment for these babies could explain the variation in survival with and without impairment. No babies born between twenty-two and twenty-three weeks survived without treatment. A small number received aggressive treatment, and a fraction survived, some with significant complications.

Researchers hope the study will offer physicians solid data to help them council parents. Undoubtedly, it will fire-up the debate concerning the age of viability. In a summary of a 2014 workshop, the American College of Obstetricians and Gynecologists and the Academy of Pediatrics noted that babies born at twenty-three weeks should be considered viable, as more than a quarter of them survive with intensive treatment. In the summary, it also states that no treatment is helpful for babies born at twenty-two weeks. The gray zone occurs between twenty-two and twenty-three weeks. Survival depends on factors such as birth weight and whether or not the mother received steroids prior to delivery to help the baby’s lungs and brain.

That is a narrow window. If a mother is ready to deliver at twenty-two weeks and six days, do we say, “sorry, there’s nothing we can do?” Add to that gray zone the reality that due dates are an estimation. What if that same mother was really twenty-three weeks pregnant?

In 2001, as a NICU nurse at a large teaching hospital, I cared for a baby born at twenty-three weeks. Her eyes were still fused shut and her skin was so thin the nurses only changed her diaper when absolutely necessary to avoid any injury. We kept her on a ventilator for twenty-four hours, the time it took for her parents to arrive from a community hospital several miles away, where her mother delivered the baby. She died within minutes after a respiratory therapist removed the breathing tube.

During my four year NICU career, I don’t recall any incident of initiating life-saving treatment for twenty-two week preemies. The cut off was twenty-four weeks. Many of those babies did well. For several years after they were discharged home, I kept in touch with some of the families and learned that Baby B was in first grade and reading, or Baby C was seven-years-old and playing soccer. It did my heart good to know they were healthy and vibrant children.

Technology has improved over the past thirteen years – if that twenty-three preemie I cared for in 2001 were born today and received aggressive treatment, maybe she’d survive. I’m not suggesting we stop initiating treatment for extremely premature babies, but with technology pushing us harder and further, with no indication in the near future of it breaking down, I wonder to what extent we are willing to let technology dictate? How far are we willing to turn that knob on the ventilator? What if Baby Z ends up with cerebral palsy, and is never able to walk, talk, or feed herself? And then there’s the flip side. When do we say we need to do more, we can’t give up, we have the medicine, the machines, the formula? What if we inject just one more dose of adrenaline? What if we press one more time on Baby Z’s chest? What if we do nothing and regret it?

As a nurse, I ate those kinds of questions for breakfast. But the answers are gray, and that gray only seems to be getting grayer.

Please, feel free to respond, react, reflect.

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Are You Wearing a Helmet?

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With the warmer temperatures finally here, maybe you’ve unlocked your bicycle from sitting stiff in the garage all winter, and have been riding it, hopefully with a helmet, to work every day. Or maybe you ride for pleasure – to feel spring wash over your face while inhaling the lilac scented breeze.

It’s estimated that nearly 70 million Americans ride bicycles. It goes without saying that riding a bicycle is good for your health, but doing so does not come without risks, especially if you are not wearing a helmet. More than 600,000 people go to emergency rooms each year for bicycle-related injuries. Each year, head injures account for about seventy-five percent of bicyclists who die from crashes. Out of the estimated 33 million children who ride bicycles each year, nearly four hundred die from crashes and 153 million go to the ER for head trauma.

But there’s good news: wearing a helmet can prevent eighty-eighty percent of TBIs from bicycle accidents. This solution is a no-brainer (no pun intended). But how many adults, and children do you see riding a bicycle without a helmet? You may wonder why some people choose not to wear a helmet, why some parents do not insist that their children wear one too. Perhaps parents don’t think it will happen to them or their children – fall into the road and hit their head on the pavement, or get hit by a car in the process. Perhaps they forgot their helmets and didn’t feel like turning around to go home and get them. Or they think they’ll look silly wearing a helmet. Better to look silly than the alternative.

I’ll stop lecturing and offer you this video about how to properly fit a helmet. It will only take three minutes and forty-seven seconds of your time. And, if you’re concerned about appearances, check out this site here for some stylish helmets.

If you cannot afford the more costly helmets, click here or here for less expensive ones (disclaimer alert: some of the larger corporate stores I don’t necessarily endorse). You might contact your local bike shop, school, or fire department for places to purchase helmets. This past March, during Brain Injury Awareness Month, the Brain Injury Association of America partnered with Nutcase Helmets to raise awareness about TBIs. For every helmet purchased, two dollars went to the BIAA. Is there a similar fundraising effort happening in your area?

The government is working to prevent brain injures from bicycle accidents by enacting legislation that would require bicyclists to wear helmets. Twenty states have some form of a helmet law, but most only apply to riders under eighteen. To see which states currently have laws in place click here.

Happy, and safe riding!

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How to Write About Body Image

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If you had to write about your body, what would you say?

First, let me define body image: it’s how you think and feel about your body, it’s shape and size, how you see yourself in the mirror, how you feel in your body.

Writing about your own body might feel a lot like walking through town naked. But I’m not here to encourage you to strip on the page, though a certain amount of stripping is required in order for our readers to get to know us as real human beings. The more important question is, when writing about your own body, how do you avoid the pitfall of naval gazing? Through metaphor, imagery, the five senses. When writing the following piece, my aim was to do just that – become intimate with peaches – to smell, feel, taste, touch my way toward a more positive image of my body. I chose peaches because they are one of my favorite fruits, and it was a peach I last recall holding before an elderly driver ran into me at a farmers’ market several years ago. So I guess you could say I’m obsessed with peaches and what they, particularly the one I held at the market, mean to me: changes in the body,  acceptance, re-newal, survival. I wrote with those interpretations in mind when crafting the following narrative:

I gently roll a peach between my palms, its downy coat tickling my fingers. I study the curves and arcs of its plump body. I’m searching for the perfect peach: golden hued with no deformities. But I notice that it has  a soft spot with a purplish bruise, and place it back in the display. I stand among the peaches for another fifteen minutes, picking up a scarred one, a wrinkled one, then another with a slit in its skin. These damaged peaches must taste like wood, I think. I choose one more, and bring it close to my nose. I inhale, smelling earth. I’m tempted to buy it, but notice a blemish at the base, and motion to place it back among the ones that are disfigured. I pause, and tell myself to give this peach a chance. Maybe it will taste better than it appears. I buy it, and as I walk away from the farm stand, sink my teeth into it, its blushed skin forgiving. Pulp bursts with warm juice. I stop, swallow. Summertime trickles down my throat. Sweet. Perfect. 

Do you have a body image narrative to share? If not, I hope this post inspires you to strip, just a little.

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Equine Therapy for Post-Traumatic Stress Disorder

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Are you in search of a creative, interactive approach to treating post-traumatic stress disorder?

Several years ago, when horseback riding, I reached behind me for my raincoat that was strapped to the back of the horse. As I swung the coat toward me to put on, the horse bucked and started running. I panicked and forgot what I had learned a few moments earlier – not to hold the reins too tightly, which will only make the horse pull harder, or lean forward, which signals the horse to run faster. The guide, who was not far behind me on his own horse, yelled for me to let up on the reins and sit back. I took a few deep breaths and and did as he said. The horse soon slowed, then finally came to a gentle stop. After my heart slowed from a gallop to a trot, the guide explained to me that I had startled the horse with my yellow coat.

Soon after that incident, I went horseback riding again, and had a positive experience. Since then, I have not been on a horse; I’m not sure why? As I age, am I more fearful that I will get hurt? Yes. And living with PTSD has made me more fearful of taking unnecessary risks. So why would I even think about getting on a horse to trot through wild territory? But horses are extremely affectionate and accepting animals, and have a lot to offer human beings.

For more than fifty million years, horses have played a role in transportation, entertainment, farming, and more. By nature, horses are instinctive and highly alert and, therefore, equine therapy can help those suffering from PTSD symptoms like hyper-vigilance. Horses may not speak, but they do communicate by mimicking human emotions. For instance, if you are feeling anxious, horses will react by, say, widening their eye or flicking their ears. In other words, horses are our mirrors. Their non-verbal feedback is a prompt for us to better understand our internal processes. We can then modify our behaviors. The key is to be in-tune with how horses react when you are with them. Equine therapy has been noted to help with emotional healing: among a long list of benefits, it decreases anxiety, improves social skills, assists in better communication; and increases confidence, self-awareness, and trust.

I recently decided that, in order to confront my fear of horses, I need to get back on a horse soon. So that’s what I intend to do this summer.

If you’re interested in equine assisted psychotherapy program, check it out!

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