Here is the closest place to death and the hope of rebirth-neonatal intensive care unit (NICU).
From July 28th to 30th, reporter Yu Meijun walked into NICU, the Second Hospital of Shanda University, and conducted a two-day and one-night interview, recording NICU's "various human beings".
"NICU" can't even be brought into the cup.
There are no four seasons, no day and no night, 365 days a year, 24 hours a day, all in the same working state: this is a place called NICU. As the transshipment center of severely ill newborns in the province, the Second Hospital of Shanda receives seriously ill children transferred from other hospitals almost every day.
Nurse Wang Li said that when the second child was released, there were more than 70 children in the intensive care unit. One person has to take care of 14, 5 babies, as busy as a bee. I don't know how many times, when she and her colleagues took a shower after work, they were tired and wronged, and tears flowed down the water. ...
NICU implements a shift system of work 12 hours and rest 12 hours. Liu Aihong, the head nurse, explained that the error rate of diagnosis and treatment will increase during the shift, which will lengthen the shift period and improve the safety of diagnosis and treatment.
For nurses, the night shift does not need to bathe the baby, do oral care, and there are many other things, such as changing diapers, feeding, injecting, and writing a 2-3-hour nursing diary. At one or two in the morning, the baby should be weighed.
As for the sudden deterioration of the baby's condition, the hospital urgently transferred to a critically ill child, and it was day and night.
On the evening of July 27th, Jiang Xue, director of pediatrics on duty, and Zhu Xiaobo, deputy director of NICU, intubated two asphyxiated children and took away two seriously ill babies.
Director Zhu said that in fact, intubation twice a night is not too much. Sometimes when a patient arrives, a string will come. For asphyxiated children, put them on a ventilator in time. It is common to intubate four or five emergency patients in one night. The night doctor is very busy and under great pressure, so the hospital has set up a monitoring post. When the doctor on duty is too busy, the doctor should be on call. ...
At 0: 00 am on July 30th, Dr. Wang Yayun was still writing the doctor's advice. From 5: 00 p.m. on July 29th, nearly 50 critically ill children, each of them should know their own condition like the back of his hand, adjust the doctor's advice in time and deal with emergencies. "Too busy to have a drink" is no exaggeration. Many people may not know that in NICU, even water cups can't be brought in.
At 0: 20 am on July 30th, Dr. Yayun adjusted the doctor's orders, and nurse Han Min put down her work and checked the doctor's orders with two other nurses, which is also a daily routine.
65438+ 0: 00 in the morning, Xiao Xibao, who had just finished surgery during the day, was so hungry that she cried and sent it to her mouth with her little hand. But after surgery, you should fast, and you can't feed when you are hungry. Nutrition can only be supplemented through veins.
Xiao Xin wore a ventilator during the day and became the focus of night nurses. At 1:40 in the morning, the ventilator in Xiao Xin showed that the airway pressure was too high. The nurse immediately cleaned Xiao Xin's respiratory tract by suctioning sputum, and another nurse cleaned the condensed water in the respiratory pipeline, which was skillful and gentle. Xiao Xin's small breasts fell together, not as anxious as in the afternoon. The condition is relatively stable, and doctors and nurses are very pleased.
At two o'clock in the morning, the baby who had a small bowel resection was going to have a blood transfusion. Before blood transfusion, the two nurses took turns to check the information on the plasma bag and the doctor's advice. At this time, the baby with ventilator was still asleep quietly and had a major operation. I hope there is no pain in the dream of the baby who survived.
At 2: 30 in the morning, another baby had a condition, and his blood oxygen was brushed off. It was the same old problem: apnea. The nurse quickly turned him over and patted him on the back. This premature baby was only born for more than 6 months and lived in NICU for more than one month. He hasn't learned to suck milk yet, so he can only supplement nutrition through stomach feeding, and he is not skilled in breathing. He often falls asleep and forgets to breathe.
At 3 o'clock in the morning, Dr. Wang Yayun has been working continuously 10 hours. She checked every baby, and when there was nothing unusual, she went to the rest room next to her to take a nap.
At 3:30 in the morning, Xiao Xin's breathing was still not smooth and his throat was purring. The nurse sucked his sputum through the drainage tube, several times a night. ...
At five o'clock in the morning, the plasma prepared by the blood bank for the baby arrived, and the nurse ran to wake up Dr. Yayun to make a doctor's order.
At 5: 30 in the morning, the storm at night has stopped, it is already bright outside, and a new day has begun. Dr. Yayun said that NICU had a rare and safe night. ...
The reporter waited for two days and one night, just in time for the rotation of Dr. Yayunbai and Cheren. The day shift is from 7: 40 to noon 12: 40 on July 29th, and he took four hours off after work. The night shift lasts from 4: 40pm on July 29th to12: 40pm on July 30th, with a two-hour break. Calculated, the day shift+night shift is 29 hours, and Dr. Yayun only took six hours off.
"Mao Mao" snatched from the jaws of death.
In NICU, most of them are premature and seriously ill babies, and their condition changes rapidly. They often eat and drink a lot one second, and the next may be a matter of life and death.
In NICU, the Second Hospital of Shanda University, there are nearly 50 critically ill babies, 70% or 80% of whom are premature babies, less than 28 weeks old, and it is very common to weigh two or three pounds. With the liberalization of the two-child policy, there are not a few elderly pregnant mothers, and the incurable diseases of newborns have also increased significantly.
Here, life and death are often only in an instant!
At 4pm on July 28th, Mao Mao, a premature baby, suddenly developed symptoms such as dyspnea, flabby skin and abdominal distension ... The attending doctor Wang Yayun immediately put the baby on a ventilator. At this time, the baby was still bleeding, the alarm of the monitor kept ringing, and the atmosphere was very tense.
Dr. Wang Bo rushed to discuss his illness with Dr. Yayun, suspecting that the baby had hemopneumothorax and necrotizing enterocolitis (NEC). Wang Bo put the stethoscope on Mao Mao's stomach, which may be a little cold or painful. The motionless Mao Mao cocked his feet, which made people feel some signs of life.
Looking at the baby's body full of tubes, it is at stake, and I am very worried.
"The most feared complication of premature infants is necrotizing enterocolitis. When I was feeding, I suddenly felt abdominal distension, and my bowel sounds disappeared ... "Wang Bo said that Mao Mao had been admitted to NICU on June 22nd, and her weight had increased to 65,438 0.74kg for more than a month. It's ok to breastfeed in the morning, but he didn't expect an accident in the afternoon.
On the evening of July 28th, Mao Mao's condition was very critical, affecting the hearts of all medical staff in NICU. In addition to the night doctors, the day doctors who have already left work also rushed back immediately. At eight or nine o'clock in the evening, Jiang Xue, director of pediatrics of the Second Hospital of Shanda, Zhu Xiaobo, deputy director, and Liu Aihong, head nurse, also came to guide the rescue. They were all racing against death.
After a night of soul-stirring rescue, Mao Mao finally survived the most dangerous moment and waited until dawn.
On the morning of July 29th, Mao Mao, who struggled with death all night, went to pediatric surgery. Early in the morning, nurses began to get busy, preparing breathing airbags, oxygen bags, sputum suction and needle sealing.
Dr. Wang Yayun said that the baby is necrotizing enterocolitis, and it is necessary to do abdominal exploration to see the degree of intestinal necrosis before deciding the next surgical plan.
Everything was ready at 1 1 on the morning of 29th. One nurse was holding little Mao Mao, and the other nurse quickly squeezed the air bag and sent the baby to the operating room quickly. At that time, the baby was accompanied by four family members. Seeing that the baby has suffered so much, everyone has tears in his eyes and a sad face. At 4 o'clock in the afternoon, Dr. Yayun introduced that the baby was sent back to NICU after the operation. The lower part of the child's small intestine is necrotic, all of which are removed, leaving only the upper part 50 cm.
On the morning of July 30th 1 p.m, after emergency operation, Mao Mao Jr. was in stable condition and temporarily out of danger. "It is our greatest pleasure to save the baby from the jaws of death." Dr. Yayun breathed a sigh of relief.
I came to an end when I was born.
"Newborns with a gestational age of less than 37 weeks and a weight of less than 2.5 kg are premature babies, and those with a gestational age of less than 28 weeks are very premature babies." Wang Bo, the attending doctor of NICU, said that there are also some seriously ill babies who have experienced a short life at birth.
Wang Bo said that it is not too difficult to treat premature babies as long as there are no serious complications. I am afraid of serious complications and can't get timely treatment. Not long ago, a seriously ill child came, pneumothorax and pulmonary hypertension. Because of being dragged in the hospital below for a long time, the child has difficulty breathing, and the oxygenation index is stubbornly declining, which can be said to be a dying state. Although the ventilator and nitric oxide were used, it still didn't help, and it was too late for parents to cry and regret. Doctors also regret that once pulmonary hypertension is advanced, it will be difficult to save it. If the child is treated early, there may be a chance.
Wang Bo introduced that the front line of NICU rescue has been transferred to the delivery room. Generally speaking, high-risk women are accompanied by Dr. NICU during the delivery process, and once the child has any problems, they will be treated at any time. A child with umbilical cord prolapse was born a few days ago and did not breathe spontaneously. After a long period of rescue and cardiopulmonary resuscitation in the delivery room, he was transferred to NICU after his condition improved.
What impressed Wang Bo the most was a child weighing only 400 grams, who was rescued two years ago. His mother gave birth prematurely at the 23rd week of pregnancy. Because it was difficult for parents to have children at that time, I wanted to stay hard. Dr. NICU went straight to the delivery room to give birth Wang Bo said that the child was too young to breathe spontaneously at birth, so he was taken directly to NICU after intubation. However, this premature baby is very easy to cause intracranial hemorrhage. Later, the child developed cerebral parenchymal hemorrhage and the prognosis was very poor. Finally, my parents gave up reluctantly.
Wang Bo said that although 300g and 400g premature babies were successfully treated everywhere, the success rate was very low, and more than 80% of them were difficult to be rescued. Wang Bo said frankly that although a child is connected with a family, some babies can barely survive after treatment, but the prognosis is not good, especially cerebral palsy. In the future, children will suffer, and the whole family will suffer. Whether it is economic pressure or psychological pressure, we will clearly inform parents of this situation. Generally speaking, for severely ill children with poor prognosis, rational parents will reluctantly let go. However, in the face of their own flesh and blood, as long as the children do not give up and have a chance, most parents will not let go first.
Zhu Xiaobo, deputy director of NICU, also introduced that a premature baby with gestational age of 29 weeks and weight of 1 180g was transferred from other places on July 26th. Because of intestinal perforation, an emergency bowel resection was performed on the 28th. The baby's small arm is only as thick as an adult's finger, and the condition is quite serious, but the parents still insist on rescue. Zhu Xiaobo lamented that the parents who saved their children at all costs were really touching.
Those babies who have "experienced 81 difficulties"
Due to organ hypoplasia, premature infants often have complications. In NICU, life and death first aid can happen at any time. It is normal to take part in this kind of severe rescue every day.
After graduating from Kloc-0/2, Zhu Xiaobo came to the Second Hospital of NICU. When the reporter asked about the most dangerous cases encountered in these years, Director Zhu said with a wry smile that there are no most dangerous cases, only more dangerous ones. The child's condition changes rapidly, such as septic shock, hemopneumothorax, pulmonary hypertension ... which situation is fatal? The baby can't talk. You can only find the cause of the disease and treat it quickly through clinical manifestations, just like the police solve the case.
In NICU, time is life, and a minute's delay means great danger. Zhu Xiaobo sighed, children's vitality is really tenacious. Those severely premature babies need to go through many hurdles such as breathing, infection and feeding, which can be said to be 81 difficulties. However, as long as it succeeds, giving some sunshine and some soil is basically brilliant. Therefore, every baby who walks out of NICU is a hero of his own life.
More than a month ago, a seriously ill baby was transferred from other places, and his breathing and heartbeat were almost gone. Dr. NICU urgently contacted multidisciplinary experts such as ultrasound, chest X-ray and surgery for consultation. Pulmonary hemorrhage, hemopneumothorax, pulmonary hypertension ... Even if only one of these serious diseases spreads to a person, they will come back from the dead.
In view of the diagnosed condition, the experts handled it methodically, and it took only two hours from admission to solving the problem. Due to timely treatment, the dying baby miraculously broke through the gate of hell. "This child stayed in NICU for more than 40 days. Today (July 29th), he was discharged from the hospital. His parents are as happy as children. I hope that this child who escaped from death can grow up safely! " Speaking of which, Zhu Xiaobo smiled brightly, and the relief in his heart could not stop.
80% of premature delivery is caused by infection, and periodontitis can also cause premature delivery.
The data shows that about1170,000 premature babies are born every year in China, accounting for 10% of all newborns. According to Zhu Xiaobo, deputy director of NICU in the Second Hospital of Shanda University, there are many factors leading to premature delivery, such as excessive mental stress of mothers, overwork and environmental pollution, but the chief culprit is infection. 80% of premature births 30 weeks ago were caused by infection. Diseases that can cause infection are mainly reproductive tract infections of pregnant women, such as vaginitis, cervicitis and pelvic inflammatory disease. Studies have found that periodontitis can also lead to premature delivery.
With the liberalization of the two-child policy, older pregnant women are more prone to pregnancy complications, which may also cause premature babies. In addition, in recent years, assisted reproductive technologies such as ovulation induction drugs and IVF have increased the number of multiple births, and the premature delivery rate of multiple births is as high as 40%-50%, which is 20% higher than that of normal pregnancy.
Premature babies sleep in the "bird's nest"
The diagnosis and treatment of every "mini-baby" requires great efforts. From the formulation and dosage of the plan to nursing, we can't be careless.
The gestational age of premature infants in ICU is mostly between 26 weeks and 27 weeks, and their weight is below 1.5 kg, and some are less than 1 kg. Because these babies have been in their mother's body for a short time and their organs are still immature, the incubator is like a mother's uterus, which has both humidity and temperature, and the baby can grow up healthily in it.
Most premature babies are insecure. In order not to disturb them too much, each incubator is covered with a cloth, and made into a bird's nest shape with a small quilt. Try to surround the baby, let the baby sleep in it and kick around, feeling like lying in the mother's womb, which is very safe.
Wash your hands and disinfect them hundreds of times a day.
In NICU, the most common action of medical staff is to wash their hands. Nurse Han Min said: "All babies should wash their hands and disinfect. We specially put a skin disinfectant outside each incubator to facilitate disinfection. " How many times can I wash my hands a day? Han Min said, I really didn't count. However, changing diapers, oral care, feeding and injections for babies are very common ... as long as they come into contact with babies, they are generally disinfected, and it is common to wash their hands and disinfect them hundreds of times a day.
Han Min says summer is better. In winter, my hands are almost washed. I'm afraid of irritating the baby, but I can't use hand cream. Therefore, in NICU, nurses with higher face value also have a pair of hands that can't be taken.
Weigh yourself every time you change diapers.
In the early morning of July 30th 1, the reporter saw the nurse take the baby out of the warm "bird's nest" and weigh it on the balance. The little ones were awakened from their sleep, clutching their hands and feet, and some even cried.
Head nurse Liu Aihong introduced that in NICU, everything is fine nursing. In addition to weighing every day, you should put it on the scale every time you change diapers. The daily urine volume shows the child's circulation, and the reason should be analyzed more or less. The amount of milk should be accurate to the milliliter. Drinking too much is easy to bloat. If you drink too little, you won't gain weight. The doctor on duty will adjust the amount of milk and injection according to the baby's condition, growth and urine volume every day.
Don't use blue light for too long.
On the afternoon of July 28th, "Bubu" with blue light was fidgety in the incubator, and the junior nurse came to hug him. "Bubu" wears a little black eye patch and sits proudly on the lap of the younger generation. It's so cool.
Dai Xiao said that the blue light irradiation time should not be too long, otherwise it is easy to get bronze syndrome (a complication of phototherapy), so babies exposed to blue light should pay special attention. The doctor said that physiological jaundice does not need treatment and can subside on its own. Pathological jaundice generally uses intermittent blue light irradiation and stops after 4-8 hours. At the same time, the bilirubin level is monitored until bilirubin drops to the normal range, and then whether to stop treatment is decided according to the hourly bilirubin curve of newborns.
Kangaroo nursing: NICU has strict requirements on ward setting and disinfection and isolation, and generally refuses non-medical personnel to visit or contact the baby. Many parents have never seen each other since their children were sent to NICU.
However, for those babies who recover well, NICU invites several mothers for kangaroo care for several hours every week.
Liu Aihong, the head nurse, said that kangaroo nursing is mainly to put premature babies in their mothers' clothes and keep skin contact, so that premature babies can feel their mothers' breathing and heart rate, and gain great sense of security, which is conducive to the recovery of their illness. For mothers, they can understand the baby's growth, promote parent-child feelings and relieve anxiety. (The children in the text are all pseudonyms)