It was a surprise, then, when I came in the next morning and heard my partner tell me the baby had died the night before. Nobody was sure why. The nurses had been changing the IV fluids and tubing attached to her umbilical lines when the baby coded and could not be revived.
Deaths in the NICU can be roughly sorted into a few categories. The most common kind of death is the extremely premature baby, the immature 23 weeker whose lungs and other organs are just not mature enough to make it. Simply born too early, these kids usually die within a couple hours to a couple of days after birth. Another category would be those babies with terrible chronic lung disease who survive several months but are never good enough to go home and who finally die. These don't occur often nowadays but are always hard when they do because everyone has grown attached to the baby. Some kids will die from infection, although with Group B strep treatment of the mom in labor and liberal use of antibiotics in newborns these deaths are becoming less frequent as well.
The deaths, though, that drive me crazy are the ones like in this baby, a child who is doing well when something unexpected and unexplained happens. This seems like the type of death that is the most preventable and deserves close scrutiny. As soon as I have time and the chart is available, I'll go over it closely to see if I can find any clues to the reasons for this death. I'll talk to my partner who was on duty at the time, and maybe to the nurse. I'm not trying to blame anyone; I just want to see if there is something we can learn from this, something we can prevent from recurring.
When bad things happen in the NICU, you can take one of two attitudes. You can say "Oh well, some tiny babies are bound to die," or you can try to examine the case and look for information that might give you even a tiny advantage in dealing with the next baby. I like to choose the latter approach. Paying attention to small details can help small babies survive, and that, after all, is what we do for a living.