How We Deal With Bad Baby's In A Small Town Hospital

It was 1997. A senior RT introduced me to OB for the first time. She showed me the Sechrist ventilator. It seemed stressful enough. But, then she introduced me to an older ventilator. I think it was called a Baby Bird. Now, that was a stressful baby ventilator.

The Sechrist was a great ventilator for its time. You plugged it in. And then you dialed in some settings. My preceptor taught me that all you have to do is remember numbers, such as 5 and 20. You set the PEEP at 5 and Pressure Control at 20. You set the rate at 30 or whatever the value was back then. And there were a few others to remember. Then you adjusted to meet the needs of the newborn.

But, they were all simple to remember. And then you set it up on the baby and didn't have to do much more.

This was nice, because it's stressful enough when you have a bad baby. When you work in a small hospital like I do, you might get only one bad baby in a five year period who requires a ventilator. So, it's good that you have something that is easy to set up if you do need it. But when I was introduced to that Baby Bird or whatever it was, that was stress. It was so confusing that you even had to take out a calculator to determine what your ventilator settings would be. It was stress just thinking about it.

Then we advanced to the Servo 300. It just sat back in the closet collecting dust. Well, not really, because we took it out monthly to play with it. We had fake scenarios that we would do. We needed to practice because we use this machine so seldom. And the few times we did have to set it up we were applauded by the nursing staff. They were so often impressed at how we therapists set it up with such aplomb. It was, as a nurse once said, as though you guys set these things up every day."

Then we advanced to the Servo i. By this time we also had another new machine. It was called the Neopuff. When this machine was first bought by the OB supervisor we RTs were annoyed. We weren't even checked off on it. We had no idea what it was. And we refused to use it. Instead, we resorted to the old method of bagging babies. Carefully squeeze, but not enough to pop a hole in the baby's lungs. Not easy to do, especially when you had to bag for 4 hours until the baby buggy arrived from larger hospital down south.

Then we started taking Neonatal Resuscitation. And here we learned of the value of the Neopuff. We learned how dangerous bagging was. That even minute changes in the pressures when we squeezed the bag could damage those baby lungs. And the Neopuff guarantees that each breath will be the same depth. Using it greatly reduced the incidence of conditions like hyaline membrane disease and bronchopulmonary dysplasia. Yep! Remember learning about those diseases?

Today we are told intubations can cause trauma to newborns too. Well, that makes sense. But, when a baby can't breathe, a tube is still needed. But, our protocol no longer calls for intubation on infants that are breathing. Even if they are retracting. And Lord knows infants born too early to make their own surfactant do need assistance. But, today the Neopuff can provide CPAP. So, we are encouraged to use it rather than intubate.

It's to the point now that we no longer even have a neonatal ventilator. Well, we have one, but it's no longer stored in OB. Basically, modern evidence shows CPAP and ship to larger children's hospital. Today I applied that CPAP to infants faces for four straight hours. Silly that we can't use our ventilator to apply that CPAP to the infant. But, this is how it is when you work at a small hospital. The experts at the children's hospital where we transfer infants to said it's best that we just use the Neopuff and leave everything else to the experts.

The baby buggy arrives eventually. Usually, it's 3-4 hours. And then we ship the baby. And our stress is gone. But, still, with the Neopuff and no ventilator, there's really not much to remember anymore other than the basic Neonatal Resuscitation stuff. A far cry from just 2 years ago.