... by a nurse who was telling me about the high rate of "toasterheads" at her NICU, a level 2 center that almost never keeps babies at less than 32 weeks.
"Repositioning is not as much of an option for us. See, those reflective skin probe covers are expensive, so we try to save them. We use clear tape. And the tape sticks pretty well once we get it on there, so we can't go ripping it off the skin every 3 hours just to reposition the kid."
Why on Earth are the kids called toasterheads if they have a flattened skull?
ReplyDeleteGood question!
ReplyDeleteAlthough the back tends to flatten out, the skull of a preemie also tends to have long, narrow sides to them, which gives the head sort of a rectangular shape as opposed to one that is more round.
Fortunately, extensive treatment isn't usually necessary for plagiocephaly to resolve (or at least become much less noticeable). However, it's largely preventable in the first place.
Plagiocephaly does occur in many severely preterm infants (say 23-25 weeks along). Those kids may spend several weeks on ventilators and prolonged periods on minimal stimulation protocols, which limits how often we're able to touch (and hence, reposition) them.
It's less understandable in a NICU that only takes care of kids who are a few weeks early and generally don't require very invasive forms of life support.
I just wonder how much money they're saving on the tiny reflective gel covers, in exchange for kicking out dozens of kids a year who have a physical reminder of their prematurity.
Reflector gel be damned. I just thought they ended up that way no matter what you did. I have had one baby in the level 3b nursery at a time and they still had the toater head. I am not entirely convinced it is positioning. I positioned them every which way and they still looked like an eggo waffle!
ReplyDeleteThen again you must look at the cost benefit analysis. Is it better to keep messing with them to decrease toasterheadedness or is is better to let them rest? I really don't know. I am asking. MY stint in the level 2b was short so I am certainly not the expert. I don't know of any study that says toaster head = bad shit. so perhaps it is just our biases. I actually think the toaster head is cute, Some of my favorite kids have had toaster heads. I saw one of them in my local paper recently and his head looked fine. He is about 7 years old now.
I agree with you in part, Pinky. A flat head is not usually physically harmful. But it can be very noticeable, even to the untrained eye. It's like having a messy bed in the NICU. It probably doesn't directly impact the kid, but it raises a red flag that the care might not be ideal.
ReplyDeleteIn your level 3 job, some of those kids probably were destined for plagiocephaly no matter what. Those are severely preterm babies though.
Here's what really concerns me about the story. We know that prone positioning has its advantages in the monitored setting of the NICU. Preemies who spend prolonged periods on their backs have higher metabolic rates, poorer weight gain and compromised chest excursion. It's just not good to leave them like that all day every day.
Didn't know that about positioning on the back and having higher metabolic rates. Very interesting.
ReplyDeleteAs I have said before, I am not the expert here in the nicu. I just had a little tour for about 6 months many years ago. I am sure a bunch of stuff has changed.
See I think they look cute with their little toaster heads. But I would take care or 1 or 2 kids at a time. It was a small community hospital so I got to know the kids really well. ANd they were feeder growers mostly. So they had already had their long difficult time in the nicu already. My job was to just feed them and let them grow and sometimes remind them to breath.
Just found this blog; very interesting!
ReplyDeleteMy sister and I were born at 31 weeks back in 1982 and my mom brought out pictures of us when we were babies shortly before my daughter was born early this year. Our heads were definitely "toaster" shaped, but I never knew that was an actual term! I saw the picture and said um...what is wrong with our heads?! lol. Mom said that it was just because we were preemies. Not surprisingly, there aren't a whole lot of pictures of us from back then.
Thanks for the comment, Sara. It's often amazing to me to see the variety of people whose lives have been touched by prematurity.
ReplyDeleteThough you won't find the term "toasterhead" in the medical dictionaries, any neonatal ICU nurse knows what it means. These days, plagiocephaly is much more common in the 22-25 week gestation infants. However, back in the early 80's, a 31 week set of twins presented a more critical situation than it does today, so it makes sense that this happened to the two of you. I'm glad it was temporary!